Mechanical strength of repairs of the hip piriformis tendon

Robinson, Patrick G; Placide, Rick; Soslowsky, Louis J.; Born, Christopher T.

doi:10.1016/j.arth.2003.08.011

Cited by 11 publications

(8 citation statements)

References 29 publications

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“…In such case, the quality of the reinsertion is conditioned by the bone quality [10]. White reports a rate of 0.9% of trochanteric fracture-avulsion with a satisfactory rate of dislocation (0.7%) [8].…”

Section: Discussionmentioning

confidence: 97%

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Capsular closure and piriformis preservation to prevent dislocation after total hip arthroplasty through the minimal posterior approach. Comparative series of 196 patients

Prigent¹

2006

Interact Surg

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Purpose of the study: This study analyzes the incidence on hip dislocation of a posterior minimally invasive approach that combines the suture of the capsular joint and the preservation of the piriformis muscle.Material and methods: A first prospective series of 98 patients having undergone hip prosthesis by a posterior minimally invasive approach that combines piriformis preservation and capsular closure is analyzed regarding 7 criteria: age, weight, duration of the intervention, piriformis integrity and quality of the capsular closure at the end of the intervention, radiological position of the implants, and rate of dislocation at M12. This series is compared to another consecutive series of 98 hip prostheses performed by the same operator, by posterior access, consisting in capsular resection and cutting of the piriformis reinserted on the trochanter.Results: The two series were identical regarding patients' age and weight. The minimally invasive surgery lasted 20 minutes more than the other intervention. In both interventions, no effect was observed on the radiological position of the implants. The rate of hip dislocation after twelve months was significantly improved by the capsular closure combined with piriformis preservation (2.9% vs 0%).Discussion: The restoration of the capsular plane has been the subject of numerous works. The techniques described had some variants, with a related rate of dislocation less than 1%.Piriformis preservation participates in the joint coaptation. This muscle is stretched out during the first step of the dislocating movement.The presented series highlights the benefit of combining a capsular flap truly suturable and the preservation of the piriformis muscle aimed at creating a ''hammock'', passive and active at the same time, at the upper posterior part of the joint, a strategic area with a high related risk of dislocation.

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Section: Discussionmentioning

confidence: 97%

“…It is a postural muscle, fatigue-resistant and containing a great quantity of slow muscular fibres (56%) [10].…”

Section: Discussionmentioning

confidence: 99%

Capsular closure and piriformis preservation to prevent dislocation after total hip arthroplasty through the minimal posterior approach. Comparative series of 196 patients

Prigent¹

2006

Interact Surg

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“…It is reported that repair of the piriformis with the other short rotators and the capsule after posterior approach for THR reduces post-operative rates of dislocation by approximately 50%, 2,19-22 even though a significant proportion of these repairs may fail. 1,[23][24][25] Whether the reduction in the incidence of dislocation is due to mechanical restraint or proprioception is unclear. It has also been calculated that at 90° of hip flexion piriformis acts as an internal rotator of the hip, 19,26 but in this position the role of piriformis as a restraint to medial rotation is lost.…”

Section: Discussionmentioning

confidence: 99%

The surgical anatomy of the piriformis tendon, with particular reference to total hip replacement

Roche

Jones

Khan

et al. 2013

The Bone & Joint Journal

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The piriformis muscle is an important landmark in the surgical anatomy of the hip, particularly the posterior approach for total hip replacement (THR). Standard orthopaedic teaching dictates that the tendon must be cut in to allow adequate access to the superior part of the acetabulum and the femoral medullary canal. However, in our experience a routine THR can be performed through a posterior approach without sacrificing this tendon. We dissected the proximal femora of 15 cadavers in order to clarify the morphological anatomy of the piriformis tendon. We confirmed that the tendon attaches on the crest of the greater trochanter, in a position superior to the trochanteric fossa, away from the entry point for broaching the intramedullary canal during THR. The tendon attachment site encompassed the summit and medial aspect of the greater trochanter as well as a variable attachment to the fibrous capsule of the hip joint. In addition we dissected seven cadavers resecting all posterior attachments except the piriformis muscle and tendon in order to study their relations to the hip joint, as the joint was flexed. At flexion of 90° the piriformis muscle lay directly posterior to the hip joint. The piriform fossa is a term used by orthopaedic surgeons to refer the trochanteric fossa and normally has no relation to the attachment site of the piriformis tendon. In hip flexion the piriformis lies directly behind the hip joint and might reasonably be considered to contribute to the stability of the joint. We conclude that the anatomy of the piriformis muscle is often inaccurately described in the current surgical literature and terms are used and interchanged inappropriately.

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“…It was assumed that the fracture surface was completely broken and in a contact state. The friction coefficient was 0.2 according to a previous study (7). The femur was subjected to numerous loads, including muscle force, joint force and dynamic impact force.…”

Section: Methodsmentioning

confidence: 99%

Characterization of novel intramedullary nailing method for treating femoral shaft fracture through finite element analysis

Cui¹,

Pan

et al. 2020

Exp Ther Med

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Femoral shaft fracture is one of the most common types of fracture encountered in the clinic. For certain complex femoral shaft fractures, the traditional intramedullary nail may not provide sufficient stability. Therefore, novel intramedullary nail systems are required. The femur 3D model and the internal fixation model were designed using Mimics 17.0 (Materialise), Geomagic Studio 2012 (Raindrop) and Solidwork 2016 (Dassault) software. The validity of the models was verified through comparison with previous data in silico. To further simulate the comminuted femoral shaft fracture, the novel and traditional type of intramedullary nail system were included in the finite element analysis with the software. The displacement and stress distribution of the two internal fixations were compared using Abaqus 6.14 (Dassault) software. The effectiveness of the model was verified. The stress at the fixed end of the novel intramedullary nail system was greater than that at the fixed end of the traditional intramedullary nail system. However, the displacement of the novel intramedullary nail method was smaller than that of the traditional intramedullary nail. The novel intramedullary nail system features good stability and stress stimulation at the broken end, which is beneficial for bone healing. The present study may provide a theoretical basis for the selection of a means of internal fixation in the clinic.

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Mechanical strength of repairs of the hip piriformis tendon

Cited by 11 publications

References 29 publications

Capsular closure and piriformis preservation to prevent dislocation after total hip arthroplasty through the minimal posterior approach. Comparative series of 196 patients

Capsular closure and piriformis preservation to prevent dislocation after total hip arthroplasty through the minimal posterior approach. Comparative series of 196 patients

The surgical anatomy of the piriformis tendon, with particular reference to total hip replacement

Characterization of novel intramedullary nailing method for treating femoral shaft fracture through finite element analysis

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