Science topic

Hip - Science topic

The projecting part on each side of the body, formed by the side of the pelvis and the top portion of the femur.
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Are these related to COVID and Steroid use? What may be the correlation of these to a high incidence?
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Yes. May be related with increase steroid use during Covid.
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Hi,
After EBM building of tensile test specimens in both horizontal and vertical directions, all specimens were HIP'ed and then tensile tested. However, tensile test results were controversial since % Elongations of vertically built specimens were quite lower than horizontally built ones. While vertical specimens yielded %2-3 elongation, horizontal specimens yielded %30-35 elongations which is a huge difference. After HIP, it is expected that microstructure becomes equiaxed and cracks get closed. So what might be the cause of that huge difference in % elongations ? What methodology do you suggest ? Thanks in advance.
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Look at the microstructures. I suspect formation of delta Ni3Nb and / or Laves phase along the grain boundaries.
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Share your experience of dealing any of such cases of the hip
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pm sent Raju Vaishya
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Please share your experiences of dealing with such a case.
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Dear Madhan, do you have the images and record of these cases?
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What is the regression equation for hip extension and hip external rotation strength calculation with age, gender and weight variables .
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The following article contains a predictive model for the maximum hip extensor strength in consideration of age.
Good luck!
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In my last research, I investigate whether patients with musculoskeletal disorders had increased susceptibility to SARS-CoV2 infection or developed more severe forms of COVID-19; as well as whether COVID-19 affected the underlying disease.
Results showed that the frequency of COVID-19 was low and statistically nonsignificant, but that led to a worsening of the underlying disease.
What are your clinical impressions, ie do you have similar research results?
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COVID-19 and Its impact on the musculoskeletal system
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:
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I am currently trying to do IF on frozen mouse bone sections (hip, tibia, femur) with CD3, CD8, and PD-L1 antibodies. CD3 seems to work fine, but CD8 and PD-L1 do not stain well. I have tried injecting CD8 intravenously into the mice, but it does not come out well either. I use CD8 antibodies from BioLegend, and PD-L1 antibodies from BD Biosciences.
Is there any protocol I can adapt to solve this issue?
Thank you in advance for the help.
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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
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I'm looking to make a few comparisons of the open source step count algorithms currently available. Do you have an open source algorithm or utility that you commonly use?
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I recommend these papers for this analysis
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Hello!
In cases where I want to evaluate an overall measure, how could I combine two means from the same group?
Example: I have pain VAS for lower back and VAS for hips. I want to know the overall pain VAS. How could I proceed?
Thank you,
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Hi expert Grads,
I attempt to plot above figure of meridional & vertical anomaly as attachement (Figure A), however, the arrow display in my plot (Figure B) are not continues. Can anyone expert in grads look into my script and do tell me which part I'm miss. Below are my script:
'open E:\IMPORTANT\Desktop\Latest2\lp_nlev.uvw.ctl'
'avu=ave(u,t=1,t=7)'
'avv=ave(v,t=1,t=7)'
'avw=ave(w,t=1,t=7)'
'set map 1 1 10'
'set grads off'
'set grid off'
'set parea off'
*
'set lev 1000 50'
'set lon 60'
'set lat -60 30'
'set zlog on'
*
'set gxout vector'
'set arrscl 0.3 0.5'
'set arrlab on'
'set ccolor 1'
'd skip(avv,1.5,1.5);avw'
*
'draw title Composite of zonal mean Vwind & w anomalies & for LIP'
'draw ylab Pressure Level (hPa)'
'printim C:\Users\atiqah\Desktop\lp.uw.nlev.jpg white'
*
*
Details ctl.file:
dset E:\IMPORTANT\Desktop\Latest2\lp.uvw.nlev.dat
title Composited MMJ of u,v & w for HIP (average:lon=55-85)
undef -9.99e+33
xdef 1 linear 1 1
ydef 241 linear -90 0.75
zdef 13 levels 1000 925 800 700 600 500 400 300 200 100 50 10 1
tdef 7 linear 00Z01MAY1980 1yr
vars 3
u 13 99 Zonal Wind [m/s]
v 13 99 Meridional Wind [m/s]
w 13 99 Vertical Velocity [Pa/s]
endvars
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Dear Syairah Atiqah , can you share your script with us?
Thanks a lot
Michelle
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What are the benefits (if any) of processing NiTi (nitinol) through: laser powder Bed Fusion (LPBS) /Direct Metal laser Melting (DMLM) vs. Extrusion-paste-printing followed by Sintering where the powder is contained within a viscous organic binder?
Can any of these procedures be followed by a HIP process?
Thanks,
Gilad
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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.
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I am working with cartilages that are in contact on the hip. In order to obtain a contour plot of the contact pressure I performed a mesh sensitivity test by selecting linear tetrahedral elements (C3D4). Nevertheless, I was advised to use a finer mesh for visualizing von Mises stress.
After doing some reading, I came across the term "reduction integration scheme" which states that strain and stress in FE uses an integration point in the center of the element. Thus, since Contact Pressure is measured in nodes of elements, it makes sense to me to increase the density of the mesh to obtain better results.
Am I correct? or Is there another explanation for this?
Thanks!
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This document may help you to solve the problem:
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Wants the related research journals on correlations hip between remedial education and performance of physics.
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It's recommended to see this links
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How could I access to such a data?
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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:
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Incorporation of bone into the components of the non-cemented arthroplasty takes time, and it is difficult to know when the incorporation is sufficient enough to withstand full load.
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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
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Medical devices cover a wide range of products ranging from crutch to active pace-maker, via hip prothesis. Classification according to risk in Europe (class I, IIa, IIb or III) or in US allows to get as close as possible to the concept of high risk. But the high risk and these classes do not necessarily overlap completely, and some divergences appear on both sides of the Atlantic Ocean. Do you have any useful elements of high risk definition to facilitate the classification of new medical devices entering the market, all of which, in principle, require clinical investigation?
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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?
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Hi all, thanks for your help in advance.
I have several health measures relating to pain that are included in a study I am working on. In case it's important, they are the following:
· Numerical rating scale for back pain
· Inflammatory back pain questionnaire
· Oswestry Disability Index
· Non arthritic hip score (NAHS)
· Knee osteoarthritis outcome score (KOOS)
· Disability arm shoulder hand (DASH) questionnaire
As you can see, they mostly refer to pain that resides in specific areas of the body. I am only interested in if they experience pain in any of these areas, so would like to merge them all into a 'pain' variable, likely binary (0=no pain 1=pain).
Are there are recommendations or procedures for doing this? The process could range from the very simple (1=report of moderate pain in any questionnaire) to the more complex (a confirmatory factor analysis of all the questions in each of these questionnaires using a 2 (no pain or pain)/3 (no pain, some pain, extreme pain) model framework).
This will end up in a structural equation model exploring how variable1 affects variable 2. Pain is associated with both variable 1 and 2. There will be a large sample size (>1000) but also potentially a lot of variables, hence the attempt to reduce these pain questionaires down into a single variable.
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Trying to merge scores without being validated will make the credibility of your work questionable and the possibility to get your work publish unlikely.
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Background 
I am working on motion capture data analysis of human walking movement. My goal is to find the variation of markers on different body part in relation to the movement of the main body.
For that I am considering upper trunk body and lower trunk body. Upper trunk body include shoulder, chest and upper abdomen. Lower body includes waist , hip ,lower back and lower abdomen. 
I have markers placed in each body location. I want to create a marker that represents just the body movement and not the surface variations and joint variations so that it can be used as a surface to create reference variation. For that purpose, I am trying to create a kinematic model
Problem
How do I create my virtual point with respect to let's say 3 markers on the upper body? Which motion analysis software can give me this functionality to create some sort of kinematic model. 
- let's say create a vector with respect to a plane made by 3 markers and then create a point from the vector with respect to the plane created by the markers.
The attached picture represents my problem for some rough visualization. Here 2 upper green markers are used to create a vector in red which is used to create a green virtual marker.
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Nexus
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"Long-term outcome of surgical treatment of developmental dyplasia of the hip using the Dega and Salter method of pelvic osteotomy with simultaneous intratrochanteric femoral osteotomy"
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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 .
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Hi everybody
I'm using abaqus dynamic implicit solver to analyze hip joint. There is not problem like this with static step. but i have to use time depended loads. so when i use dynamic implicit; there are stresses only in force applied area but no stress or displacement in anywhere else. i also tried with dynamic explicit step and concentrated and pressure loads but the problem didnt solve.
i've used frictionless surface to surface contact and fixed a region far from load applied area. and material properties defined by mimics software.
i'll also add a photo and abaqus files fore details. thanks alot for your help.
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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.
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I'm trying to set up a fretting test that rembles the in-vivo hip implant contact pressure. This means that I need to know the input force that will push a sphere down on the substrate. To calculate this force from the contact pressure that I got from different research articles, I first simulated it in SolidWorks with the material properties of each body. This would result in the indentation depth in the surface. Is there a way to calculate the force that relates to that indentation depth? Or am I going in the wrong direction all together?
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Kindly go through the hardness testing methods and instruments this will solve your all problems
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Doing Hot isostatic pressing (HIP) after SLM is often considered as a best way to reduce the porosity and anisotropy. But in the most of the research papers, tests has been carried out on samples of cubic/ cuboid shape. Are there any papers available on studies HIP carried out on some complex AM components (one having internal channels , with thin sections etc.) ? Will this process have any significant effect in the dimension and shape?
Any leads will be helpful.
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Yes, it may degrade the intricacies of the object
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I would like to assess the pressure pain threshold in hip osteoarthritis and i cannot find reported sites of measurement as in knee osteoarthritis.
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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
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Most implant manufacturers now make 3D printed titanium sockets, available off-the-shelf, for hip replacement. This seems like a good idea, mechanically, because they can make the bone-facing backside very porous and make this surface part of the implant instead of a coating. However, they are few clinical outcomes published.
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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
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Hi all,
I am trying to populate a CATIA manikin with preferred angles and zones of comfort in order to run an ergonomics analysis. However, I am struggling to decipher zones of comfort for sitting posture angles, particularly the ankles and hips. I have come across literature on driving but in my case I have manikins doing upper body tasks only. From what I have read I can gather what the optimal sitting position is but have found no indications as to how to go about segmenting comfort zones past certain angular thresholds.
Has anyone any data, experience or references for this that you could point me too?
Thanks
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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?
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Greetings.
How do you aply Spotorno score when facing a hip arthroplasty revision with severe bone defect in proximal femur, how do you rate Singh index in thse cases in the decision process of employing a cemented or non cemented stem?
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I wanna investigate wear resistance of a part of some implant that need high wear resistance, but I don't khow which part has more need..
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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
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Congratulations for this excellent review, in line with the 2012 consensus initiative I participated in.
The question rises directly from your last sentence "...needs to be prioritized is the investigation of potential systemic risks due to accumulation of metal ions". Do you think that european health authorities are ready to wait for this answer to take definite decision about MoM (whatsoever the head size ?) market retrieval, according to the "precaution principle" that currently governs political deciders in the health field ? What is the trend in Germany thus far ? In France, MoM THA use decreased from 7% of the market at its top (2010) to only 2% in 2013 ...
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I agree with Dr Picardi, I do not think there is a future for the friction pair MoM
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hip replacement may be needed according to different cases such accident or terrorism attach or different diseases
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The patient wears a shoe that absorbs shock and avoids work that involves vibrations
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Evidence demonstrates the efficacy of preventive medication and non-medication measures in fractures due to osteoporosis in the hip.
But it is a fact that the cost and the low adherence of these preventive measures, can be a limiting factor of their results.
Is there room for surgical prophylaxis of hip osteoporosis fractures in patients with osteoporosis?
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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
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Hi,
I'm Atiqah student from the University of Malaya and has been working on the teleconnection between the Antarctic and Indian Monsoon.  As referring to some articles ( Prabhu et al, 2016 & Sun J et al, 2009) states that the connection between the polar and tropic is through the meridional wave train. So my question is could zonal wind pattern anomalies (Figure attached below) represent the wave activity that connecting polar and tropic? The figures show the reverse variation of zonal wind anomalous from the Antarctic until the India continent where its produce positive and negative anomalies from the polar to the tropic. Thus, due to the positive and negative anomaly I assume that as a wave train.
Really appreciate any suggestion and comment.
Note: The figure is a composite wind anomaly difference between HIP and LIP  at 700 hPa and 200 hPa. 
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Good question
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I would like to support why doing partner plyometric hip flexor exercise, e.g.: pushing your partner's straight legs down from 90 degrees and having them resist this motion eccentrically and pull their legs back up is likley to increase strain to the lumbar spine (because of the psoas origin) into hyperextension; especially if the abdominal muscles are not strong enough to maintain a neutral spine.
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Presently working in hip implants and the question is implant failure because of micro-moton between implant and body interface. what does that mean.?
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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.
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The data which shows the walking therapy progression or walking ability recovery throughout a rehabilitation therapy course; from therapy admission until recovery. For example data for weekly therapy over four months therapy duration/course. I am interested in hip/knee/ankle joints angle vs gait cycle or stride time data for each therapy session until end.
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Your best bet may be to mine this data from PDFs of published reviews on the topic.
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In the past, pelvis and proximal femur correction osteotomies were very often applied to ameliorate the biomechanics of dysplasic hips, not only in childhood, but also in adults. What is the nowadays trend ? Are these surgeries obsolete procedures today ?
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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.
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I need the co-ordinates of knee,ankle and hip as 2-dimensional gait data for inclined and declined walking. Winter's bio mechanics has a similar data, but it is for horizontal walking.
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hip replacement may be needed according to different cases such accident or terrorism attach or different diseases
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Thanks for your answer
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If hip damages severely by arthritis, a fracture, or other conditions, hip replacement is needed to relieve pain and increase motion.
Its more common in elderly , however the risk of problems after surgery increases because of their weaknesses and age . Most of them are forbidden from such aggressive treatment and implantation .
So whats solution ? can the risk of surgery be managed?
Or a substitute treatment is required ?
Is stem cell infusion as effective as surgery ?
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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.
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Femoral head and acetabular cup generally has ball-socket joint with conformal contact. Many research papers have taken either line contact or point contact (in reciprocating tribometer) and a few have taken surface contact to demonstrate tribological performance of Hip Implant materials.
Can anybody explain this?
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Thanks
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Role of ultrasound in developmental dysplasia of the infants hip (DDH) joint very informative and valuable before 6 months infants age.
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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
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A short femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Since
the life service of hip prosthesis is less than the longevity of young patient and they 'll need to revision total hip replacement , the short stem prosthesis is better for them.
But are there any another advantages for short stem over standard stem?
And whether do they cause the standard stem will be useless?
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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.
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Talking about acetabular revision in major bone defect. What do you think about acetabular cups that rely on iliac bone fixation like the McMinn stemmed cup or similar ?
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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.
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I have limited experience in nonunion treatment by autogenous bone marrow aspirates (ABMA)
I published 2009 an article on(tretment of  infected nonunion by autogenous Bone marrow aspirates in Yemen) in the egyptian journal of Orthopedic surgery.
there is a research work on bone marrow aspirates for treatment of bone defect.
bone marrow injection for treatment of aneurysmal bone cyst published in 2016.
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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.
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Other than contrast agents that can enhance the MRI image, what substance we can use to mark points during the bones are still in intact joint state and after the intact joint is opened we can identify the exact location in the articular cartilage of the hip bone before proceeding to other experimental steps.
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Dear Michelle, yes you are right with my question. Thank you for your honest response. Yes, need to try your suggestion some other time.
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He is known case of Ca prostate and recently sustained right sided hemiplegia.
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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.
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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
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Can you please suggest plan of management for 2 months old polytrauma in 18 year old morbidly obese lady, who sustained a complex pelvic # with bilateral feet drop? Should we try to salvage this hip with an attempt at ORIF or do a primary THR?
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We did post. and ant.fixation in the same sitting. post fixation was very difficult due to scarring.
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for example, if i want to examine the correlation between hamstring strength during tow different tasks and hamstring strength was normally distributed in one task but non normally distributed in the other task. what should i do in this case? should i use Spearman ?
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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
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Hello
I would like to test the hip flexors and extensors isometric strength in supine position using the Biodex System 4. These are my options:
1. Set the starting position at 45 degrees so I can test both muscle groups simultaneously. This may give me optimal performance of both muscle groups.
2. Test the hip flexors at 0 degrees and the hip extensors at 90 degrees of hip flexion as a starting position. 
Which position is best? If you have other suggestions kindly let me know.
Thank you
Mohamed
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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
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85yo woman. Dislocation occurred 6 months after revision alloplasty. The patient walked without pain before. Dislocation occurred without any improper movement. There are no radiological signs of loosening nor any laboratory test of inflammation. After quite easy repositioning we observed strong tendency to dislocation of the prosthesis in every move apart of abduction. Is the revision usually needed in such cases?
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Education is very important too. You could try a hip protector as outer stabilizer. 
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I wonder what is the experience of our colleagues with the use of Hip Protectors. These have emerged about ten years ago and provide a mechanical   protection to the vulnerable part of the hip bone. It is a simple device ( several models ) that absorbs part of the energy directed to the hip when falling. It atenuates the blow and may diminish the risk of fracture. 
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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.
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I have recently encountered a young man who developed transient osteoporosis of the talus , 4 months after having it in the hip.
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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.
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She is non alcoholic, non smoker and does not take steroids.
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Totally agree with the diagnosis. Even the MRI showed marrow edema epicentered in femoral neck region with some sparing of Subchondral head area
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Is one better than the other in improving hip ROM
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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.
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Total Hip arthroplasty: choice of approach,intra-operative tips and tricks, choice of implants etc
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 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.
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I am looking into whether a mathematical model of the hip joint exists to determine contact area to allow me to calculate hip joint stress. Models exist for the patellofemoral joint, is anyone aware of models that are available for the hip.
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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
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There are reports of BMD difference between right and left hip during ageing up to 6%, but is it actually reflected in hip fractures?
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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.
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Orthopedic surgeons in India are using both slow eccentric and rapid eccentric (isolytic) stretches in rehabilitation following hip and knee surgery (see attachment). I am interested to discover the mechanisms associated with these methods, particularly relating to intra -and inter- muscular connective tissue structures.
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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.
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Dear all,
I am running some test on human femoral heads using the hip simulator against different material cups to workout which material is the best, could you please tell me what is the best way to preserve the samples during the test, which serum works best? Most studies use bovine serum but I have real human samples and am not sure if I can use that. Also is it okay to run the samples for 1 million cycles (or more)? Is it necessary to adjust the environment temperature in order to avoid any damage to the samples? Wouldn't its properties change during the test? Are there any groups that work on human samples in hip simulators with different cup materials?
Many thanks in advance,
Maryam  
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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.
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A large lytic lesion in the proximal femur. Possible diagnosis and line of management please.
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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
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Hello everybody!
How can it be possible to feel no pain in a full-squat, but feel pain in the knee when deadlifting with a wider stance (Sumo-deadlift)? Is the pressure on the meniscus greater when greater abduction occurs in the hips?
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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.
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34 year male,history of closed fracture dislocation left hip 17 years back. now presented with pain left hip last 6 months ,limping since 15 years
on examination
left hip 30 degree FFD, further flexion upto 50
20 degree adduction deformity
rotations painful just jog of movt present
measurements left side 9 cm apparent shortening
4 cm true shortening ,which is supra trochanteric
these are the x rays n CT scan
2nd x ray is taken after squarring pelvis
plz discuss regarding the management options
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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
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Does anyone have experience in treatment of hip luxation in konradi syndrome?
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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
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I just want to know that how much quantity of Nacl mixed with 1lit distilled water for corrosion test of Co-Cr-Mo alloy.
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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 ..
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In the last 10-15 years there is a certain trend to the appliaction of this type of hip replacement. In any case, I do not know if the long-term results are satisfactory. In the past, some 30-40 years age the Wagner cup has been very popular but the long- term results have not been  satisfactory. What is the situation today based on your personal experience with resurfacing hip arthroplasty ?
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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
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We want to change from grid to air gap-technique, to hopefully reduce dose and maintain, or even increase, image quality.
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yes please, that would be great :D
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I am doing research in computational orthopedic biomechanics.
I am trying to develop new design concept for actabular cup precisely used in dysplasia by using alloys. For this I require commercially available implant geometry for my research purpose only. I tried to extract it from publications/patents but failed to get exact information.
Please help to how to get this geometry/drawing from implant manufacturing companies.
Send mail to at least 50 companies through enquiry by their official websites. But no response form manufacturer side.
Help Me
Thanks
Nishant
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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!!!
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I am interested in what methods clinicians use to verify that successful reduction of hip dislocation has occurred, specifically during harness or abduction splintage of children with developmental dysplasia of the hip.
Do you rely on ultrasound verification of reduction during treatment and if so by which ultrasound technique.
Or do you rely on ultrasound or xray verification that reduction has occurred after completion of treatment.
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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.  
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It's also a very tricky scenario when deal with a moderate deficient acetabulum as for choosing the proper bone coverage and abduction of the cup in THA., in case of avoiding bone graf,  does anyone have a practical technique and surgic philosophy in this aspect to share with me?
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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.
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This is a very rare case, but it happens sometimes. What procedure do you propose?
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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   
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I am particularly interested in the range of motion of knee, hip and foot. The purpose is to have an easy way to find potential exercises for a dynamic RSA(x-ray) study.
To specify, I need the actual motion coordinates, or at least motion ranges, of e.g. the knee during squat, step-up etc.
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Dear Christian This book describes the entire physiology of joint movements , with plans and vectors.
Enjoy
Kapandji. The Physiology of the Joints
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I want to analyze a hip implant in Ansys 14. so i want to know which type of element i should use to support torque and bending moments besides i cant use this software help very well. furthermore where can i enter yield and ultimate strength? 
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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.
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I am an arthroplasty surgeon with a lot of revision reconstruction and complex hip surgery under my belt and I have done a few of DDH in my career achieving lengthening of 4-5cm. After my first complication following a Crowe IV hip in a patient of short stature (sciatic nerve palsy), I am questioning if the given "safe" length is just a number or if this has to follow a 'relative to the height of the patient' equation. As mentioned the present patient is of short stature and all my previous experiences were on taller patients. Anybody with any knowledge to this specific problem?
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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.  
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I'm looking in especially for a review with emphasis on the prevalence of hip injuries in dancers. Are hip-hop dancers at risk?
Thanks for the help
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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.
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Manufacturer information form Heraeus does not recommend this, yet a number of surgeons in the hospital inform us that this is common practice.
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No, not come across such practise