THA loading arising from increased femoral anteversion and offset may lead to critical cement stresses

Kleemann, Ralf U.; Heller, Markus O.; Stoeckle, Ulrich; Taylor, William R.; Duda, Georg N.

doi:10.1016/s0736-0266(03)00040-8

Cited by 70 publications

(45 citation statements)

References 42 publications

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“…10,11 Computational models of the musculoskeletal system provide access to the internal loads at the tibiofemoral (TF) and PF joints based on external measurements, and can be used to systematically explore the effects of factors relevant to the internal loading conditions. [12][13][14] While early studies estimated PF forces using 2D analyses, 15 recent models can predict 3D muscle and joint contact forces by employing more complex quasistatic or dynamic optimization techniques. [16][17][18] Here, a large variation in PF forces is apparent, especially for activities involving high knee flexion, 1 with PF forces during squatting ranging from 1.9 19 to 3.1 BW 15 at 1008 flexion.…”

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Patellofemoral joint contact forces during activities with high knee flexion

Trepczynski

Kutzner

Kornaropoulos

et al. 2011

Journal Orthopaedic Research

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The patellofemoral (PF) joint plays an essential role in knee function, but little is known about the in vivo loading conditions at the joint. We hypothesized that the forces at the PF joint exceed the tibiofemoral (TF) forces during activities with high knee flexion. Motion analysis was performed in two patients with telemetric knee implants during walking, stair climbing, sit-to-stand, and squat. TF and PF forces were calculated using a musculoskeletal model, which was validated against the simultaneously measured in vivo TF forces, with mean errors of 10% and 21% for the two subjects. The in vivo peak TF forces of 2.9-3.4 bodyweight (BW) varied little across activities, while the peak PF forces showed significant variability, ranging from less than 1 BW during walking to more than 3 BW during high flexion activities, exceeding the TF forces. Together with previous in vivo measurements at the hip and knee, the PF forces determined here provide evidence that peak forces across these joints reach values of around 3 BW during high flexion activities, also suggesting that the in vivo loading conditions at the knee can only be fully understood if the forces at the TF and the PF joints are considered together. ß

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confidence: 99%

Patellofemoral joint contact forces during activities with high knee flexion

Trepczynski

Kutzner

Kornaropoulos

et al. 2011

Journal Orthopaedic Research

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“…There is also a compression-bending force acting on the stem. Increased anteversion, especially in combination with a larger femoral offset, has been shown to raise stresses within the cement mantle [19]. However, this relates only to the bending stresses that mainly load the calcar, but does not take into account the internal rotational torque that is high when loading a hip in flexion [5].…”

Section: Discussionmentioning

confidence: 99%

The importance of adequate stem anteversion for rotational stability in cemented total hip replacement

Kiernan

Hermann

Wagner

et al. 2013

The Bone & Joint Journal

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Progressive retroversion of a cemented stem is predictive of early loosening and failure. We assessed the relationship between direct post-operative stem anteversion, measured with CT, and the resulting rotational stability, measured with repeated radiostereometric analysis over ten years. The study comprised 60 cemented total hip replacements using one of two types of matt collared stem with a rounded cross-section. The patients were divided into three groups depending on their measured post-operative anteversion (< 10°, 10° to 25°, > 25°). There was a strong correlation between direct post-operative anteversion and later posterior rotation. At one year the < 10° group showed significantly more progressive retroversion together with distal migration, and this persisted to the ten-year follow-up. In the < 10° group four of ten stems (40%) had been revised at ten years, and an additional two stems (20%) were radiologically loose. In the ‘normal’ (10° to 25°) anteversion group there was one revised (3%) and one loose stem (3%) of a total of 30 stems, and in the > 25° group one stem (5%) was revised and another loose (5%) out of 20 stems. This poor outcome is partly dependent on the design of this prosthesis, but the results strongly suggest that the initial rotational position of cemented stems during surgery affects the subsequent progressive retroversion, subsidence and eventual loosening. The degree of retroversion may be sensitive to prosthetic design and stem size, but < 10° of anteversion appears deleterious to the long-term outcome for cemented hip prosthetic stems. Cite this article: Bone Joint J 2013;95-B:23–30.

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“…Femoral anteversion directly influences patella tracking, which may induce increased pressure at the point of patellofemoral contact, resulting in joint degeneration during repetitive daily activities 32) . The quadriceps, especially the vastus medialis, provide dynamic patellofemoral joint stabilization 33) .…”

Section: Discussionmentioning

confidence: 99%

Effects of Visual Biofeedback Using a Laser Beam on the EMG ratio of the Medial and Lateral Vasti Muscles and Kinematics of Hip and Knee Joints during a Squat Exercise

Yoon

Kang

2011

J Phys Ther Sci

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Abstract.[Purpose] The purpose of this study was to examine the effects of visual biofeedback on the EMG ratio of the medial and lateral vasti muscles and on the lower extremity joint angles during squat exercises performed by subjects with femoral anteversion.[Subjects] Seventeen subjects (5 men, 12 women) with femoral anteversion participated in this study.[Methods] Subjects performed a double-leg squat with and without visual biofeedback using a laser beam fixed to a patella strap. The peak angles of hip internal rotation and knee valgus were analyzed using a 3D motion analysis system, and the vastus medialis oblique/vastus lateralis (VMO/VL) activity ratio was calculated using the value recorded by surface electromyography during the squat exercises.[Results] Significant decreases were found in the hip internal rotation angle and knee valgus angle, and a significant increase in the VMO/VL activity ratio was observed on the dominant side when performing a double-leg squat with visual biofeedback using a laser beam.[Conclusions] We suggest that laser-beam visual biofeedback would be used as an effective for improving VMO muscle strength and reducing the angle of hip internal rotation and knee valgus during squat exercises.

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THA loading arising from increased femoral anteversion and offset may lead to critical cement stresses

Cited by 70 publications

References 42 publications

Patellofemoral joint contact forces during activities with high knee flexion

Patellofemoral joint contact forces during activities with high knee flexion

The importance of adequate stem anteversion for rotational stability in cemented total hip replacement

Effects of Visual Biofeedback Using a Laser Beam on the EMG ratio of the Medial and Lateral Vasti Muscles and Kinematics of Hip and Knee Joints during a Squat Exercise

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