Is the hip capsule thicker in diseased hips?

Rakhra, Kawan; Bonura, Andrew; Nairn, Robert; Schweitzer, Mark E.; Kolanko, N. M.; Beaulé, Paul E.

doi:10.1302/2046-3758.511.2000495

Cited by 26 publications

(24 citation statements)

References 20 publications

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“…7,10,52,54,65 All lateral iliofemoral ligaments were also relatively thick, as measured after the capsulotomy. This finding coincided with previous imaging studies that found thicker anterosuperior capsules in symptomatic cam FAI 63,80 and suggested that our cohort was representative of individuals at risk of symptoms. Fourth, we performed the T-capsulotomy instead of an interportal-only capsulotomy.…”

Section: Discussionsupporting

confidence: 92%

Hip Joint Torsional Loading Before and After Cam Femoroacetabular Impingement Surgery

Daou

Bankes

et al. 2018

Am J Sports Med

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Background:Surgical management of cam femoroacetabular impingement (FAI) aims to preserve the native hip and restore joint function, although it is unclear how the capsulotomy, cam deformity, and capsular repair influence joint mechanics to balance functional mobility.Purpose:To examine the contributions of the capsule and cam deformity to hip joint mechanics. Using in vitro, cadaveric methods, we examined the individual effects of the surgical capsulotomy, cam resection, and capsular repair on passive range of motion and resistance of applied torque.Study Design:Descriptive laboratory study.Methods:Twelve cadaveric hips with cam deformities were skeletonized to the capsule and mounted onto a robotic testing platform. The robot positioned each intact hip in multiple testing positions: (1) extension, (2) neutral 0°, (3) flexion 30°, (4) flexion 90°, (5) flexion-adduction and internal rotation (FADIR), and (6) flexion-abduction and external rotation. Then the robot performed applicable internal and external rotations, recording the neutral path of motion until a 5-N·m of torque was reached in each rotational direction. Each hip then underwent a series of surgical stages (T-capsulotomy, cam resection, capsular repair) and was retested to reach 5 N·m of internal and external torque again after each stage. During the capsulotomy and cam resection stages, the initial intact hip’s recorded path of motion was replayed to measure changes in resisted torque.Results:Regarding changes in motion, external rotation increased substantially after capsulotomies, but internal rotation only further increased at flexion 90° (change +32%, P = .001, d = 0.58) and FADIR (change +33%, P < .001, d = 0.51) after cam resections. Capsular repair provided marginal restraint for internal rotation but restrained the external rotation compared with the capsulotomy stage. Regarding changes in torque, both internal and external torque resistance decreased after capsulotomy. Compared with the capsulotomy stage, cam resection further reduced internal torque resistance during flexion 90° (change −45%, P < .001, d = 0.98) and FADIR (change −37%, P = .003, d = 1.0), where the cam deformity accounted for 21% of the intact hip’s torsional resistance in flexion 90° and 27% in FADIR.Conclusion:Although the capsule played a predominant role in joint constraint, the cam deformity provided 21% to 27% of the intact hip’s resistance to torsional load in flexion and internal rotation. Resecting the cam deformity would remove this loading on the chondrolabral junction.Clinical Relevance:These findings are the first to quantify the contribution of the cam deformity to resisting hip joint torsional loads and thus quantify the reduced loading on the chondrolabral complex that can be achieved after cam resection.

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Section: Discussionsupporting

confidence: 92%

Hip Joint Torsional Loading Before and After Cam Femoroacetabular Impingement Surgery

Daou

Bankes

et al. 2018

Am J Sports Med

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Section: Propertiesmentioning

confidence: 99%

“…In terms of functional stability, it further suggests that the aperture mechanism of the zona orbicularis concentrically gathers these posterior thin fibers to create the stability-inducing collar during extreme hip motions. More recently, the MRI study by Rakhra et al further compared 3 groups: hips with cam FAI, hips with chondrolabral pathology, and healthy control hips 38 . They indicated that the capsule thickness of the cam FAI group was similar to the chondrolabral pathology group.…”

Section: Propertiesmentioning

confidence: 99%

“…It is essential to understand that capsular characteristics and mechanical properties of the hip with pathological conditions are different (i.e., a thicker, stiffer capsule) than a healthy joint 38,50,52 ; thus, the need for full capsular closure may depend on several other confounding factors (e.g., age, sex, osseous anatomy, and muscle function) [53][54][55] . More importantly, since unrepaired capsulotomies have been shown to heal within 24 weeks postoperatively 56 , and completely resecting the iliofemoral ligament does not destabilize the native hip 43 , there is evidence that not all capsulotomies need to be repaired after The findings of in vitro cadaveric studies on the effects of capsular conditions and surgical stages, outlining the contributions of the interportal capsulotomy 5,7,8,10,11,14,46 and T-capsulotomy 6,11,14,15,46 and the effects of instability 7,[11][12][13]16,47 , effusion arthroscopy, especially when capsular contracture may be part of the pathological process.…”

Section: Surgical Management Hip Preservation Capsulotomy and Repairmentioning

confidence: 99%

“…In addition to mechanical responses, tissue dimensions of capsular ligaments (i.e., thickness and length) can also adapt with progressive arthritis, which can further result in larger cross-sectional areas and tighter capsular ligaments 37 - 39 . Since the previous material characteristics were from excised capsules of cadaveric hips without pathology, more imaging modalities evolved to quantify the capsular thickness of hips with pathology using magnetic resonance imaging (MRI) 38 - 40 . Weidner et al, in 2012, reviewed imaging data of patients with either symptomatic cam, pincer, or mixed femoroacetabular impingement (FAI) and noted that the anterosuperior capsule (i.e., iliofemoral ligament) was the thickest region (6 mm compared with nonpathological thicknesses of 3.5 to 4.2 mm), and further noted that the zona orbicularis was more prominent in the posterior region, where the capsule was thinner and longer 39 .…”

Section: Characteristicsmentioning

confidence: 99%

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Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

Jeffers

Beaulé

2019

The Journal of Bone and Joint Surgery

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ä Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ä The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension). ä To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. ä It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic. ä During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability. Characteristics Anatomy Human ligaments consist of predominantly type-I collagen (85%) and combinations of type III, V, VI, XI, and XIV (15%) 21,22. Within the hip joint, higher ratios of type-III collagen in the ligamentous capsule are associated with hip instability 23,24 , whereas elevated levels in the cartilage are associated with Disclosure: The authors indicated grant support from the Engineering and Physical Sciences Research Council (EPSRC) (EP/K027549/1 and EP/ N006267/1) and the Wellcome Trust (088844/Z/09/Z), during the conduct of the study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/F511).

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Biomechanics of the Native Hip from Normal to Instability

Bankes

Cobb

et al. 2020

Hip Dysplasia

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Is the hip capsule thicker in diseased hips?

Cited by 26 publications

References 20 publications

Hip Joint Torsional Loading Before and After Cam Femoroacetabular Impingement Surgery

Hip Joint Torsional Loading Before and After Cam Femoroacetabular Impingement Surgery

Hip Joint Capsular Anatomy, Mechanics, and Surgical Management

Biomechanics of the Native Hip from Normal to Instability

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