GAIT DOES NOT RETURN TO NORMAL FOLLOWING TOTAL HIP ARTHROPLASTY: IMPLICATIONS FOR A RETURN TO ATHLETIC ACTIVITIES

The purpose of this study was to determine the effect of total hip arthroplasty (THA) on the biomechanics of the lower extremity during walking. Twenty THA patients and 20 healthy control participants performed several trials of level walking for which three-dimensional (3D) hip, knee and ankle angles, forces, moments and powers were recorded and calculated. Results revealed that the gait mechanics of THA patients do not return to normal following surgery, especially during the transition from double- to single-limb stance. These patients produced lower hip abduction moments that are perhaps a result of hip abductor weakness. Kinematic and kinetic adaptations at the distal joints were also found. Hip musculature deficiencies should be addressed in rehabilitation programs, especially if patients want to return to athletic activities

DO PEOPLE WITH UNILATERAL CAM FAI FAVOUR THEIR SYMPTOMATIC LEG DURING MAXIMAL DEPTH SQUATS?

Cam Femoroacetabular Impingement (FAI) is caused by an abnormally convex femoral head-neck junction and can damage the peripheral acetabulum in activities requiring a large hip range of motion (ROM). This study analyzed the three-dimensional (3D) ground reaction forces (GRF) and moments (GRM) and the resultant GRF of the symptomatic and asymptomatic legs in participants with unilateral cam FAI during a maximal depth squat. Seventeen participants with unilateral cam FAI performed 5 maximal depth squats with each leg on a separate forceplate. No significant differences were found between the two legs. These results indicate that participants with cam FAI do not favour their affected leg during maximal depth squats

LOWER LIMB BIOMECHANICAL ADAPTATIONS TO TOTAL HIP ARTHROPLASTY EXIST DURING SITTING AND STANDING TASKS

The purpose of this study was to determine the effect of total hip arthroplasty (THA) on lower limb mechanics during the tasks of sit-to-stand and stand-to-sit. Twenty THA patients and 20 control participants performed three trials of sit-to-stand and stand-to-sit. Three-dimensional (3D) hip, knee and ankle angles were calculated. Forces, moments and powers were obtained with an inverse dynamics approach. THA patients exhibited lower joint forces and moments, as well as lower hip flexion and higher abduction angles, near seat-on and seat-off. These results indicate that THA patients were able to adopt a strategy that allowed them to reduce loading at the operated lower limb joints. Although such a strategy may be desirable given that higher loads can increase friction and accelerate wear of the prosthesis, reduced loading may be an indication of inadequate muscle strength that needs to be addressed

A COMPARISON OF PRE- AND POST-OPERATIVE THREE-DIMENSIONAL HIP KINEMATICS DURING LEVEL WALKING IN PATIENTS WITH CAM FEMOROACETABULAR IMPINGEMENT

Cam femoroacetabular impingement (FAI) is an idiopathic progressive pathological condition of the hip joint characterized by an abnormal bony protuberance on the femoral head-neck junction (Beck, Leunig, Parvizi, Boutier, Wyss & Ganz, 2004). During the limits of hip range of motion (ROM), the protuberance jams into the acetabulum (Ganz, Parvizi, Beck, Leunig, Nötzli & Siebenrock, 2003), resulting in acute hip and groin pain (Beaulé, LeDuff, & Zaragoza, 2007). Impingement has also been shown to occur within normal ROM of the hip during basic tasks such as walking, reducing peak hip abduction angles as well as hip frontal and sagittal ROM (Kennedy, Lamontagne & Beaulé, 2009). Cam FAI primarily affects young and athletic males (Ganz, Parvizi, Beck, Leunig, Nötzli & Siebenrock, 2003), and is common in hockey, football, soccer, rugby, martial arts and tennis athletes (Philippon, Schenker, Briggs & Kuppersmith, 2007). Restricted hip mobility during activities requiring low ROM suggests more pronounced limitations during demanding athletic tasks. Surgical procedures have been developed to remove the bony abnormality from the femoral head-neck junction with the objective of attenuating hip pain and restoring normal hip biomechanics, enabling athletes to return to sport. The purpose of this study is to assess the clinical outcome of cam FAI corrective surgery by comapring pre-operative and post-operative three-dimensional (3-D) hip kinematics during level walking

A custom-made guide-wire positioning device for Hip Surface Replacement Arthroplasty: description and first results

<p>Abstract</p> <p>Background</p> <p>Hip surface replacement arthroplasty (SRA) can be an alternative for total hip arthroplasty. The short and long-term outcome of hip surface replacement arthroplasty mainly relies on the optimal size and position of the femoral component. This can be defined before surgery with pre-operative templating. Reproducing the optimal, templated femoral implant position during surgery relies on guide wire positioning devices in combination with visual inspection and experience of the surgeon. Another method of transferring the templated position into surgery is by navigation or Computer Assisted Surgery (CAS). Though CAS is documented to increase accurate placement particularly in case of normal hip anatomy, it requires bulky equipment that is not readily available in each centre.</p> <p>Methods</p> <p>A custom made neck jig device is presented as well as the results of a pilot study.</p> <p>The device is produced based on data pre-operatively acquired with CT-scan. The position of the guide wire is chosen as the anatomical axis of the femoral neck. Adjustments to the design of the jig are made based on the orthopedic surgeon's recommendations for the drill direction. The SRA jig is designed as a slightly more-than-hemispherical cage to fit the anterior part of the femoral head. The cage is connected to an anterior neck support. Four knifes are attached on the central arch of the cage. A drill guide cylinder is attached to the cage, thus allowing guide wire positioning as pre-operatively planned.</p> <p>Custom made devices were tested in 5 patients scheduled for total hip arthroplasty. The orthopedic surgeons reported the practical aspects of the use of the neck-jig device. The retrieved femoral heads were analyzed to assess the achieved drill place in mm deviation from the predefined location and orientation compared to the predefined orientation.</p> <p>Results</p> <p>The orthopedic surgeons rated the passive stability, full contact with neck portion of the jig and knife contact with femoral head, positive. There were no guide failures. The jig unique position and the number of steps required to put the guide in place were rated 1, while the complexity to put the guide into place was rated 1-2. In all five cases the guide wire was accurately positioned. Maximum angular deviation was 2.9° and maximum distance between insertion points was 2.1 mm.</p> <p>Conclusions</p> <p>Pilot testing of a custom made jig for use during SRA indicated that the device was (1) successfully applied and user friendly and (2) allowed for accurate guide wire placement according to the preoperative plan.</p

Mathematical evaluation of jumping distance in total hip arthroplasty: Influence of abduction angle, femoral head offset, and head diameter

Background and purpose The jumping distance (JD) is the degree of lateral translation of the femoral head center required before dislocation occurs. The smaller the distance, the higher the theoretical risk of dislocation. The aim of our study was to evaluate this jumping distance and its variation according to the characteristics of the implant, and also the theoretical gain in using large head diameters of above 38 mm