Hip joint moments in symptomatic vs. asymptomatic people with mild radiographic hip osteoarthritis

Our primary objective was to examine external hip joint moments during walking in people with mild radiographic hip osteoarthritis (OA) with and without symptoms and disease-free controls. Three groups were compared (symptomatic with mild radiographic hip OA, n = 12; asymptomatic with mild radiographic hip OA, n = 13; OA-free controls, n = 20). Measures of the external moment (peak and impulse) in the sagittal, frontal and transverse plane during walking were determined. Variables were compared according to group allocation using mixed linear regression models that included individual gait trials, with group allocation as fixed effect and walking speed as a random effect. Participants with evidence of radiographic disease irrespective of symptoms walked 14–16% slower compared to disease-free controls (p = 0.002). Radiographic disease without symptoms was not associated with any altered measures of hip joint moment compared to asymptomatic OA-free controls once speed was taken into account (p ≥ 0.099). People with both mild radiographic disease and symptoms had lower external peak hip adduction moment (p = 0.005) and lower external peak internal rotation moment (p < 0.001) accounting for walking speed. Among angular impulses, only the presence of symptoms was associated with a reduced hip internal rotation impulse (p = 0.002) in the symptomatic group. Collectively, our observations suggest that symptoms have additional mechanical associations from radiographic disease alone, and provide insight into potential early markers of hip OA. Future research is required to understand the implications of modifying walking speed and/or the external hip adduction and internal rotation moment in people with mild hip OA.     

Sex determination of fetal and neonate skeletons by means of discriminant analysis

Facing the requirements of refined paleodemographical analyses, the access to the early ontogenetic sex ratio of skeletal populations is an important feature. Using raw data provided byFazekas & Kosa (1978) for a sample of known sex, discriminant functions are derived from hip and thigh bone dimensions that allow an almost unbiased classification of more than 70% of fetal and neonate individuals.     

Power and work produced in different leg muscle groups when rising from a chair

The aim of this study was to determine the power output and work done by different muscle groups at the hip and knee joints during a rising movement, to be able to tell the degree of activation of the muscle groups and the relationship between concentric and eccentric work. Nine healthy male subjects rose from a chair with the seat at knee level. The moments of force about the hip and knee joints were calculated semidynamically. The power output (P) and work in the different muscle groups surrounding the joints was calculated as moment of force times joint angular velocity. Work was calculated as: work = f Pdt. The mean peak concentric power output was for the hip extensors 49.9 W, hip flexors 7.9 W and knee extensor 89.5 W. This power output corresponded to a net concentric work of 20.7 J, 1.0 J and 55.6 J, respectively. There was no concentric power output from the knee flexor muscles. Energy absorption through eccentric muscle action was produced by the hip extensors and hip flexors with a mean peak power output of 4.8 W and 7.4 W, respectively. It was concluded that during rising, the hip and knee muscles mainly worked concentrically and that the greatest power output and work were produced during concentric contraction of the knee and hip extensor muscles. There was however also a demand for eccentric work by the hip extensors as well as both concentric and eccentric work by the hip flexors. The knee flexor muscles were unloaded.     

Higher medially-directed joint reaction forces are a characteristic of dysplastic hips: A comparative study using subject-specific musculoskeletal models

Acetabular dysplasia is a known cause of hip osteoarthritis. In addition to abnormal anatomy, changes in kinematics, joint reaction forces (JRFs), and muscle forces could cause tissue damage to the cartilage and labrum, and may contribute to pain and fatigue. The objective of this study was to compare lower extremity joint angles, moments, hip JRFs and muscle forces during gait between patients with symptomatic acetabular dysplasia and healthy controls. Marker trajectories and ground reaction forces were measured in 10 dysplasia patients and 10 typically developing control subjects. A musculoskeletal model was scaled in OpenSim to each subject and subject-specific hip joint centers were determined using reconstructions from CT images. Joint kinematics and moments were calculated using inverse kinematics and inverse dynamics, respectively. Muscle forces and hip JRFs were estimated with static optimization. Inter-group differences were tested for statistical significance (p ≤ 0.05) and large effect sizes (d ≥ 0.8). Results demonstrated that dysplasia patients had higher medially directed JRFs. Joint angles and moments were mostly similar between the groups, but large inter-group effect sizes suggested some restriction in range of motion by patients at the hip and ankle. Higher medially-directed JRFs and inter-group differences in hip muscle forces likely stem from lateralization of the hip joint center in dysplastic patients. Joint force differences, combined with reductions in range of motion at the hip and ankle may also indicate compensatory strategies by patients with dysplasia to maintain joint stability.     

CAT & MAUS: A novel system for true dynamic motion measurement of underlying bony structures with compensation for soft tissue movement

Optoelectronic motion capture systems are widely employed to measure the movement of human joints. However, there can be a significant discrepancy between the data obtained by a motion capture system (MCS) and the actual movement of underlying bony structures, which is attributed to soft tissue artefact. In this paper, a computer-aided tracking and motion analysis with ultrasound (CAT & MAUS) system with an augmented globally optimal registration algorithm is presented to dynamically track the underlying bony structure during movement. The augmented registration part of CAT & MAUS was validated with a high system accuracy of 80%. The Euclidean distance between the marker-based bony landmark and the bony landmark tracked by CAT & MAUS was calculated to quantify the measurement error of an MCS caused by soft tissue artefact during movement. The average Euclidean distance between the target bony landmark measured by each of the CAT & MAUS system and the MCS alone varied from 8.32 mm to 16.87 mm in gait. This indicates the discrepancy between the MCS measured bony landmark and the actual underlying bony landmark. Moreover, Procrustes analysis was applied to demonstrate that CAT & MAUS reduces the deformation of the body segment shape modeled by markers during motion. The augmented CAT & MAUS system shows its potential to dynamically detect and locate actual underlying bony landmarks, which reduces the MCS measurement error caused by soft tissue artefact during movement.     

Lower limb kinematics in individuals with chronic low back pain during walking

Several investigators have suggested the presence of a link between Chronic Low Back Pain (CLBP) and lower limbs kinematics that can contribute to functional limitations and disability. Moreover, CLBP has been connected to postural and structural asymmetry. Understanding the movement pattern of lower extremities and its asymmetry during walking can provide a basis for examination and rehabilitation in people with CLBP. The present study focuses on lower limbs kinematics in individuals with CLBP during walking. Three-dimensional movements of the pelvic, hip, knee and ankle joints were tracked using a seven-camera Qualysis motion capture system. Functional dada analysis (FDA) was applied for the statistical analysis of pelvic and lower limbs motion patterns in 40 participants (20 CLBP and 20 controls). The CLBP group showed significantly different hip motion pattern in the transvers plane, altered knee and ankle motion pattern in the sagittal plane on the dominant side and different hip motion pattern in the transvers and frontal planes on the non-dominant side in comparison with the control group over the stance phase. In terms of symmetry, in the CLBP group, hip and knee moved through a significantly different motion patterns in the transvers plane on the dominant side in comparison with the non-dominant side. In the control group, knee moved through a significantly different motion pattern in the transvers plane on the dominant side in comparison with the non-dominant side. In conclusion, low back pain lead to altered movement patterns of the main joints of lower limbs especially on the dominant side during stance phase. Therefore, care should be taken to examine dominant lower limb movement pattern in CLBP to make a better clinical decision.     

切开与闭合复位空心钉内固定对移位股骨颈骨折患者骨折复位质量和髋关节功能的影响

摘要 目的：探讨切开与闭合复位空心钉内固定对移位股骨颈骨折患者骨折复位质量和髋关节功能的影响。方法：本研究为回顾性研究,选取98例移位股骨颈骨折患者的临床资料,根据手术方式的不同将患者分为A组（n=50,切开复位）和B组（n=48,闭合复位）,比较两组患者优良率、骨折复位质量、髋关节功能、围术期指标、术后并发症发生率和二次手术发生率。结果：A组患者术后6个月的优良率为78.00%（39/50）,高于B组的58.33%（28/48）（P<0.05）。两组术后负重下地时间、术中透视时间比较无差异（P>0.05）;B组手术时间、住院时间短于A组,术中出血量少于A组（P<0.05）。两组患者术后1个月、术后3个月、术后6个月髋关节功能Harris评分均较术前升高,且A组高于B组（P<0.05）。两组二次手术及并发症发生率比较无差异（P>0.05）。A组Ⅰ型、Ⅱ型的例数均多于B组,Ⅲ型例数少于B组（P<0.05）。结论：与闭合复位空心钉内固定相比,切开复位空心钉内固定虽损伤较大,但其术后骨折复位质量和髋关节功能改善效果更佳,且不增加并发症发生率和二次手术发生率。     

Superimposing hip extension on knee flexion evokes higher activation in biceps femoris than knee flexion alone

Hamstring muscle function during knee flexion has been linked to hamstring injury and performance. However, it is unclear whether knee flexion alone (KF) requires similar hamstring electromyography (EMG) activity pattern to simultaneous hip extension and knee flexion (HE-KF), a combination that occurs in the late swing phase of sprinting. This study examined whether HE-KF maximal voluntary isometric contraction (MVIC) evokes higher (EMG) activity in biceps femoris long head (BFlh) and semitendinosus (ST) than KF alone. Effects of shank rotation angles were also tested. Twenty-one males performed the above-mentioned MVICs while EMG activity was measured along ST and BFlh. Conditions were compared using a one-way mixed functional ANOVA model under a fully Bayesian framework. Higher EMG activity was found in HE-KF in all shank rotation positions than in KF in the middle region of BFlh (highest in the 9th channel, by 0.022 mV [95%CrI 0.014 to 0.030] in neutral shank position). For ST, this was only observed in the neutral shank position and in the most proximal channel (by 0.013 mV [95%CrI 0.001 to 0.025]). We observed muscle- and region-specific responses to HE-KF. Future studies should examine whether hamstring activation in this task is related to injury risk and sprint performance.     

超声引导下硬膜外阻滞在老年髋关节置换手术中的应用

目的:探讨超声引导下硬膜外阻滞在老年髋关节置换手术中的应用方法与效果。方法:2017年6月至2020年5月选择在本院进行髋关节置换手术的老年患者112例,根据随机数字表法把患者分为研究组与对照组,各56例。研究组给予超声引导下硬膜外阻滞,对照组给予传统的静脉持续镇痛。两组都给予全麻诱导与维持,记录镇痛效果与患者术后康复情况。结果:两组的性别、年龄、麻醉时间、手术时间与术中出血量等对比差异无统计学意义(P>0.05),研究组的术后住院时间显著短于对照组(P<0.05)。两组术后1 d、3 d、7 d的疼痛视觉模拟评分法(Visual Analogue Scale/Score,VAS)评分都低于术前1 d,观察组也都显著低于对照组,对比差异都有统计学意义(P<0.05)。研究组术后1 d、3 d、7 d的髋关节活动度都显著高于对照组(P<0.05)。研究组术后1 d、3 d、7 d的血清P物质(Substance P,SP)、前列腺素E2(Prostaglandin E2,PGE2)含量都高于术前1 d,观察组低于对照组,对比差异都有统计学意义(P<0.05)。结论:超声引导下硬膜外阻滞在老年髋关节置换手术中的应用能抑制血清SP、PGE2的释放,能缓解患者术后疼痛,促进髋关节功能的恢复,缩短患者的康复时间。     

An anatomical subject-specific FE-model for hip fracture load prediction

In order to reduce the socio-economic burden induced by osteoporotic hip fractures, finite element models have been evaluated as an additional diagnostic tool for fracture prediction. For a future clinical application, the challenge is to reach the best compromise between model relevance and computing time. Based on this consideration, the current study focused on the development and validation of a subject-specific FE-model using an original parameterised generic model and a specific personalization method. A total of 39 human femurs were tested to failure under a quasi-static compression in stance configuration. The corresponding FE-models were generated and for each specimen the numerical fracture load (F _FEM) was compared with the experimental value (F _EXP), resulting in a significant correlation (F _EXP = 1.006 F _FEM with r ² = 0.87 and SEE = 1220 N, p < 0.05) obtained with a reasonable computing time (30 mn). Further in vivo study should confirm the ability of this FE-model to improve the fracture risk prediction.