Dual-mobility socket in challenging total hip arthroplasty : 2-6 years follow-up.

The success of dual-mobility sockets in achieving implant stability in primary hip replacement is already well established. However, stability cannot always be achieved, especially when dealing with more difficult indications. At our department, 104 dual-mobility sockets (92 uncemented and 12 cemented) were implanted for primary total hip arthroplasty in 97 patients between 2009 and 2013. Indications for hip arthroplasty included primary and secondary coxarthrosis, acetabular and subcapital fractures, avascular necrosis, tumor surgery and metastatic fractures. Although no loosenings were observed, 2 dislocations and 1 infection occurred shortly after surgery. In this challenging group of patients no fixation problems or intraprosthetic dislocations have been observed. The design therefore seems to be a valid alternative to constrained implants, especially in high-risk cases, although dislocation cannot be prevented at all times. Although the findings are very promising, long-term survival studies are mandatory to evaluate intraprosthetic stability and fixation longevity of dual-mobility sockets

Soft tissue structure modelling for use in orthopaedic applications and musculoskeletal biomechanics

We present our methodology for the three-dimensional anatomical and geometrical description of soft tissues, relevant for orthopaedic surgical applications and musculoskeletal biomechanics. The technique involves the segmentation and geometrical description of muscles and neurovascular structures from high-resolution computer tomography scanning for the reconstruction of generic anatomical models. These models can be used for quantitative interpretation of anatomical and biomechanical aspects of different soft tissue structures. This approach should allow the use of these data in other application fields, such as musculoskeletal modelling, simulations for radiation therapy, and databases for use in minimally invasive, navigated and robotic surgery

Accuracy of navigated cam resection in femoroacetabular impingement: A randomised controlled trial.

BACKGROUND: The main cause for revision hip arthroscopy surgery is incomplete bony resection of femoroacetabular impingement (FAI). This study aimed to compare the cam resection accuracy via the conventional hip arthroscopy technique with the navigation technique. METHODS: Two prospectively randomized groups were recruited: navigated (n = 15) and conventional (n = 14). A pre-operative CT and post-operative MRI scan were obtained in all cases to compare alpha angle, range of motion simulation and determine a pre-operative 3D surgical resection plan. RESULTS: Post-operatively, the mean maximal alpha angle improved significantly in the navigated group compared with the conventional group (55°vs.66°; P = 0.023), especially in the 12 o' clock position (45°vs.60°; P = 0.041). However, positioning time and radiation exposure were significantly longer in the navigated group. CONCLUSION: Navigated surgery is effective for patients with cam type FAI in helping restore normal anatomy, however, not without drawbacks. Larger studies will be required to validate our results.Jan Van Houcke was supported by a doctoral grant of the Research Foundation‐Flanders

Patient-specific modelling in orthopedics: from image to surgery

In orthopedic surgery, to decide upon intervention and how it can be optimized, surgeons usually rely on subjective analysis of medical images of the patient, obtained from computed tomography, magnetic resonance imaging, ultrasound or other techniques. Recent advancements in computational performance, image analysis and in silico modeling techniques have started to revolutionize clinical practice through the development of quantitative tools, including patient#specific models aiming at improving clinical diagnosis and surgical treatment. Anatomical and surgical landmarks as well as features extraction can be automated allowing for the creation of general or patient-specific models based on statistical shape models. Preoperative virtual planning and rapid prototyping tools allow the implementation of customized surgical solutions in real clinical environments. In the present chapter we discuss the applications of some of these techniques in orthopedics and present new computer-aided tools that can take us from image analysis to customized surgical treatment

Extra-articular hip endoscopy: a review of the literature

The aim of this review is to evaluate the current available literature evidencing on periarticular hip endoscopy (the third compartment). A comprehensive approach has been set on reports dealing with endoscopic surgery for recalcitrant trochanteric bursitis, snapping hip (or coxa-saltans; external and internal), gluteus medius and minimus tears and endoscopy (or arthroscopy) after total hip arthroplasty. This information can be used to trigger further research, innovation and education in extra-articular hip endoscopy

Personalized hip joint kinetics during deep squatting in young, athletic adults

The goal of this study was to report deep squat hip kinetics in young, athletic adults using a personalized numerical model solution based on inverse dynamics. Thirty-five healthy subjects underwent deep squat motion capture acquisitions and MRI scans of the lower extremities. Musculoskeletal models were personalized using each subject's lower limb anatomy. The average peak hip joint reaction force was 274 percent bodyweight. Average peak hip and knee flexion angles were 107 degrees and 112 degrees respectively. These new findings show that deep squatting kinetics in the younger population differ substantially from the previously reported in vivo data in older subjects

Conventional versus direct magnetic resonance imaging in detecting labral lesions in femoroacetabular impingment - a retrospective multicenter study.

The purpose of this study was to assess the reliability of Direct Magnetic Resonance Arthography (MRA) and Conventional Magnetic Resonance Imaging (MRI) in diagnosing labral lesions in patients with symptoms of femoroacetabular impingement (FAI). Materials and methods: Imaging and surgical data (n=490) were retrospectively collected from 5 high-volume centres providing arthroscopic treatment of FAI patients. Preoperative magnetic resonance imaging findings were compared with the actual surgical findings regarding labral condition in order to assess the effectiveness of MRI and MRA in identifying the presence of labral tears in patients with FAI. The results of this study indicate that MM and MRA may both be useful for the diagnosis of acetabular labral lesions. The accuracy is slightly higher for MRI (71,4 %) compared to MRA (68,2 %), although MRA has higher sensitivity (74.4%,) as compared to MRI (66,9%). Conclusions: In a clinically suspected labral tear MRA has higher sensitivity than MRI. Further studies on asymptomatic patients may be needed to determine the specificity of different MRI techniques

The History of Biomechanics in Total Hip Arthroplasty.

Biomechanics of the hip joint describes how the complex combination of osseous, ligamentous, and muscular structures transfers the weight of the body from the axial skeleton into the appendicular skeleton of the lower limbs. Throughout history, several biomechanical studies based on theoretical mathematics, in vitro, in vivo as well as in silico models have been successfully performed. The insights gained from these studies have improved our understanding of the development of mechanical hip pathologies such as osteoarthritis, hip fractures, and developmental dysplasia of the hip. The main treatment of end-stage degeneration of the hip is total hip arthroplasty (THA). The increasing number of patients undergoing this surgical procedure, as well as their demand for more than just pain relief and leading an active lifestyle, has challenged surgeons and implant manufacturers to deliver higher function as well as longevity with the prosthesis. The science of biomechanics has played and will continue to play a crucial and integral role in achieving these goals. The aim of this article, therefore, is to present to the readers the key concepts in biomechanics of the hip and their application to THA

initMIP-Antarctica: an ice sheet model initialization experiment of ISMIP6

Ice sheet numerical modeling is an important tool to estimate the dynamic contribution of the Antarctic ice sheet to sea level rise over the coming centuries. The influence of initial conditions on ice sheet model simulations, however, is still unclear. To better understand this influence, an initial state intercomparison exercise (initMIP) has been developed to compare, evaluate, and improve initialization procedures and estimate their impact on century-scale simulations. initMIP is the first set of experiments of the Ice Sheet Model Intercomparison Project for CMIP6 (ISMIP6), which is the primary Coupled Model Intercomparison Project Phase 6 (CMIP6) activity focusing on the Greenland and Antarctic ice sheets. Following initMIP-Greenland, initMIP-Antarctica has been designed to explore uncertainties associated with model initialization and spin-up and to evaluate the impact of changes in external forcings. Starting from the state of the Antarctic ice sheet at the end of the initialization procedure, three forward experiments are each run for 100 years: a control run, a run with a surface mass balance anomaly, and a run with a basal melting anomaly beneath floating ice. This study presents the results of initMIP-Antarctica from 25 simulations performed by 16 international modeling groups. The submitted results use different initial conditions and initialization methods, as well as ice flow model parameters and reference external forcings. We find a good agreement among model responses to the surface mass balance anomaly but large variations in responses to the basal melting anomaly. These variations can be attributed to differences in the extent of ice shelves and their upstream tributaries, the numerical treatment of grounding line, and the initial ocean conditions applied, suggesting that ongoing efforts to better represent ice shelves in continental-scale models should continue

Human Muscle Satellite Cells as Targets of Chikungunya Virus Infection

BACKGROUND: Chikungunya (CHIK) virus is a mosquito-transmitted alphavirus that causes in humans an acute infection characterised by fever, polyarthralgia, head-ache, and myalgia. Since 2005, the emergence of CHIK virus was associated with an unprecedented magnitude outbreak of CHIK disease in the Indian Ocean. Clinically, this outbreak was characterized by invalidating poly-arthralgia, with myalgia being reported in 97.7% of cases. Since the cellular targets of CHIK virus in humans are unknown, we studied the pathogenic events and targets of CHIK infection in skeletal muscle. METHODOLOGY/PRINCIPAL FINDINGS: Immunohistology on muscle biopsies from two CHIK virus-infected patients with myositic syndrome showed that viral antigens were found exclusively inside skeletal muscle progenitor cells (designed as satelllite cells), and not in muscle fibers. To evaluate the ability of CHIK virus to replicate in human satellite cells, we assessed virus infection on primary human muscle cells; viral growth was observed in CHIK virus-infected satellite cells with a cytopathic effect, whereas myotubes were essentially refractory to infection. CONCLUSIONS/SIGNIFICANCE: This report provides new insights into CHIK virus pathogenesis, since it is the first to identify a cellular target of CHIK virus in humans and to report a selective infection of muscle satellite cells by a viral agent in humans