Hip - Science topic

Yes. May be related with increase steroid use during Covid.

Look at the microstructures. I suspect formation of delta Ni3Nb and / or Laves phase along the grain boundaries.

pm sent Raju Vaishya

The following article contains a predictive model for the maximum hip extensor strength in consideration of age.

Good luck!

Not only the people with musculoskeletal disorders are more susceptible to the COVID-19 pandemic (1), but musculoskeletal symptoms are one of the manifestations of COVID-19 illness (2). Furthermore, these disorders are also more common in people as long-term effects of COVID-19 (or long-COVID) (3-4).

Please have a look at these articles for evidence:

1.

2.

3.

4.

Hi Audrey,

I would need some information regarding your sample processing technique to give you accurate suggestions.

But here is what I did to immuno-stain mouse calvarial samples:

1. Section the PFA fixed OCT embedded samples by tape transfer technique ( I wanted to keep the mineral content of the bone. If you want you could decalcify the bone and then embed your sample. You cold go for normal frozen sectioning, in that case).

2. Follow the protocol suggested by the antibody provider (Ex: Abcam has some good protocols).

Figure 4 in my paper (attached) is an example of collagen-I and BSP staining on mouse calvaria.

Good luck with staining!

Aja

I recommend these papers for this analysis

Dear Syairah Atiqah , can you share your script with us?

Thanks a lot

Michelle

If you will follow the extrusion-paste-printing procedure, then you will get disseminated regions on the surface after a few numbers of actuation-cycle. This is due to local concentration. For homogeneity behaviors, better to follow the LPBS/DMLM.

This document may help you to solve the problem:

It's recommended to see this links

https://www.jstor.org/stable/20151807

For those who may be interested, we have recently published an open access dataset of kinematic (including joint angles), kinetic and EMG individual data of 50 healthy subjects (age range 6 - 72 yrs) during different locomotor tasks: walking at different speeds, stiars ascending/descending, toe/heel walking. The dataset is published on Scientific Data Journal and can be freely downloaded at this link:

Our 10 -year experience on early weight bearing did not show any problems with early weight bearing (Day 1)

However for those patients whose proximal femur were wired following fractures we delayed weight bearing for 6 weeks.Our choice of implants were mainly Depuy and Biomet

The difficulty lies in the initial classification of a new device, and the initial assessment of its level of risk. I took the example of the hip prosthesis, because it is classified in Europe in class III (the highest risk) while it is considered in the US in class II American (see : https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPCD/classification.cfm?ID=LPH ). In this specific case, the regulatory demands are indeed different.

As you point out, few clinical studies are carried out for medical devices, especially when they follow a 510k process instead of a Premarket approval (PMA). Do you think that a high-risk classification should systematically lead to the performance of a demonstrative clinical study before obtaining marketing authorization, and if so, what would be your arguments for asking for it?

Dear Daniel Dyball

Trying to merge scores without being validated will make the credibility of your work questionable and the possibility to get your work publish unlikely.

Nexus

We had conducted study from 1989 to 1995 where DDH patient of 1-5 yr were managed .Depending upon acetabular and femoral dysplasia osteotomy were carried out with OR.combined osteotomy in selected cases were done with gud long term result .

Chee Loong Chin Thanks a lot for your helpful answer.

Units were not consistent. The mimics soft had defined density in g/cm3 but because distances was in mm; the consistent unit for density was tonne/mm3.

Problem solved and thank you again.

Kindly go through the hardness testing methods and instruments this will solve your all problems

Yes, it may degrade the intricacies of the object

Here is agood reference that may help; Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis

panelA.K.Suokas,D.A.Walsh,D.F.McWilliams†L.Condon B., Moreton V., Wylde‡L.Arendt-Nielsen§, W.Zhang Osteoarthritis and Cartilage

Volume 20, Issue 10, October 2012, Pages 1075-1085

Dear Alister J Hart, The idea is good, but the continuity implant from the human body is still being studied. There are results of rejection and there is good continuity. This depends on the resulting microstructure, chemical composition, mechanical properties, surface topography, etc. factors. It is good to get acquainted and then apply it. Wishing for success in the responsible scientific work. Regards Emil Yankov

Ideal comfort and energy efficiency is with a hip angle of 110º or even 120º with the thighs/femurs parallel to the ground and the sacrum and spine against the chair back at at this 110º to 120º angle. Not 90º.

However, 90º angle at knees and at ankles.

Do you need references/citations for this for your work?

You can read our paper about the hip joint

Davood,

The femoral components of the THA and TKA would be most resistant to wear for the following reason. In the THA, ceramic and cobalt chrome femoral heads are known to have much harder surfaces then polyethylene and so are more resistant to wear.

Now, the new XLPE are much more wear resistant than the traditional UHMWPE. This may have an impact on the answer but I think it is reasonable to assume the femoral aspect of both the THA and TKA components are most resistant to wear.

Check out this paper on PubMed looking at XLPE: PMID: 29040124

Hope this helps,

Kind regards,

Gerard A. Sheridan

I agree with Dr Picardi, I do not think there is a future for the friction pair MoM

The patient wears a shoe that absorbs shock and avoids work that involves vibrations

Thanks for your answer it is not easy for simple radiological studies to determine the possibility of a neck fracture of the femur and even more if there are no prodromal symptoms. If there is a compression fracture, that is, in the lower cortex, a MRI may be indicated to locate the fracture, it is feasible that the simple radiograph could diagnose the modality of tension

Good question

These links may help you

Not to upset the apple cart too much but it comes down to Newtonian physics. (pun intended)

You place an implant into a bone and there is movement between the bone and the implant, that movement is the micro motion. If the bone is real stiff the motion is less if the bone is real soft the relative motion is greater. (Depending upon the amount of force that is applied, the speed at which it is applied, etc.)When we talk about micro motion were generally talking about something that occurs during the healing phase of the bone to implant interface. Obviously the implant is not healed to the bone, but the bone does heal to the implant. The more motion that occurs early on during the healing process the less likely it is for the bone to heal to that implant because the motion that occurs at the interface exceeds some healing threshold of the bone.

Your best bet may be to mine this data from PDFs of published reviews on the topic.

I believe that in younger age somebody can perform such osteotomies and definitely the dysplastic joints are still a reason to do such procedure. Despite this our improvement to the understanding of replacements and the improved materials as well as (to be cynical) the market made these a very rare presence in everybody's armatorium.

I have different paper about your problems you can visit may page.Also these links may help you

https://lib.ugent.be/fulltxt/RUG01/001/029/229/RUG01-001029229_2010_0001_AC.pdf

Thanks for your answer

Advances in Pre and post operative optimisation of patient and overall bone health and rehab part should play good role in making most patients lead optimal outcome and should be the focus than stem cells as of now.

Thanks

some other potential useful references:

Screening in Developmental Dysplasia of the Hip (DDH).

Paton RW.

Surgeon. 2017 Oct;15(5):290-296. doi: 10.1016/j.surge.2017.05.002

How to use… Hip examination and ultrasound in newborns.

Collins-Sawaragi YC, Jain K.

Arch Dis Child Educ Pract Ed. 2018 Feb;103(1):34-40

Previous studies demonstrated that both short cementless stem and conventional cementless stem provided stable fixation and achieved a satisfactory result in patients 70 years and older and the short cementless stem had a low incidence of thigh pain and intra-operative fracture.

J Orthop Surg Res. 2016; 11: 33.

Dear Dr Pignatti

If you face with an acetabular defects of less than 30%; Paprosky types  2 or less, porous cementless cups fixed with screws maybe enough.acetabular defects greater than 30%; at least Paprosky types 3A maybe need  impacted morsellised allografts with ofcourse a cemented cup technique . Difficult cases with pelvic discontinuity require acetabular plates or large cages but its really a disaster.

For delayed union or non union we have this procedure:

we drill under fluoroscopy control the fracture zone and we inject percutaneous bone marrow aspirated from iliac bone. We had good results in all delayed union cases but in non union we prefer to use also the PRP technique.

Dear Michelle, yes you are right with my question. Thank you for your honest response. Yes, need to try your suggestion some other time.

All comments have merit. I am always high on THA or cemented Bipolar if the patients potential life expectations is moderate to high with the note that a hip surgeon performs the surgery. This case is beyond the skill set of a general orthopaedic surgeon (in my opinion) Panayot is correct in comment of high risk of failure.

Todays skill set for an experienced hip surgeon can replace this hip within 45 to 60 minutes and provide a stable hip for the remained of this patients life. I would also recommend a cemented stem.

Non surgical approach would be restricted to the ability of skilled hip surgeon availability and or potential life expectation of this patient.

The Effects of Active Release Technique on Hamstring Flexibility: A Pilot Study

James W. George, DCcorrespondencePress enter key for correspondence information

, Andrew C. Tunstall, DC

, Rodger E. Tepe, PhD

, Clayton D. Skaggs, DC

DOI: http://dx.doi.org/10.1016/j.jmpt.2006.01.008

We did post. and ant.fixation in the same sitting. post fixation was very difficult due to scarring.

It depends on a number of factors: How non-normal is  the dataset. Are there just a few outliers? How does a plot  look like? Is it close to an oval, or a curve, or a curve With just with a few outliers? How many pairs of measuremenst do you have?

As a general rule: With a sufficient number of data, parametric methods are more informative (useful) than non-parametric.

By the way: I would consider this a question of analysing agreement, not association=correlation. Making paired subtractions would then be more appropriate? ... for example after normalizing the two sets of data.

The is a lot of erroneous use of correlation coefficients in medical papers, where paired differences should have been used.

Arne

Dear Mohamed 

First of all, do you mean of best for subjects comfort or for analysing data?

If you mean for analysing data make sure to choose starting position which isolate your group muscles that you want to evaluate from other muscles.

Secondly, try to be sure that all the muscles of the muscle group that you want to test are active in that starting position.

In addition, it is better to use a position which is used before in previous studies, otherwise you have to justify why you used this starting position.

I hope my answer will give a hint for choosing starting position.

All the best 

Mohammad Alali

Education is very important too. You could try a hip protector as outer stabilizer. 

NICE quidelines include hip protectors in the armatorium for the protection of hip fracture in the elderly population. They state that "Hip protectors may be most useful for people who are confused or have dementia, are falling often or for those frailer individuals in residential care whose bones are very fragile, especially if they have previously had broken bones." 

However they continue that "The biggest issue with hip protectors has been comfort and fit. Correct fitting of the underpants and positioning of the pads will ensure they are comfortable and more likely to be worn whenever the person is at risk of falling, even at night. Some of the modern types of pads have ventilation channels for temperature regulation and only a small part of their surface is in contact with the skin helping to reduce heat formation and sweating. These might be more comfortable when worn for a longer time, even throughout the day and night".

The evidence for NICE is limited and they write "A recent large review of hip protector studies, suggested that frail older people who wore hip protectors in nursing homes had a modest reduction in hip fracture. However there was no evidence of this reduction in people who used hip protectors in their own homes. The reason for these findings is uncertain but it is possible that some individuals did not wear the hip protectors all the time or that they were not fitted properly. People in nursing homes may have benefited more because staff had been trained to fit the hip protectors and to encourage residents to wear them".

In other words it is obviously reasonable to prescribe them on the frail patients as already mentioned by Arthur and potentially in a controlled environment which will make sure that they will be worn.

Iv. bisphosphonates have been proven to be effective in treating transient migratory osteoporosis in several German studies (See early papers by Johan Ringe). They specifically reduce or remove bone marrow edema, which is the main driver of pain in the area. I use 2 doses of iv. zoledronic acid 5 mg 3 months apart with excellent results. The maximal effect on pain is within 3 months, but varies a lot. Unfortunately radiologist have gotten into the habit to denote virtually all cases with bone marrow edema (or bone marrow lesions) osteonecrosis, which is wrong. All the available histological data from Bone Marrow Edema lesions show characteristics in line with a repair phenomenon, without any signs of necrosis. In the case of transient osteoporosis a general skeletal weakness leading to micro damage and repair (i.e. the bone marrow edema). Bisphosphonates will not only reduce pain, but also by its bone strengthening effects reduce the risk of subsequent new episodes with pain.

Totally agree with the diagnosis. Even the MRI showed marrow edema epicentered in femoral neck region with some sparing of Subchondral head area

In my opinion exercises imrove blood supply and muscle strength actively, while heat packs do so in a passive way. So I prefer active exercises.

 Lateral transtrochanteric approach. Standard cemetless cup and stem. Some problems may arise with stem because of the shortened neck. In such a case a long stem with distal fixation should work instead of standard stem.

Dear dr. Sinclair,

we have developed and validated (by clinical studies) models for resultant hip force in the one-legged stance and for contact stress in the hip,  reviews are given in the links below

The weight bearing area is defined in the model for stress.

There are more publications at

original papers with the models are from 1993 and 1999.

In the homepage of the Laboratory of Biophysics there is also software HIPSTRESS, however it runs only in older computers. We will update the software, meanwhile, the nomograms can be used which are in the first link above.

If you would like to use the models and you need help please let me know, kraljiglic@gmail.com

V. Kralj-Iglic

Greetings. I haven't encountered any studies in the literature finding side to side difference in hip fractures, unless there is a good reason for this. There are several studies investigating bone mineral density in osteoarthritic hips (patients with OA of the hip tend to disuse the affected side, which decreases the bone mineral density) that showed higher incidence of fractures at the osteoarthritic hip.

Good luck.

Wolf O, Ström H, Milbrink J, Larsson S, Mallmin H. Differences in hip bone mineral density may explain the hip fracture pattern in osteoarthritic hips. Acta Orthopaedica. 2009;80(3):308-313.

I"d like to see studies comparing the 15 sec time of stretching with longer times as 60-90 seconds.

Another issue is the intensity of the stretching that is abstract and dificulty to evaluate.

Very good paper, Congratulations.

Many years ago (more than 12) I had been in Switzerland in a hip simulating lab and they were using for the tests of ceramic on ceramic articulations bovine serum. Their argument was that it was cheap enough and easy to be found. Friction must be similar to human anyway. About the cycles you have to experiment on this. I believe that you have to careful as the heads may not have the same bone density and they may not all  "afford" to be stressed with the same number of cycles. A bone density of each head may help you understand the limitations. Sorry that I cannot be more helpful. I wish you good luck.

Dear Raju

Long nail is there only to internally support your femur and prevent any revision surgery in case of the appearance of secondary deposits or an accidental fall resulting a new fracture.

Your fixation is correct and I am not criticise it. I only said my opinion and the way of the preferred by me approach. This platform is here to help learning and not to criticise and believe me we learn from each other. Opinions, as the one expressed by me, are for discussion not to be imposed.

You have done a fixation which is functional and successful. I hope that my opinion is clearer now.

Thank you very much, for the opportunity given to discuss your interesting case.

Respectfully

George

Dear Kristian, it is because of anatomy and biomechanics. Medial meniscus is more vulnerable to injury because of its anatomical attachments and pathomechanics involved in squatting. Lateral meniscus is attached with joint capsule so that it will be moved outward while we squatting. But medial meniscus trapped between bones during squatting. The weight through medial compartment will be increased with wider stance. In stance anterior horn is more vulnerable and as the flexion increases weight on meniscus will shift to posterior horn. So the optimal position for squatting is legs in shoulder width apart. Both too narrow and too wider stance are not biomechanically correct. Simple Answer to your question is wider stance will increase pain in medial meniscus.

This case is elective for THA. As it's a post-traumatic arthrosis , once infection is ruled out, it's recommended  during the surgical approach to have the options for posterior wall reconstruction,  as bone graft and or trabecular augmentation. 

Good luck ,

Please send us the post op.  Images

Dear Ali

Conradi-Hünermann syndrome is a rare genetic disorder characterized by skeletal malformations, skin abnormalities, cataracts and short stature. The specific symptoms and severity of the disorder may vary greatly from one individual to another

The treatment of Conradi-Hünermann syndrome is directed toward the specific symptoms that are apparent in each individual. Such treatment may require the coordinated efforts of a team of medical professionals, such as pediatricians; physicians who diagnose and treat disorders of the skeleton, joints, muscles, and related tissues (orthopedists); skin specialists (dermatologists); eye specialists; and/or other health care professionals.

Various orthopedic measures, including surgery, may be recommended to help prevent, treat, or correct certain skeletal abnormalities associated with the disorder. Surgery may also be advised for certain craniofacial malformations, scoliosis or other physical abnormalities. The surgical procedures performed will depend on the nature, severity, and combination of anatomical abnormalities, their associated symptoms, and other factors.

Genetic counseling may be of benefit for affected individuals and their families. Other treatment is symptomatic and supportive.

I dont have experience with this syndrome but i think the treatment of hip dislocation, when indicated, should be similar to the treatment of teratological  congenital hip dislocation . The conservative treatment does not provide good results. Surgeries can range from removal of soft tissue interposition, through femoral osteotomy and pelvic osteotomies

Sir one more thing, actually i cast an alloy with taking cobalt as a base material and add 30% Cr with 0-4 wt.% Mo. so at wt.% of Mo gives minimum corrosion ..

As far as hip resurfacing is concerned, it is a high demand surgery meant only for high demand individuals. It fell into disrepute because of design issues of ASR from DePuy and few others (Durom from Zimmer) leading to very high failure rates. However, BHR from Smith & Nephew has had excellent results at both the designing centers as well as other centers. A recent results' analysis is available at http://www.ncbi.nlm.nih.gov/pubmed/25708400

 Personally, I reserve this implant for high demand individuals but not to be used in avascular necrosis. Revising a well integrated resurfacing cup can be a pain. Fortunately, we don't have to revise many. In case you have to revise any, my published technique (copy attached) for revising the same is available at  http://journals.lww.com/techortho/Abstract/publishahead/Revision_of_a_Well_fixed_Brimingham_Hip.99971.aspx

yes please, that would be great :D

I think that the best way you can follow is to contact an orthopedic doctor and ask to him if can give several of this implants, in order to make a reverese engineering operation for reconstructing the geometry. Manufacturer never gives the geometries of thei implants!!!

Very interesting question, because we are facing in our everyday practice.

According my opinion this is very complex problem and evaluation of reduction of femoral head in acetabulum must be first of all clinically, by ultrasound: static and dynamic, X-ray and in some cases MRI. It's depends from the level of pathology according Graf's Classification and type: decentrered hips, unstable hips or stable but dysplastic hips. Ultrasound can provide an assessment of the position, stability and morphology of the hip until the child is one year old. I prefer more Tubingen Hip Flexion orthosis designed by Prof Bernau, because this orthosis is better for saving reduction in human position. But anyway diagnostic, evaluation and treatment is very complex and specific for every patients.  

Of course, Dr. Wu, your proposal is also possible. Unfortunately, the x-ray cosmesis is not the only drawback. I have in mind the unhappy situation of repeated dislocations.

This is an excellent and really a very interesting question Prof Tanchev. Thank you. Its a very tricky scenario. The variables that i would be interested in are the age of the patient, co-morbidities, activity level, site of the fracture, fracture pattern (spiral or transverse), cemented polished taper stem or uncemented HA coated stem and the quality of the residual bone stock.

As the stem is fractured, i would assume this to be unstable and loose. If its uncemented and a spiral fracture, i would use the fracture as my osteotomy, remove the stem and revise it to an uncemented modular distal bearing plasma coated or fluted stem, with supplement cables and an allograft strut, if additional stability is needed. I would go atleast two cortical lengths past the fracture site. If its a transverse fracture, i will have a lower threshold to use a strut for added stability. 

If its a cemented stem and the patient is fit enough for a lengthy procedure, i would go down the same route after removing all the cement mantle. If not, and if the cement mantle is reasonable and if it is a polished stem, i will consider stem removal and a cement in cement revision, with an additional cable plate or allograft strut for stability.

If its a comminuted high fracture, one of the options could be a proximal femoral endoprosthetic replacement. This might warrant some additional stability in the form of a constrained acetabular liner or a complete acetabular component revision.

I hope you find this answer useful. Thank you   

Dear Christian This book describes the entire physiology of joint movements , with plans and vectors.

Enjoy

Kapandji. The Physiology of the Joints

I agree, but this (usingYoung's modulus and poisson's ratio) will allow you simulate only the elastic response of the bone-implant interphase and this is merely a comparative indicator for a very complex system.

If you want to get information concerning the fracture and/or loosening of the stent then you should use non-linear properties and consider anisotropy. Optimally you could also incorporate a failure criterion.

Another aspect I would suggest is to use second order elements (to reduce shear locking) this preferential to first order elements when simulating bending.

Equations are not common in orthopedic surgery. However, I would proceed as follows:

         180 cm  height        -         4 cm lengthening

          150 cm height        -           x    

          x =   (150 x 4) : 180 = 3.33 cm

This seems very simplified, but there is also logics in it, not only mathematics.  

Dear Markus

These informations may be useful for you

Duthon VB, Charbonnier C, Christophe FK, et al. Correlation of clinical and MRI findings in professional dancers’ hip: A new femoroacetabular impingement? Paper #FP29-650. Presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress 2012. May 2-5. Geneva.

For more information:Victoria B. Duthon, MD, can be reached at the Department of Orthopaedic Surgery, University Hospital of Geneva, 24 rue Micheli-du-Crest, 1211, Geneva, Switzerland; email: victoria.duthon@hcuge.ch.

No, not come across such practise