An in vivo determination of total hip arthroplasty pistoning during activity

Lombardi, Adolph V.; Mallory, Thomas H.; Dennis, Douglas A.; Komistek, Richard D.; Fada, Robert A.; Northcut, E.

doi:10.1054/arth.2000.6637

Cited by 128 publications

(84 citation statements)

References 31 publications

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“…Dennis et al also noted that use of the same measurement technique in subjects with unconstrained total hip arthroplasty demonstrated a femoral head-acetabular surface displacement averaging 3.3 mm (range 1.9-5.2 mm). 33,34 These data are consistent with the mean 3.0 mm (range 0.9-5.6 mm) joint center-to-center distance measured in our LCPD subjects. The consistency between the pathological and normal subjects, respectively, of our study with those of Dennis et al 33,34 supports the validity of the present technique and the measurements subsequently obtained.…”

Section: Discussionsupporting

confidence: 89%

Novel three‐dimensional MRI technique for study of cartilaginous hip surfaces in Legg‐Calvé‐Perthes disease

Pienkowski

Resig

Talwalkar

et al. 2009

Journal Orthopaedic Research

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Treatment of Legg-Calvé-Perthes disease (LCPD) may improve if new knowledge can be obtained regarding how articular cartilage changes shape during the course of this disorder. A new technique is presented showing how analyses of magnetic resonance images can be used to quantify the three-dimensional changes in the femoral and acetabular articulating cartilage surfaces of children with LCPD. Ten male subjects (8 AE 1 years) with unilateral LCPD were enrolled in this IRB approved study. Sets of magnetic resonance images of both hips were obtained at three different times. Three-dimensional virtual models of the cartilage were created from these images, and mathematical spheres were fit to the articulating surfaces. Five parameters (size, shape deformity (sphericity error), radial growth rate, joint fit, and joint incongruity) were used to quantify cartilage surface shape. Data were analyzed by using a linear mixed-model. Joint incongruity, i.e., the distance between the centers of the femoral and acetabular spheres, was slightly more than 2.5 times larger (p ¼ 0.001) in LCPD hips than the contralateral normal hips. Cartilage shape deformity was 65% larger in hips with LCPD than in normal hips. Growth rates of the femoral head and the opposing acetabular surface showed that distortion of the femoral surface occurred first and the opposing acetabular surface followed. Mean radial difference (acetabular surface radius minus femoral surface radius) in LCPD hips was less than half (p < 0.01) the value of normal hips. Interobserver variability was $10% of the value attributable to LCPD. This is the first known report presenting a technique that quantifies the three-dimensional size, deformity, growth, fit. and incongruity of the femoral and acetabular articulating cartilaginous surfaces of LCPD and contralateral normal hips. The data obtained support the use of this technique and provide pilot data for a future clinical study of LCPD. Objective assessment of cartilage shape enabled by this technique may aid future diagnoses, enable monitoring of three-dimensional femoral and acetabular remodeling, and permit quantitative assessment of treatment efficacy. ß

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Section: Discussionsupporting

confidence: 89%

Novel three‐dimensional MRI technique for study of cartilaginous hip surfaces in Legg‐Calvé‐Perthes disease

Pienkowski

Resig

Talwalkar

et al. 2009

Journal Orthopaedic Research

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“…Computational models using motion and load inputs determined from kinematic and inverse dynamic data from human‐subject optoelectronic motion capture can provide an alternative approach to the physical simulation 32. A fluoroscopic technique has been developed to detect the translational displacement of the cup and head bearings under dynamic conditions 16, 17. However, with the complexity of dynamic microseparation, there is no in vivo dynamic data available with respect to the contact loads and kinematics associated with microseparation and corresponding rim contact.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, translational malpositioning can produce a more severe contact condition and edge loading 15. A typical condition resulting from translational malpositioning is dynamic microseparation16, 17 of hip joints or subluxation, for which a translation of the head relative to the cup occurs leading to contact at the superior lateral rim of the cup 18, 19. There are many contributing factors for microseparation including head offset deficiency, medialized cup, stem subsidence, impingement and laxity of the soft tissues 11.…”

Section: Introductionmentioning

confidence: 99%

Effect of microseparation on contact mechanics in metal‐on‐metal hip replacements—A finite element analysis

2014

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Some early failures of metal‐on‐metal (MoM) hip replacements associated with elevated wear have caused concerns for the use of this bearing combination. Simulator studies have shown that microseparation and its associated rim contact and edge loading may produce the most severe wear in MoM bearings. It is generally recognized that this high wear can be attributed to the high contact stress of the head on the rim of the cup. In this study, an improved finite element contact model that incorporates an elastic‐perfectly plastic material property for cobalt‐chrome alloy of the metal bearing was developed in an attempt to provide an accurate prediction of the stress and strain for the rim contact. The effects of the microseparation displacement (0.1−2 mm), cup inclination angle (25−65°) and cup rim radius (0.5−4 mm) on the contact stress/strain were investigated. The results show that a translational displacement >0.1 mm under a load >0.5 kN can produce a highly concentrated contact stress at the surface of the cup rim which can lead to plastic deformation. This study also suggests that the magnitude of translational displacement was the major factor that determined the severity of the contact conditions and level of stress and strain under microseparation conditions. Future studies will address the effect of surgical translational and rotational malposition and component design on the magnitude of microseparation, contact stress and strain and severity of wear. © 2014 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 103B: 1312–1319, 2015.

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“…10,11 The hip periarticular soft tissues, including the labrum, and the capsule with its associated ligaments and zona orbicularis, appear to play a role in providing hip stability in distraction to overcome this frequently applied force. Surgical procedures such as THA, resurfacing arthroplasty, and procedures involving surgical dislocation of the hip require violation of some or all of the periarticular soft tissue passive restraints and can lead to instability in distraction.…”

Section: Discussionmentioning

confidence: 99%

“…A less recognized, but clinically common loading mode is hip distraction. Fluoroscopy studies showed hip subluxation during the swing phase of gait in total hip arthroplasty (THA) subjects, 10,11 suggesting inertial distraction forces occur with every gait cycle and are not overcome by normal muscle contractions crossing the joint. These findings suggest that soft tissue structures such as the capsule, capsular ligaments, or the labrum play a role in resisting joint distraction, and that disruption of these structures, as happens with THA, can lead to hip instability.…”

mentioning

confidence: 99%

The proximal hip joint capsule and the zona orbicularis contribute to hip joint stability in distraction

Ito

Song

Lindsey

et al. 2009

Journal Orthopaedic Research

152

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ABSTRACT:The structure and function of the proximal hip joint capsule and the zona orbicularis are poorly understood. We hypothesized that the zona orbicularis is an important contributor to hip stability in distraction. In seven cadaveric hip specimens from seven male donors we distracted the femur from the acetabulum in a direction parallel to the femoral shaft with the hip in the neutral position. Eight sequential conditions were assessed: (1) intact specimen (muscle and skin removed), (2) capsule vented, (3) incised iliofemoral ligament, (4) circumferentially incised capsule, (5) partially resected capsule (distal to the zona orbicularis), (6) completely resected capsule, (7) radially incised labrum, and (8) completely resected labrum. The reduction of the distraction load was greatest between the partially resected capsule phase and completely resected capsule phase at 1, 3, and 5 mm joint distraction (p ¼ 0.018). The proximal to middle part of the capsule, which includes the zona orbicularis, appears grossly and biomechanically to act as a locking ring wrapping around the neck of the femur and is a key structure for hip stability in distraction. ß

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An in vivo determination of total hip arthroplasty pistoning during activity

Cited by 128 publications

References 31 publications

Novel three‐dimensional MRI technique for study of cartilaginous hip surfaces in Legg‐Calvé‐Perthes disease

Novel three‐dimensional MRI technique for study of cartilaginous hip surfaces in Legg‐Calvé‐Perthes disease

Effect of microseparation on contact mechanics in metal‐on‐metal hip replacements—A finite element analysis

The proximal hip joint capsule and the zona orbicularis contribute to hip joint stability in distraction

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