BACKGROUND: Variations observed in biomechanical studies might be attributed to errors made by operators during the construction of musculoskeletal models, rather than being solely attributed to patient-specific geometry. RESEARCH QUESTION: What is the impact of operator errors on the construction of musculoskeletal models, and how does it affect the estimation of muscle moment arms and hip joint reaction forces? METHODS: Thirteen independent operators participated in defining the muscle model, while a single operator performed 13 repetitions to define the muscle model based on 3D bone geometry. For each model, the muscle moment arms relative to the hip joint center of rotation was evaluated. Additionally, the hip joint reaction force during one-legged stance was assessed using static inverse optimization. RESULTS: The results indicated high levels of consistency, as evidenced by the intra- rater and inter-rater agreement measured by the Intraclass Correlation Coefficient (ICC), which yielded values of 0.95 and 0.99, respectively. However, the estimated muscle moment arms exhibited an error of up to 16 mm compared to the reference musculoskeletal model. It was found that muscles attached to prominent anatomical landmarks were specified with greater accuracy than those attached over larger areas. Furthermore, the variability in estimated moment arms contributed to variations of up to 12% in the hip joint reaction forces. SIGNIFICANCE: Both moment arm and muscle force demonstrated significantly lower variability when assessed by a single operator, suggesting the preference for employing a single operator in the creation of musculoskeletal models for clinical biomechanical studies.
- MeSH
- biologické modely MeSH
- biomechanika MeSH
- kosterní svaly * fyziologie MeSH
- kyčelní kloub * fyziologie MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Femoroacetabular impingement syndrome is a complex, often post-traumatically developing impairment of the hip joint, characterized by ambiguous symptomatology, which makes early diagnosis diffi cult, especially in the early stages. Experimental retrospective study was carried out to evaluate the usability of a triaxial gyroscopic sensor in routine practice as an additional indication criterion for operative versus conservative treatment procedures. MATERIAL AND METHODS 92 patients were included in the retrospective study, and 62 completed the investigation. All patients signed informed consent. A gyroscopic sensor was placed on the right side of the pelvis above the hip joint, and the patients walked approximately 15 steps. Furthermore, an evaluation of the data during stair climbing and a complete clinical examination of the dynamics and physiological movements in the joint was carried out. Data measured with a gyroscopic sensor were processed using differential geometry methods and then evaluated using spectral analysis and neural networks. The proposed technique of diagnosing FAI using gyroscope measurement is a fast, easy-to-perform method. RESULTS Our approach in processing gyroscopic signals used to detect the stage of arthrosis and post-traumatically developing FAI could lead to more accurate early detection and capture in the early stages. CONCLUSIONS The obtained data are easily evaluated, interpretable and benefi cial in diagnosing the early stages of FAI. The results of the conducted research showed this approach to more accurate early detection of arthrosis and post-traumatically developing FAI. Key words: wearable sensors; osteoarthritis; mathematical biophysics; telemedicine.
- MeSH
- dítě MeSH
- konzervativní terapie MeSH
- kyčelní kloub * diagnostické zobrazování patologie MeSH
- lidé MeSH
- nekróza hlavice femuru MeSH
- Perthesova nemoc diagnóza etiologie patofyziologie terapie MeSH
- skluz proximální femorální epifýzy chirurgie diagnóza etiologie patofyziologie MeSH
- synovitida diagnóza etiologie patofyziologie terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.
- MeSH
- acetabulum MeSH
- dítě MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- luxace kyčle * diagnostické zobrazování etiologie chirurgie MeSH
- mladiství MeSH
- mozková obrna * komplikace chirurgie MeSH
- následné studie MeSH
- pánev MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: The study evaluates long-term results in patients treated by valgus intertrochanteric osteotomy (VITO) for partial avascular necrosis of the femoral head (ANFH) after fracture of the femoral neck in adolescent age. Although this method is mentioned in literature frequently, there are only few studies in the literature dealing with it in detail. METHODS: Authors evaluated five patients at the interval of 15 to 20 years following VITO. The mean age of the patients at the time of injury was 13.6 years and at the time of VITO 16.7 years. The studied parameters included resorption of necrotic segment of femoral head, development of posttraumatic osteoarthritis and leg shortening. RESULTS: Comparison of radiographs and MRI scans before and after VITO showed resorption of the necrotic segment of the femoral head and its remodeling in all five patients. However, two patients gradually developed slight osteoarthritic changes. In one patient, remodeling of the femoral head occurred during the first 6 years postoperatively. Subsequently, the patient developed severe osteoarthritis with marked clinical symptoms. CONCLUSION: VITO can improve the long-term function of the hip joint in adolescents with ANFH after a femoral neck fracture, but cannot restore completely the original shape and structure of the femoral head.
- MeSH
- fraktury krčku femuru * diagnostické zobrazování etiologie chirurgie MeSH
- kyčelní kloub chirurgie MeSH
- lidé MeSH
- mladiství MeSH
- nekróza hlavice femuru * diagnostické zobrazování etiologie chirurgie MeSH
- osteoartróza * MeSH
- osteotomie škodlivé účinky metody MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Ultrasound (US)-guided intraarticular hip joint injections are commonly performed using an in-plane anterior approach, which has several limitations. OBJECTIVE: To describe and report a "lateral" (lateral to medial) approach for US-guided intraarticular hip injection. DESIGN: Cadaveric investigation. SETTING: Academic institution, department of anatomy. PARTICIPANTS: One cadaveric specimen. METHODS: Both hips of a single cadaver were injected using the US-guided lateral approach. In the left hip, the needle was inserted and kept in situ. The right hip was injected with white-colored water-diluted latex dye. Subsequently, a layer-by-layer anatomical dissection was performed. MAIN OUTCOME MEASURES: Presence and distribution of latex dye and location of needle tip within the joint capsule of the hip. RESULTS: Anatomical dissection of the left and right hips confirmed the correct intraarticular position of the needle tip and the placement of the latex dye, respectively. During layer-by-layer dissection of the left hip, positions of the lateral cutaneous nerve and the lateral circumflex femoral artery were observed anterior to the needle, 30 mm for the nerve and 8 mm for the artery. CONCLUSIONS: This preliminary study demonstrated that the US-guided lateral approach is a convenient technique to access the hip joint in a cadaveric specimen. Compared with the "classical" anterior technique, the lateral approach may provide several advantages, including improved needle visibility, theoretically decreased risk of vascular injury, and less risk of needle contamination. Because injury to the lateral epiphyseal arteries is possible when lateral approach is used, caution is required, especially in children. These preliminary conclusions will need to be validated in future/larger clinical studies.
Osteonekróza je relativně časté onemocnění s různou četností svých podjednotek - podle postižení jednotlivých kostí. Toto onemocnění má často výrazné klinické projevy a vysokou pravděpodobnost progrese do pokročilých stadií, což znamená nutnost operačního řešení aloplastikou daného kloubu. V diagnostice hrají hlavní a nepostradatelnou roli zobrazovací metody, tedy zejména prostý snímek, výpočetní tomografie a vyšetření magnetickou rezonancí. Své zastoupení má i nukleární mediána. Prostý snímek a CT vyšetření odhaluje zejména pozdní změny kosti, pomáhá ale v posouzení sekundárních změn v okolia CT pak pomáhá v posouzení tvarových změn kosti. Magnetická rezonance dokáže odhalit změnyještě v preklinickém stadiu, a tedy napomoci omezení progrese do pokročilejších stadií choroby.
Osteonecrosis is a relatively common pathology with varying frequencies of its subunits - according to the affected bone, with significant clinical manifestations and a high probability of progression to an advanced stage, respectively the need for surgical treatment by alloplasty of the given joint. Imaging methods play a major and indispensable role in diagnosis, namely simple scan, computed tomography and magnetic resonance imaging. Nuclear medicine is also represented. A simple scan and CT scan mainly reveals late changes in the bone, but it helps in the assessment of secondary changes in the surrounding area and especially CT scan helps in the assessment of the shape changes of the bone. Magnetic resonance imaging can detect changes even in the preclinical stage and thus help to limit progression only to the lighter stages of the disease.
- Klíčová slova
- morbus Ahlbäck,
- MeSH
- artralgie etiologie MeSH
- artroplastiky kloubů MeSH
- artróza kolenních kloubů chirurgie diagnostické zobrazování patologie MeSH
- kolenní kloub chirurgie diagnostické zobrazování patologie MeSH
- kyčelní kloub diagnostické zobrazování patologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- osteonekróza * chirurgie diagnostické zobrazování epidemiologie klasifikace patologie MeSH
- počítačová rentgenová tomografie MeSH
- rizikové faktory MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY Our study aimed to assess the mid-term outcomes and complications with the ICON hip resurfacing system and to carry out a detailed analysis of pitfalls and risks associated with pairing the bearing surfaces of metal-on-metal hip implants. MATERIAL AND METHODS A total of 52 hip joints were assessed in 43 patients who received the ICON hip resurfacing system at our department between 2009 and 2013. The cohort included 34 men and 9 women. Their age at the time of primary surgery ranged from 34 to 67 years, with the mean age of 51.8 years. The mean follow-up was 7.6 years. The evaluation focused on the position and osseointegration of both components, bone remodelling around the implant, and signs of potential aseptic loosening. The functional status of the hip was assessed by Harris Hip Score. RESULTS The primary stability of both components was always good, there were no femoral neck fractures reported in our cohort. All the acetabular components were stable, showing appropriate osseointegration, with no radiolucent zones or signs of osteolysis around them. There was not a single case of the femoral component stem being in a biomechanically disadvantageous varus position. In zone I and III according to Beaulé, cancellous bone osteolysis developed in two patients. The narrowing of the femoral neck below the end of the femoral component, compared to postoperative X-rays, achieved the mean value of 1.3% according to Grammatopolouse. The HHS increased from 64 to 95.5 points. An excellent outcome was observed in 48 joints, whereas the outcome of the remaining 4 joints was very good. The mean survival rate of the resurfacing hip implant calculated using the Kaplan-Meier analysis achieved 100%. The cobalt and chromium levels in the blood of patients did not exceed the reference physiological value. DISCUSSION The resurfacing system enables to preserve the bone tissue of the metaphysis and a part of the femoral head. The reduced mechanical endurance of the peripheral part of femoral components smaller in size caused by implant malposition resulted in fatal consequences in the ASR system. Greater range of motion conditioned by the design of the resurfacing system led to a mechanical wear, with a significant increase in the concentration of metal particles in the effective joint space. The elevated levels of cobalt and chromium ions in some patients induced delayed-type hypersensitivity with subsequent development of aseptic lymphocyte-dominated vasculitis associated lesions presented as peri-acetabular changes (pseudotumors to osteolysis) with subsequent failure of implant fixation. We have not observed this complication in the ICON system as yet. In patients suffering from hip pain after the resurfacing hip arthroplasty and simultaneous high chromium and cobalt blood levels, pelvic CT/MRI is indicated with reduction of artefacts around the metal material. Surgical treatment of soft tissue affections, bone defects and reimplantation using conventional or revisioncementless components is a possible treatment option. CONCLUSIONS The ideal patient indicated for hip resurfacing is a physically active man under 60 years of age (with a femoral head size of 54-60 mm), with primary or secondary osteoarthritis, no joint deformity, with a good quality bone tissue in the femoral neck and head region. As for the functional performance, the resurfacing system allows the patients a large range of motion with very good joint stability immediately after surgery. Despite that, the metal-on-metal tribological pairing must be approached with caution. The risk of developing lesions associated with ALVAL is unpredictable. In our cohort of patients with ICON hip resurfacing system, mostly excellent outcomes with minimum complications were reported provided the indication criteria and the correct surgical procedure had been complied with. Key words: hip resurfacing system, metal articulating surfaces, adverse reaction to metal particles, aseptic lymphocytedominated vasculitis associated lesions, pseudotumor.
- MeSH
- chrom MeSH
- dospělí MeSH
- kobalt MeSH
- kovy MeSH
- kyčelní kloub diagnostické zobrazování chirurgie MeSH
- kyčelní protézy * škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu * metody MeSH
- osteolýza * etiologie chirurgie MeSH
- protézy - design MeSH
- reoperace MeSH
- selhání protézy MeSH
- senioři MeSH
- vaskulitida * komplikace chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
PURPOSE: Treatment outcomes of conservative and surgical treatment of Legg-Calvé-Perthes disease (LCPD) have been shown to be conditioned by a number of factors that may vary across different populations. This retrospective study aimed to evaluate factors affecting radiographically assessed treatment outcomes in patients treated surgically or conservatively for LCPD at Faculty Hospital Motol, Prague, Czech Republic, between the years 2006 and 2019. METHODS: Data of forty-seven children comprising 52 hips were analysed. Treatment outcomes were evaluated according to Stulberg classification. Predictors included the initial stage of fragmentation of the hip joint according to Herring classification, type of treatment (conservative or surgical), age at the time of diagnosis and sex. RESULTS: Older age and severity of LCPD according to Herring classification but not the type of treatment were the strongest factors determining treatment outcomes. Treatment outcomes were comparable in patients treated conservatively or surgically both across the whole cohort of patients and a group of young children < six years of age. CONCLUSIONS: Results strengthen the roles of severity of the LCPD at onset of treatment and age of the patient in predicting treatment outcomes in patients with LCPD. Conservative and surgical treatments appear to yield similar treatment outcomes irrespective of age of patients.
- MeSH
- dítě MeSH
- kyčelní kloub MeSH
- lidé MeSH
- osteotomie metody MeSH
- Perthesova nemoc * diagnostické zobrazování chirurgie MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
