How Does Chondrolabral Damage and Labral Repair Influence the Mechanics of the Hip in the Setting of Cam Morphology? A Finite-Element Modeling Study.
Ontology highlight
ABSTRACT:
SUBMITTER: Todd JN
PROVIDER: S-EPMC8846280 | biostudies-literature | 2022 Mar
REPOSITORIES: biostudies-literature
Publications
How Does Chondrolabral Damage and Labral Repair Influence the Mechanics of the Hip in the Setting of Cam Morphology? A Finite-Element Modeling Study.
Todd Jocelyn N JN Maak Travis G TG Anderson Andrew E AE Ateshian Gerard A GA Weiss Jeffrey A JA
Clinical orthopaedics and related research 20220301 3
<h4>Background</h4>Individuals with cam morphology are prone to chondrolabral injuries that may progress to osteoarthritis. The mechanical factors responsible for the initiation and progression of chondrolabral injuries in these individuals are not well understood. Additionally, although labral repair is commonly performed during surgical correction of cam morphology, the isolated mechanical effect of labral repair on the labrum and surrounding cartilage is unknown.<h4>Question/purposes</h4>Usin ...[more]
Similar Datasets
Project description:Using a validated finite element (FE) protocol, we quantified cartilage and labrum mechanics, congruency, and femoral coverage in five male patients before and after they were treated for acetabular retroversion with peri-acetabular osteotomy (PAO). Three-dimensional models of bone, cartilage, and labrum were generated from computed tomography (CT) arthrography images, acquired before and after PAO. Walking, stair-ascent, stair-descent, and rising from a chair were simulated. Cartilage and labrum contact stress, contact area, and femoral coverage were calculated overall and regionally. Mean congruency (average of local congruency values for FE nodes in contact) and peak congruency (most incongruent node in contact) were calculated overall and regionally. Load supported by the labrum was represented as a raw change in the ratio of the applied force transferred through the labrum and percent change following surgery (calculated overall only). Considering all activities, following PAO, mean acetabular cartilage contact stress increased medially, superiorly, and posteriorly; peak stress increased medially and posteriorly. Peak labrum stresses decreased overall and superiorly. Acetabular contact area decreased overall and laterally, and increased medially. Labral contact area decreased overall, but not regionally. Load to the labrum decreased. Femoral head coverage increased overall, anterolaterally, and posterolaterally, but decreased anteromedially. Mean congruency indicated the hip became less congruent overall, anteriorly, and posteriorly; peak congruency indicated a less congruent joint posteriorly.Clinical relevanceMedialization of contact and reductions in labral loading following PAO may prevent osteoarthritis, but this procedure increases cartilage stresses, decreases contact area, and makes the hip less congruent, which may overload cartilage. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2567-2576, 2017.
| S-EPMC5623608 | biostudies-literature
Project description:BackgroundThe cam deformity causes the anterosuperior femoral head to obstruct with the acetabulum, resulting in femoroacetabular impingement (FAI) and elevated risks of early osteoarthritis. Several finite element models have simulated adverse loading conditions due to cam FAI, to better understand the relationship between mechanical stresses and cartilage degeneration. Our purpose was to conduct a systematic review and examine the previous finite element models and simulations that examined hip joint stresses due to cam FAI.MethodsThe systematic review was conducted to identify those finite element studies of cam-type FAI. The review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and studies that reported hip joint contact pressures or stresses were included in the quantitative synthesis.ResultsNine articles studied FAI morphologies using finite element methods and were included in the qualitative synthesis. Four articles specifically examined contact pressures and stresses due to cam FAI and were included in the quantitative synthesis. The studies demonstrated that cam FAI resulted in substantially elevated contact pressures (median = 10.4 MPa, range = 8.5-12.2 MPa) and von Mises stresses (median 15.5 MPa, range = 15.0-16.0 MPa) at the acetabular cartilage; and elevated maximum-shear stress on the bone (median = 15.2 MPa, range = 14.3-16.0 MPa), in comparison with control hips, during large amplitudes of hip motions. Many studies implemented or adapted idealized, ball-and-cup, parametric models to predict stresses, along with homogeneous bone material properties and in vivo instrumented prostheses loading data.ConclusionThe formulation of a robust subject-specific FE model, to delineate the pathomechanisms of FAI, remains an ongoing challenge. The available literature provides clear insight into the estimated stresses due to the cam deformity and provides an assessment of its risks leading to early joint degeneration.
| S-EPMC4727804 | biostudies-literature
Project description:In the setting of femoroacetabular impingement, the acetabular labrum may be torn or pathologic, and it must be surgically repaired to restore the native suction seal and hip function. However, the current methods of arthroscopic suture passage commonly result in some degree of disruption of the chondrolabral junction, with penetration and shuttling of the repair sutures. Novel instrumentation and surgical techniques have aimed to repair the acetabular labrum with decreased violation of the intrasubstance fibers to provide anatomic eversion/inversion of the labrum to restore the suction seal. In this Technical Note, we describe a method of suture passage through the use of a self-grasping suture-passing device that allows for anatomic labral repair while maintaining the chondrolabral junction as well as minimizing iatrogenic damage the labrum intrasubstance fibers.
| S-EPMC7528393 | biostudies-literature
Project description:Persistent pain after hip arthroscopy may be due to residual impingement, hip dysplasia, osteoarthritis progression, labral injury, or insufficient capsular closure. A patient's history, physical examination findings, and imaging studies should be used to determine whether revision hip arthroscopy is indicated. If surgical management is chosen, careful preoperative planning is essential. During revision hip arthroscopy, the presence and location of adhesions should be considered during interportal capsulotomy and T-capsulotomy creation and while applying traction sutures. The presence of a residual cam or pincer lesion and the adequacy of the labrum or labral graft should be assessed and properly addressed. If capsular redundancy is recognized, capsular plication may be performed. The purpose of this Technical Note is to describe an approach to revision hip arthroscopy for labral repair and residual cam lesion resection.
| S-EPMC8821039 | biostudies-literature
Project description:BackgroundArthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied.PurposeTo (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture).Study designCohort study; Level of evidence, 3.MethodsThis retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion.ResultsIn this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ (P < .001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators (P < .001 for all).ConclusionAlthough most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors.
| S-EPMC10986152 | biostudies-literature
Project description:Osteoarthritis of the hip can result from mechanical factors, which can be studied using finite element (FE) analysis. FE studies of the hip often assume there is no significant loss of fluid pressurization in the articular cartilage during simulated activities and approximate the material as incompressible and elastic. This study examined the conditions under which interstitial fluid load support remains sustained during physiological motions, as well as the role of the labrum in maintaining fluid load support and the effect of its presence on the solid phase of the surrounding cartilage. We found that dynamic motions of gait and squatting maintained consistent fluid load support between cycles, while static single-leg stance experienced slight fluid depressurization with significant reduction of solid phase stress and strain. Presence of the labrum did not significantly influence fluid load support within the articular cartilage, but prevented deformation at the cartilage edge, leading to lower stress and strain conditions in the cartilage. A morphologically accurate representation of collagen fibril orientation through the thickness of the articular cartilage was not necessary to predict fluid load support. However, comparison with simplified fibril reinforcement underscored the physiological importance. The results of this study demonstrate that an elastic incompressible material approximation is reasonable for modeling a limited number of cyclic motions of gait and squatting without significant loss of accuracy, but is not appropriate for static motions or numerous repeated motions. Additionally, effects seen from removal of the labrum motivate evaluation of labral reattachment strategies in the context of labral repair.
| S-EPMC5815394 | biostudies-literature
Project description:Some early failures of metal-on-metal (MoM) hip replacements associated with elevated wear have caused concerns for the use of this bearing combination. Simulator studies have shown that microseparation and its associated rim contact and edge loading may produce the most severe wear in MoM bearings. It is generally recognized that this high wear can be attributed to the high contact stress of the head on the rim of the cup. In this study, an improved finite element contact model that incorporates an elastic-perfectly plastic material property for cobalt-chrome alloy of the metal bearing was developed in an attempt to provide an accurate prediction of the stress and strain for the rim contact. The effects of the microseparation displacement (0.1-2 mm), cup inclination angle (25-65°) and cup rim radius (0.5-4 mm) on the contact stress/strain were investigated. The results show that a translational displacement >0.1 mm under a load >0.5 kN can produce a highly concentrated contact stress at the surface of the cup rim which can lead to plastic deformation. This study also suggests that the magnitude of translational displacement was the major factor that determined the severity of the contact conditions and level of stress and strain under microseparation conditions. Future studies will address the effect of surgical translational and rotational malposition and component design on the magnitude of microseparation, contact stress and strain and severity of wear.
| S-EPMC4737106 | biostudies-other
Project description:It is difficult to study the breakdown of disc tissue over several years of exposure to bending and lifting by experimental methods. There is also no finite element model that elucidates the failure mechanism due to repetitive loading of the lumbar motion segment. The aim of this study was to refine an already validated poro-elastic finite element model of lumbar motion segment to investigate the initiation and progression of mechanical damage in the disc under simple and complex cyclic loading conditions. Continuum damage mechanics methodology was incorporated into the finite element model to track the damage accumulation in the annulus in response to the repetitive loading. The analyses showed that the damage initiated at the posterior inner annulus adjacent to the endplates and propagated outwards towards its periphery under all loading conditions simulated. The damage accumulated preferentially in the posterior region of the annulus. The analyses also showed that the disc failure is unlikely to happen with repetitive bending in the absence of compressive load. Compressive cyclic loading with low peak load magnitude also did not create the failure of the disc. The finite element model results were consistent with the experimental and clinical observations in terms of the region of failure, magnitude of applied loads and the number of load cycles survived.
| S-EPMC3787695 | biostudies-literature
Project description:Coxa profunda presents a unique challenge in surgical treatment approach given global acetabular overcoverage. Arthroscopic treatment can be fraught with difficulty obtaining hip distraction for safe arthroscopic instrumentation, and limited arthroscopic access may prevent sufficient osseous resection of the excess acetabular rim. Although hip arthroscopy use has increased markedly over the past decades for all types of hip pathology, coxa profunda may represent one unique indication for surgical hip dislocation. This technique describes open surgical hip dislocation, rim resection, femoral osteoplasty, and labral reconstruction using anterior tibialis allograft for coxa profunda with combined-type femoroacetabular impingement syndrome and labral ossification.
| S-EPMC9437615 | biostudies-literature
Project description:Traditional techniques for acetabular osteoplasty in femoral acetabular impingement have required surgical detachment of the labrum at the chondrolabral junction. Such approaches compromise labral blood flow and contribute to a limited ability for healing at the chondrolabral junction. In this technical note and accompanying video, we present a technique for preservation of the chondrolabral junction during labral repair and acetabular osteoplasty. We elevate the chondrolabral complex subperiosteally off the acetabular rim, and the acetabular shelf is then contoured under fluoroscopic guidance. The labrum is then repaired and reconstituted to a new anatomic footprint. We find this technique to be advantageous because it preserves the blood flow to the labrum, thereby maximizing healing potential. Outcome studies are warranted to further elucidate the functional and outcome benefits of this surgical technique.
| S-EPMC3834728 | biostudies-literature