Kinematics, kinetics, and finite element analysis of commonplace maneuvers at risk for total hip dislocation

Nadzadi, Mark E.; Pedersen, Douglas R.; Yack, H. John; Callaghan, John J.; Brown, Thomas

doi:10.1016/s0021-9290(02)00232-4

Cited by 146 publications

(139 citation statements)

References 18 publications

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“…However, in these patients with obesity, it is not known whether the risk is only in the early postoperative period or if the risk persists several years after surgery. Biomechanical studies [10,11,31] have shown that the periprosthetic soft tissues, especially large thighs, can act as moment arms (soft tissue impingement or thigh impingement) during adduction to create a laterally directed force on the femoral component and dislocation (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Dual-mobility or Constrained Liners Are More Effective Than Preoperative Bariatric Surgery in Prevention of THA Dislocation

Hernigou

Trousselier

Roubineau

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Obesity is associated with an increased risk of dislocation after total hip arthroplasty (THA). However, in patients with obesity, it is not known whether the risk is only in the early postoperative period or whether it persists several years after surgery, and whether having bariatric surgery before undergoing THA and/or receiving a specific device (such as a dual-mobility or constrained acetabular liner) is more effective in terms of decreasing the risk of dislocation. Question/purposes (1) What is the cumulative risk of dislocation in patients with obesity after THA in the absence of a dual-mobility or constrained liner, and is this related to component positioning? (2) Does bariatric surgery before undergoing THA decrease dislocation risk in patients with obesity? (3) Are dual-mobility and constrained liners efficient in preventing dislocation in patients with obesity? Methods At our university-based practice, all surgeons adhered to the following treatment approaches: Before 2000 no dual-mobility implants or constrained liners were used for primary THAs. 2 ) who received standard cups, 85 hips in patients with bariatric surgery before THA using standard cups (with reduction to a BMI \ 30 kg/m 2 ), and 155 hips in patients with obesity who received dual-mobility (when younger than 70 years) or constrained liners (when older than 70 years). All patients received the same implants except for different femoral head diameters (32-mm head with standard cups and 28-mm head with dual-mobility or constrained liners). The patients were followed at routine intervals and were specifically queried about dislocation. All the 670 hips had a minimum followup of 5 years with a mean followup of 14 years (range 5-25 years). At the most recent followup, 101 (15%) hips were lost to followup (respectively, 36 of 215, 34 of 215, five of 85, 24 of 155), which is the same ratio as observed among the underlying populations from which the patients were drawn.Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

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Section: Introductionmentioning

confidence: 99%

Dual-mobility or Constrained Liners Are More Effective Than Preoperative Bariatric Surgery in Prevention of THA Dislocation

Hernigou

Trousselier

Roubineau

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The rate of dislocation varies from 0.5% to 11.2% [4,22,44,51,71,77,79,83,122,134,135]. Various factors contribute to a dislocation, including surgical technique, surgical skill, the type of prosthesis, alignment, surgical approach, revision surgery, and a history of neuromuscular disorders [4,22,35,77,82,134].…”

Section: Hip Precautionsmentioning

confidence: 99%

“…Anterior dislocation occurs rarely with the posterior approach but may be the dominant mode of dislocation if the anterior approach to the hip is used [134]. These two modes of dislocation were examined in a worstcase scenario finite-element computer simulation [83]. Maneuvers studied included those at risk for posterior dislocation (adduction, flexion, internal rotation) and anterior dislocation (extension and external rotation).…”

Section: Hip Precautionsmentioning

confidence: 99%

Myths and Legends in Orthopaedic Practice: Are We All Guilty?

Tejwani

Immerman

2008

Clinical Orthopaedics &Amp; Related Research

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Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit contamination; bending the patient's knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis; antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains; routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices.

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“…All occur during functional activities when the position of the pelvis and femur are different from that seen on standard radiographs or on the operating table [6][7][8][9][10][11]. Hip kinematics are specific to each individual and change the functional alignment of the components [10].…”

Section: Introductionmentioning

confidence: 99%

Patient Specific Component Alignment in Total Hip Arthroplasty

Pierrepont

Stambouzou²,

Miles³

et al. 2016

ReconRev

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Appropriate component alignment is critical for improving stability, maximising bearing performance and restoring native anatomy after Total Hip Arthroplasty (THA). Due to the large variation in patient kinematics between functional activities, current technologies lack definition of what constitutes correct target alignment. Analysis of a large series of symptomatic THA patients confirms that apparently wellorientated components on standard radiographs can still fail due to functional component malalignment. Evidently, previously defined "safe zones" are not appropriate for all patients as they do not consider the dynamic behaviour of the hip joint.The Optimized Positioning System™ (OPS™) comprises preoperative planning based on a patientspecific dynamic analysis, and patient-specific instrumentation for delivery of the target component alignment. This paper presents the application of OPS™ in three case studies.

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Kinematics, kinetics, and finite element analysis of commonplace maneuvers at risk for total hip dislocation

Cited by 146 publications

References 18 publications

Dual-mobility or Constrained Liners Are More Effective Than Preoperative Bariatric Surgery in Prevention of THA Dislocation

Dual-mobility or Constrained Liners Are More Effective Than Preoperative Bariatric Surgery in Prevention of THA Dislocation

Myths and Legends in Orthopaedic Practice: Are We All Guilty?

Patient Specific Component Alignment in Total Hip Arthroplasty

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