Biomechanical analysis of two insertion sites for the fixation of the sacroiliac joint via an oblique lateral approach

Dubé-Cyr, Roxanne; Aubin, Carl‐Éric; Villemure, Isabelle; Bianco, Rohan-Jean; Godio‐Raboutet, Yves; Arnoux, Pierre‐Jean

doi:10.1016/j.clinbiomech.2020.02.010

Cited by 8 publications

(7 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As such, the configuration with one implant only partially decreased the vertical and angular displacements, which is consistent with a previous experimental study. 16 Significant ROM reduction was found only in flexion-extension, potentially due to the higher SIJ mobility for that load. A supplementary 14%-18% ROM reduction was obtained with a second implant in compression and in flexion-extension.…”

Section: Discussionmentioning

confidence: 97%

“…The method for measuring those displacements was detailed in a previous experimental study and summarized here. 16 Briefly, six points were selected across each SIJ. For the vertical displacements, the displacement of the middle ilium point was subtracted from that of the sacrum.…”

Section: Methodsmentioning

confidence: 99%

“…Yet, no study has assessed SIJ fixation performance for patients with a lower bone quality. Several experimental studies assessed the effect of fusion implants on SIJ range of motion (ROM) 10‐16 . Such studies, however, do not allow isolating the effects of certain parameters such as bone quality, and results were influenced by other factors (e.g., sex, age, and state of the specimen, its stiffness, experimental conditions, etc.).…”

Section: Introductionmentioning

confidence: 99%

“…Several experimental studies assessed the effect of fusion implants on SIJ range of motion (ROM). [10][11][12][13][14][15][16] Such studies, however, do not allow isolating the effects of certain parameters such as bone quality, and results were influenced by other factors (e.g., sex, age, and state of the specimen, its stiffness, experimental conditions, etc.). In addition, cadaveric testing is often limited to a relatively small number of specimens (n < 10), making it difficult to measure the effect of a specific specimenrelated parameter, such as bone density.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Instrumentation of the sacroiliac joint with cylindrical threaded implants: A detailed finite element study of patient characteristics affecting fixation performance

Dubé-Cyr

Villemure

Arnoux

et al. 2021

Journal Orthopaedic Research

Self Cite

View full text Add to dashboard Cite

The sacroiliac joint (SIJ) is a known pain generator that, in severe cases, may require surgical fixation to reduce intra-articular displacements and allow for arthrodesis.The objective of this computational study was to analyze how the number of implants affected SIJ stabilization with patient-specific characteristics such as the pelvic geometry and bone quality. Detailed finite element models were developed to account for three pelvises of differing anatomy. Each model was tested with a normal and low bone density (LD) under two types of loading: compression only and compression with flexion and extension moments. These models were instrumented with one to three cylindrical, threaded and fenestrated implants through a posterior oblique trajectory, requiring less muscle dissection than the more common lateral trajectory used with triangular implants. Compared with the noninstrumented pelvis, the change in range of motion (ROM) and stress distribution were used to characterize joint stabilization. Noninstrumented mobility ranged from 0.86 to 2.55 mm and from 1.37°to 6.11°. Across patient-specific characteristics, the ROM reduction with one implant varied from 3% to 21% for vertical and 15% to 47% for angular displacements. With two implants, the ROM reduction ranged from 12% to 41% for vertical and from 28% to 61% for angular displacements. Three implants, however, did not further improve the joint stability (14% to 42% for vertical and 32% to 63% for angular displacements). With respect to patient characteristics, an LD led to a decreased stabilization and a higher volume of stressed bone (>75% of yield stress). A better understanding of how patient characteristics affect the implant performance could help improve surgical planning of sacroiliac arthrodesis.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Instrumentation of the sacroiliac joint with cylindrical threaded implants: A detailed finite element study of patient characteristics affecting fixation performance

Dubé-Cyr

Villemure

Arnoux

et al. 2021

Journal Orthopaedic Research

Self Cite

View full text Add to dashboard Cite

show abstract

“…While our study did not incorporate this additional modality of testing, the biomechanics literature provides evidence that higher bone density does correspond to increased pullout force. A number of cadaveric biomechanical studies utilizing lateral or posterolateral implants have been performed to investigate the influence on sacroiliac joint stability [22][23][24], but a direct comparison using the two approaches may provide an interesting follow-up to this analysis. Based on these findings, we hypothesize that a lateral approach may provide a fixation that is more secure and less likely to loosen when compared to a SIJ fusion utilizing the posterolateral approach.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of the lateral and posterolateral trajectories for fixation of the sacroiliac joint—a cadaveric study

et al. 2020

View full text Add to dashboard Cite

Background A number of minimally invasive sacroiliac (SI) joint fusion solutions for placing implants exist, with reduced post-operative pain and improved outcomes compared to open procedures. The objective of this study was to compare two MIS SI joint fusion approaches that place implants directly across the joint by comparing the ilium and sacrum bone characteristics and SI joint separation along the implant trajectories. Methods Nine cadaveric specimens (n = 9) were CT scanned and the left and right ilium and sacrum were segmented. The bone density, bone volume fraction, and SI joint gap distance were calculated along lateral and posterolateral trajectories and compared using analysis of variance between the two orientations. Results Iliac bone density, indicated by the mean Hounsfield Unit, was significantly greater for each lateral trajectory compared to posterolateral. The volume of cortical bone in the ilium was greater for the middle lateral trajectory compared to all others and for the top and bottom lateral trajectories compared to both posterolateral trajectories. Cortical density was greater in the ilium for all lateral trajectories compared to posterolateral. The bone fraction was significantly greater in all lateral trajectories compared to posterolateral in the ilium. No differences in cortical volume, cortical density, or cancellous density were found between trajectories in the sacrum. The ilium was significantly greater in density compared with the sacrum when compared irrespective of trajectory (p < 0.001). The posterolateral trajectories had a significantly larger SI joint gap than the lateral trajectories (p < 0.001). Conclusion Use of the lateral approach for minimally invasive SI fusion allows the implant to interact with bone across a significantly smaller joint space. This interaction with increased cortical bone volume and density may afford better fixation with a lower risk of pull-out or implant loosening when compared to the posterolateral approach.

show abstract

Biomechanical analysis of the number of implants for the immediate sacroiliac joint fixation

et al. 2021

View full text Add to dashboard Cite

Biomechanical analysis of two insertion sites for the fixation of the sacroiliac joint via an oblique lateral approach

Cited by 8 publications

References 29 publications

Instrumentation of the sacroiliac joint with cylindrical threaded implants: A detailed finite element study of patient characteristics affecting fixation performance

Instrumentation of the sacroiliac joint with cylindrical threaded implants: A detailed finite element study of patient characteristics affecting fixation performance

Comparative analysis of the lateral and posterolateral trajectories for fixation of the sacroiliac joint—a cadaveric study

Biomechanical analysis of the number of implants for the immediate sacroiliac joint fixation

Contact Info

Product

Resources

About