Ganganalyse nach minimal-invasiver Hüftprothesenimplantation

Sander, Klaus; Layher, Frank; Anders, C.; Röth, Andreas; Babisch, J.; Scholle, Hans‐Christoph; Kinne, Raimund W.

doi:10.1007/s00132-011-1891-6

Cited by 11 publications

(7 citation statements)

References 25 publications

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“…The present study also showed details of the amplitude drop between the two peaks, representing a period of reduced muscle activation and corresponding to the decline phase just after the weight acceptance peak in the vertical ground reaction force [33, 41]. This level of detail was also likely due to the high time and amplitude resolution.…”

Section: Discussionsupporting

confidence: 52%

Detailed spatial characterization of superficial hip muscle activation during walking: A multi-electrode surface EMG investigation of the gluteal region in healthy older adults

et al. 2017

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PurposeA multi-electrode array was used to generate spatially resolved Surface electromyography (SEMG) data of the hip muscles in healthy older adults. The cohort was meant to serve as an age-matched, normal control population for future surgical and rehabilitative studies in patients undergoing total hip arthroplasty, in view of the large, continuously increasing number of hip joint replacements.MethodsBilateral hip muscle SEMG activity, including tensor fasciae latae (TFL), gluteus medius (Gmed), and gluteus maximus (Gmax), was measured during locomotion on a walkway at self-selected slow, normal, and fast walking speeds (age-matched cohort of 29 females and 25 males). Eight equally-spaced, vertically oriented bipolar channels were applied on a horizontal line at mid-distance between iliac crest and greater trochanter (length 17.5 cm; named P1 to P8). Time-independent parameters (e.g., mean amplitude) were derived from the amplitude curves expressed as root mean square.ResultsThe acquired SEMG data were not significantly influenced by gender (p = 0.202) or side (p = 0.313) and were therefore pooled. The most ventral to central electrode positions P1 to P5, representing TFL and ventral to central Gmed, showed the highest mean amplitude levels (averaged over the whole stride; 0.001 < p < 0.027 against P6 to P8; Bonferroni-adjusted paired t-test) at all walking speeds. Also, the respective curves showed two distinct amplitude peaks (representing load acceptance and hip stabilization during mid-stance), with a continuous increase of the first peak from P1 to P4 (most pronounced at fast speed) and the second peak from P1 to P3. Independently of the underlying individual muscles, both peaks displayed a continuous time shift from the most dorsal P8 to the most ventral P1 position, with the peaks for the ventral positions occurring at later time points during the normalized stride.ConclusionsThe continuously changing activation patterns of the superficial muscles in the gluteal region during walking may reflect function-driven, finely tuned coordination patterns of neighboring muscles and muscle segments, rather than independent activation of anatomically defined muscles. This may be important for the definition of specific target parameters for the improvement and/or normalization of muscle function during training and post-injury rehabilitation.

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Section: Discussionsupporting

confidence: 52%

Detailed spatial characterization of superficial hip muscle activation during walking: A multi-electrode surface EMG investigation of the gluteal region in healthy older adults

et al. 2017

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“…Ein Jahr postoperativ wurden keine signifikanten funktionellen Unterschiede erhoben (Harris Hip Score, Merle dʼAubigné, SF-36) -die postoperativ durchgeführte Ganganalyse wie auch die CT-gestützte Analyse der Implantatpositionierung ergab keine Unterschiede [55]. Ganganalysen können derzeit durch Beurteilung der kinematischen oder kinetischen Parameter keine Verbesserungen der minimalinvasiven Zugangswege gegenüber konventionellen Zugän-gen belegen [51,54]. Bei minimalinvasiv modifizierten Zugangswegen zum Hüftge-lenk muss des Weiteren eine operative Lernkurve berücksichtigt werden, die möglicherweise in einer erhöhten Komplikationsund Revisionsrate resultieren könnte.…”

Section: Single Incision Techniqueunclassified

“…Nachteile der minimalinvasiven Zugangswege waren eine erhöhte Komplikationsrate, die sich wegen einer eingeschränkten intraoperativen Übersicht in einer erhöhten Rate an Fehlimplantationen äußerte[33]. Zwar ist zum heutigen Zeitpunkt eine Vielzahl an Studien der Evidenzgrade I und II[18,52,54,56,71,72] wie auch Metaanalysen und systematischen Literaturübersichten verfügbar[61][62][63][64][65][66][67][68][69][70], dennoch präsentiert sich die aktuelle Literatur zu vielen Einzelaspekten -wie u. a. zu potenziellen Vor-und Nachteilen, Komplikationen und Revisionsursachen im Langzeitverlauf -limitiert, sodass aus den verfügbaren Metaanalysen[61][62][63][64][65][66][67][68][69][70] keine eindeutige Überlegenheit gegenüber den Standardzugängen hergeleitet werden kann. Auch die Beurteilung der Primärliteratur gestaltet sich äußerst schwierig, da nur wenige kontrollierte Studien existieren, die einen konventionellen Zugang zum Hüftgelenk und dessen minimalinvasive Modifikation vergleichen.…”

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“…Lediglich der anteriore minimalinvasive Zugang schonte in 4 von 5 Fällen den M. gluteus medius. Der N. gluteus superior wurde 4-malig nach anterolateralem minimalinvasivem Zugang geschädigt, hingegen aber nur einmalig nach konventionellem lateralem Zugang.Bildgebende Untersuchungen und Ganganalysen zum postoperativen Vergleich minimalinvasiver und konventioneller Zugangswege sind bis dato noch nicht in ausreichender Anzahl verfügbar, um eine abschließende Beurteilung zu nachweisbaren Muskelschädigungen und Degenerationen der zugangsspezifisch kompromittierten Muskeln im zeitlichen Verlauf zu treffen[52,54,56,71,72,76]. Dennoch bieten bildgebende Verfahren -hier insbesondere die MRT durch den vorteilhaften Weichteilkontrast -gegenüber indirekten Evaluationsmethoden (u. a. Funktionsscores, Entlassungszeitpunkt) den Vorteil der direkten Visualisierung einer zugangsspezifischen Muskel-und Weichteilschädi-gung.…”

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Stellenwert minimalinvasiver Zugangswege bei der primären Hüftendoprothetik – ein Update

2014

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Presently, the available literature does not allow definitive assessment regarding the significance of minimally invasive approaches at the hip joint. Future, random-controlled studies are necessary in order to compare the reliable (long-term) results of the established standard approaches with the hip approaches according to minimally invasive criteria. As long as sufficient long-term results regarding the complication and revision rates of minimally invasive approaches are not available, the method cannot be recommended as "gold standard."

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“…Movement analysis is also used in sports medicine for functional diagnostics and performance analysis [11] and in the rehabilitative sector for therapy management [12]. In orthopaedic trauma surgery care research, instrumental movement analysis is used to evaluate surgical interventions, such as comparison of different implants and surgical approaches [13]. Developments and supplies in orthopaedic technologies and orthopaedic schoe technologies can be planned and checked [14,15].…”

Section: Introductionmentioning

confidence: 99%

Movement Analysis in Orthopedics and Trauma Surgery – Measurement Systems and Clinical Applications

et al. 2019

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Background Technical development lead to an enhancement of clinical movement analysis in the last few decades and expanded its research and clinical applications. Since the mid 20th century, human movement analysis has made its way into clinical practice, e.g. in treating poliomyelitis and infantile cerebral palsy. Today, it has a wide range of applications in various clinical areas. The aim of this narrative review is to illustrate the variety of camera-based systems for human movement analysis and their clinical applications, specifically in the field of orthopaedics and trauma surgery (O/U). Benefits and limitations of each system are shown. Future development and necessary improvements are discussed. Material and Methods A selective literature review was undertaken with the databases PubMed and Google Scholar using keywords related to clinical human movement analysis in the field of orthopaedics and trauma surgery. Furthermore standard book references were included. Results Common video camera systems (VS) are used for basic visual movement analysis. Instrumented movement analysis systems include marker-based systems (MBS), markerless optical systems (MLS) and rasterstereographic analysis systems (VRS). VS, MBS and MLS have clinical use for dynamic examination of patients with various disorders in movement and gait. Among such are e.g. neuro-orthopaedic disorders, muscular insufficiencies, degenerative and post-trauma deficiencies with e.g. resultant pathologic leg axis. Besides the measurement of kinematic data by MBS and MLS, the combination with kinetic measurements to detect abnormal loading patterns as well as the combination with electromyography (EMG) to detect abnormal muscle function is a great advantage. Validity and reliability of kinematic measurements depend on the camera systems (MBS, MLS), the applied marker models, the joints of interest and the observed movement plane. Movements in the sagittal plane of the hip and knee joint, pelvic rotation and tilt as well as hip abduction are generally measured with high reliability. In the frontal and transverse planes of the knee and ankle joint substantial angular variabilities were noted due to the small range of motion of the joints in these planes. Soft tissue artefacts and marker placement are the biggest sources of errors. So far MLS did not improve these limitations. MBS are most accurate and remain the gold-standard in clinical and scientific movement analysis. VRS is used clinically for static 3D-analysis of the trunk posture and spine deformities. Current systems allow the dynamic measurement and visualisation of trunk and spine movement in 3D during gait and running. Planar x-ray-imaging (Cobbʼs angle) and to some extent cross sectional imaging with CT-scan or MRI are commonly used for the evaluation of patients with spinal deformities. VRS offers functional 3D data of trunk and spine deformities without radiation exposure, thus allowing safer clinical monitoring of the mainly infantile and adolescent patients. The accuracy, validity and reliability of measurements of different VRS-systems for the clinical use has been proven by several studies. Conclusion The instrumented movement analysis is an additional tool that aids clinical practitioners of O/U in the dynamic assessment of pathologic movement and loading patterns. In conjunction with common radiologic imaging it aids in the planning of type and extent of corrective surgical interventions. In the field of orthopaedics and trauma surgery movement analysis can help as an additional diagnostic tool to develop therapeutic strategies and evaluate clinical outcomes.

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Ganganalyse nach minimal-invasiver Hüftprothesenimplantation

Cited by 11 publications

References 25 publications

Detailed spatial characterization of superficial hip muscle activation during walking: A multi-electrode surface EMG investigation of the gluteal region in healthy older adults

Detailed spatial characterization of superficial hip muscle activation during walking: A multi-electrode surface EMG investigation of the gluteal region in healthy older adults

Stellenwert minimalinvasiver Zugangswege bei der primären Hüftendoprothetik – ein Update

Movement Analysis in Orthopedics and Trauma Surgery – Measurement Systems and Clinical Applications

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