1
|
Sadeghian SM, Lewis CL, Shefelbine SJ. Can pelvic tilt cause cam morphology? A computational model of proximal femur development mechanobiology. J Biomech 2023; 157:111707. [PMID: 37441913 DOI: 10.1016/j.jbiomech.2023.111707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
Cam deformity of the proximal femur is a risk factor for early osteoarthritis. While cam morphology is related to mechanical force at a formative time in skeletal growth, the specific problematic forces contributing to the development of cam morphology remain unknown. Individuals with femoroacetabular impingement syndrome exhibit an increased anterior pelvic tilt during walking, which alters their hip joint forces. This study aims to investigate the influence of altered joint force caused by anterior pelvic tilt on proximal femur epiphyseal growth and the potential association between increased anterior pelvic tilt and the development of cam morphology. A computational model is utilized to simulate the endochondral ossification in the proximal femur and predict cam formation. Cartilage growth and ossification patterns for a gait cycle with and without anterior pelvic tilt were modeled. The simulated growth results indicated an increased alpha angle (53° for typically developing to 68° for anterior pelvic tilt) and aspherical femoral head in the model with anterior pelvic tilt. We conclude that anterior pelvic tilt may be sufficient to cause the formation of the cam morphology. Identifying the critical mechanical conditions that increase the risk of cam deformity could help prevent this condition by adjusting the physical activities before skeletal maturity.
Collapse
Affiliation(s)
- S Mahsa Sadeghian
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Cara L Lewis
- Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Sandra J Shefelbine
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA; Department of Bioengineering, Northeastern University, Boston, MA, USA.
| |
Collapse
|
2
|
Filan D, Mullins K, Carton P. Hip Range of Motion Is Increased After Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e797-e822. [PMID: 35494261 PMCID: PMC9042900 DOI: 10.1016/j.asmr.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/08/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To investigate the impact of arthroscopic correction of symptomatic femoroacetabular impingement on postoperative hip range of motion (ROM), as an objectively measured postoperative clinically reported outcome. Methods A systematic review of the current literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, OVID/MEDLINE, EMBASE, and Cochrane databases were queried in November 2020. Studies not reporting pre- to postoperative ROM measurements were excluded. Methodologic quality was assessed using the MINORS assessment, and certainty of evidence was assessed using the GRADE approach. Effect size using standardized mean differences assessed magnitude of change between pre- and postoperative ROM. Results In total, 23 studies were included evaluating 2,332 patients. Mean age ranged from 18 to 44.2 years. Flexion, internal rotation (IR), and external rotation (ER) were the predominantly measured ROMs reported in 91%, 100% and 65% of studies, respectively. Observed change following hip arthroscopy was considered significant in 57.1% (flexion), 74% (IR), and 20% (ER). Effect size of change in significantly improved ROMs were weak (16.7% flexion, 33.3% ER), moderate (58.3% flexion, 29.4% IR), and large (25% flexion, 64.7% IR, 66.7% ER). For goniometric assessment mean observed changes ranged as follows: flexion: 0.1° to 12.2°; IR: 3.6° to 21.9°; ER: –2.6° to 12.8°. For computed tomography–simulated assessment, the mean observed change ranged as follows: flexion: 3.0° to 8.0°; IR 9.3° to 14.0°. Conclusions Outcome studies demonstrate overall increased range of flexion and IR post-hip arthroscopy, with a moderate and large effect respectively. Change in ER is less impacted following hip arthroscopy. Certainty of evidence to support this observation is low. Current research evaluating changes in this functional ability is limited by a lack of prospective studies and non-standardized measurement evaluation techniques. Level of Evidence Level IV, systematic review of Level II-IV studies.
Collapse
Affiliation(s)
- David Filan
- UPMC Whitfield, Waterford, Ireland
- Address correspondence to David Filan, Suite 5, UPMC Whitfield, Butlerstown North, Cork Road, Waterford, Ireland.
| | | | - Patrick Carton
- Hip and Groin Clinic, Waterford, Ireland
- UPMC Whitfield, Waterford, Ireland
| |
Collapse
|
3
|
Dzupa V, Konarik M, Knize J, Veleminsky P, Vranova J, Baca V, Kachlik D. The size and shape of the human pelvis: a comparative study of modern and medieval age populations. Ann Anat 2021; 237:151749. [PMID: 33940120 DOI: 10.1016/j.aanat.2021.151749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Great variability in shape and size of the bony pelvis can be observed in the current population, but there is not enough data on how long the historical period must elapse to gain changes in pelvic shape and size. The aim of the study was to identify morphological changes in bony pelvis in males and females after a developmentally short period of approximately one thousand years. MATERIAL AND METHODS Seventeen defined external dimensions of pelvic bone from 120 adult individuals (two craniocaudal, two ventrodorsal, six mediolateral, three acetabular dimensions, and four dimension of the auricular surface) were measured. The medieval sample of 60 pelvic bones (30 male and 30 female) was obtained from the Great Moravian site of Mikulčice-Valy (9th-10th century), while the modern collection of 60 pelvic bones (30 male and 30 female) dates from the late 19th and first half of the 20th centuries. Obtained results were evaluated using the independent t-test at a 5% level of significance. RESULTS A comparison of male and female pelvic dimensions within a single population yielded expected results: the mean male values were greater. In modern population, male pelvis mean values were greater in 15 of defined parameters, while in medieval population, male dimensions were larger in 16 variables. A comparison of modern and medieval female pelvic bones found 11 variables to be greater in medieval sample (one determining the craniocaudal dimension, five the mediolateral, all three the acetabular, and two determining the auricular surface dimensions), but only two were significant (two dimensions determining the mediolateral dimensions). In modern female samples, there were five variables greater (one determining the craniocaudal dimension, one the ventrodorsal, one the mediolateral, and two determining the auricular surface dimensions), but only two were significant as well (one determining the craniocaudal and one the ventrodorsal dimensions). A comparison of male pelvic bones found 13 variables to be greater in medieval pelvis (one determining the craniocaudal dimension, all six the mediolateral, one the ventrodorsal, all three the acetabular, and two determining the auricular surface dimensions), but only four were significant as well (all determining the mediolateral dimensions). In modern male sample, there were only four variables greater (one determining the craniocaudal dimension, one the ventrodorsal, and two determining the auricular surface dimensions), but only one was significant (determining the craniocaudal dimension). CONCLUSION Unexpectedly, our study did not find the early medieval population to have a smaller pelvis compared to the modern population. While pelvic bones of the former were somewhat lower, but wider, those of the latter population were a bit higher and narrower. The study allows a very careful statement that one millennium is a time period long enough for measurable morphological deviations of the pelvic bones shape and size to occur.
Collapse
Affiliation(s)
- Valer Dzupa
- Department of Orthopaedics and Traumatology, Third Faculty of Medicine, Charles University, and University Hospital Kralovske Vinohrady, Srobarova 50, 100 00, Prague 10, Czech Republic; Center for Integrated Studies of the Pelvis, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| | - Marek Konarik
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague 5, Czech Republic; Center for Integrated Studies of the Pelvis, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| | - Jakub Knize
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague 5, Czech Republic; Center for Integrated Studies of the Pelvis, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| | - Petr Veleminsky
- Department of Anthropology, National Museum, Vaclavske nam. 68, 110 00, Prague 1, Czech Republic.
| | - Jana Vranova
- Department of Biophysics and Informatics, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| | - Vaclav Baca
- Department of Health Care Studies, Colleague of Polytechnics Jihlava, Tolsteho 16, 586 01, Jihlava, Czech Republic; Center for Integrated Studies of the Pelvis, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague 5, Czech Republic; Center for Integrated Studies of the Pelvis, Third Faculty of Medicine, Charles University, Ruska 87, 100 00, Prague 10, Czech Republic.
| |
Collapse
|
4
|
Kobayashi N, Higashihira S, Kitayama H, Kamono E, Yukizawa Y, Oishi T, Takagawa S, Honda H, Choe H, Inaba Y. Effect of Decreasing the Anterior Pelvic Tilt on Range of Motion in Femoroacetabular Impingement: A Computer-Simulation Study. Orthop J Sports Med 2021; 9:2325967121999464. [PMID: 33959669 PMCID: PMC8060763 DOI: 10.1177/2325967121999464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/09/2020] [Indexed: 11/07/2022] Open
Abstract
Background: The influence of pelvic tilt mobility, which can be reproduced in
computer-simulation models, is an important subject to be addressed in the
understanding of femoroacetabular impingement (FAI) pathophysiology. Purpose: To use computer-simulation models of FAI cases to evaluate the optimum
improvement in hip range of motion (ROM) achieved by decreasing the anterior
pelvic tilt and compare the results with the improvement in ROM achieved
after cam resection surgery. Study Design: Controlled laboratory study. Methods: The pre- and postoperative computed tomography (CT) images from 28 patients
with FAI treated with arthroscopic cam resection were evaluated. Using a
dynamic computer-simulation program, 3-dimensional models with a 5° and a
10° decrease in anterior pelvic tilt from the supine functional pelvic plane
(baseline) were created from the preoperative CT scans. Similar models were
constructed for hips before (at baseline) and after cam resection.
Improvements from baseline in maximum internal rotation at 45°, 70°, and 90°
of flexion were assessed for the 5° change in pelvic tilt, 10° change in
pelvic tilt, and cam resection models, and the results were compared for all
conditions. Results: The combination of a 10° change in pelvic tilt and cam resection showed the
largest ROM improvement from baseline (P < .001).
Improvement in internal rotation in the cam resection model was
significantly higher compared with the 5° pelvic tilt change model
(P < .001), while there was no significant
difference between the cam resection model and the 10° pelvic tilt change
model. Conclusion: Decreasing anterior pelvic tilt by 10° in the preoperative computer
simulation model resulted in an equivalent effect to cam resection, while a
5° change in pelvic tilt was inferior to cam resection in terms of ROM
improvement. Clinical Relevance: Enough of a decrease in anterior pelvic tilt may contribute to ROM
improvement that is as effective as that of cam resection surgery.
Collapse
Affiliation(s)
- Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Shota Higashihira
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Haruna Kitayama
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan.,Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Emi Kamono
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Yohei Yukizawa
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Takayuki Oishi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Shu Takagawa
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideki Honda
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| |
Collapse
|
5
|
Abstract
As our understanding of hip function and disease improves, it is evident that the acetabular fossa has received little attention, despite it comprising over half of the acetabulum’s surface area and showing the first signs of degeneration. The fossa’s function is expected to be more than augmenting static stability with the ligamentum teres and being a templating landmark in arthroplasty. Indeed, the fossa, which is almost mature at 16 weeks of intrauterine development, plays a key role in hip development, enabling its nutrition through vascularization and synovial fluid, as well as the influx of chondrogenic stem/progenitor cells that build articular cartilage. The pulvinar, a fibrofatty tissue in the fossa, has the same developmental origin as the synovium and articular cartilage and is a biologically active area. Its unique anatomy allows for homogeneous distribution of the axial loads into the joint. It is composed of intra-articular adipose tissue (IAAT), which has adipocytes, fibroblasts, leucocytes, and abundant mast cells, which participate in the inflammatory cascade after an insult to the joint. Hence, the fossa and pulvinar should be considered in decision-making and surgical outcomes in hip preservation surgery, not only for their size, shape, and extent, but also for their biological capacity as a source of cytokines, immune cells, and chondrogenic stem cells. Cite this article: Bone Joint Res 2020;9(12):857–869.
Collapse
Affiliation(s)
- Pablo A Slullitel
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Coutu
- Regenerative Medicine Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Martin A Buttaro
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Paul Edgar Beaule
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | | |
Collapse
|
6
|
Dukas AG, Gupta AS, Peters CL, Aoki SK. Surgical Treatment for FAI: Arthroscopic and Open Techniques for Osteoplasty. Curr Rev Musculoskelet Med 2019; 12:281-290. [PMID: 31264173 PMCID: PMC6684728 DOI: 10.1007/s12178-019-09572-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW To review the relevant literature and techniques regarding arthroscopic and open treatment of femoroacetabular impingement (FAI). To discuss both the senior authors' preferred method of arthroscopic and open treatment of FAI. RECENT FINDINGS Routine treatment of FAI has moved away from open techniques and is more focused arthroscopic methods. Arthroscopic treatment of FAI has more recently focused on differing techniques of hip access and capsular management. Open techniques still have a role in FAI, but indications for open management are focused on cases with more severe pathology. While arthroscopic techniques have shown better outcomes in the short term and higher return to play, it is not without risk and is a procedure with a steep learning curve. In cases of complex joint pathology, such as FAI coupled with dysplasia or Legg-Calve-Perthes, arthroscopy may be not indicated and an open approach preferred. We outline various techniques for both arthroscopic and open treatment of FAI and their outcomes when possible.
Collapse
Affiliation(s)
- Alex G Dukas
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Andrew S Gupta
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Christopher L Peters
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| |
Collapse
|