The traction force of the pulled limb in hip arthroscopic surgery is determined by stiffness coefficient which is significantly related to muscle volume

Yin, Yu; Xue, Shilin; Zhang, Xin; Yang, Gang; Xu, Yan; Wang, Jianquan; Huang, Hongjie

doi:10.1007/s00167-022-07261-3

Cited by 2 publications

(1 citation statement)

References 24 publications

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“…Recent research has identified a positive correlation between traction forces and factors such as body weight and the presence of hip osteoarthritis [31]. However, Yin at el suggests lower extremity muscle volume is a greater indicator of higher traction forces than BMI [43]. Thus, these patient factors must be considered when determining risk for patients with prior TKAs.…”

Section: Discussionmentioning

confidence: 99%

Soft Tissue Mechanics in Hip Distraction after Total Knee Arthroplasty: A Finite Element Analysis

Soehnlen,

Sadeqi,

Kumaran

et al. 2024

Preprint

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INTRODUCTION: Improvement in diagnostic and surgical techniques in hip arthroscopy have led to a surge in hip distraction procedures over the recent years with the predicted annual frequency being four out of every 10,000 orthopedic procedures in 2017. Due to the large traction force required to achieve the appropriate joint spacing intra-operatively, an emergence of traction-related neurological and soft tissue injuries have surfaced. Pre-existing hip joint pathologies and surgical procedures disrupt the biomechanical stability of the joint and significantly increase the risk of iatrogenic damage. Furthermore, patients with total knee arthroplasties are often subject to intra-articular ligament releases, leading to reduced stability; however, it is not well understood how this may impact their outcomes of hip arthroscopic procedures. The current study aims to investigate the biomechanical behavior of various instrumented knee joints subjected to traction forces to aid clinical understanding and advancements of hip arthroscopy techniques. METHODS: A validated finite element (FE) model of the pelvis and lower extremity was developed from computed tomography (CT) scans of a healthy 45-year-old female. Three different models were assembled according to different TKA techniques performed: Bi-Cruciate Retaining (BCR) model, Posterior-Cruciate Retaining (PCR) model, and Posterior Stabilized (PS) model. The BCR model is noted by retaining all native ligaments of the knee joint (ACL, PCL, MCL, and LCL), whereas the PCR model was subject to ACL removal and the PS model required ACL and PCL removal (Figure 1). The pelvis was encastered to prevent translation under the traction forces as motion of the patients trunk is restrained, intraoperatively. To simulate the loading condition of hip distraction, an axial force was coupled to the distal fibula and tibia and incrementally increased from 100N to 500N. Joint spacing and ligament strain in the hip and knee joint were analyzed to assess the effects of traction forces. RESULTS: The medial and lateral compartment stiffness of the knee joint was analyzed under hip distraction for the three different TKA scenarios. The BCR model displayed the greatest average knee complex stiffness. Release of the ACL resulted in a larger decrease of stiffness compared to release of the PCL. There was no change in forces required for hip distraction as result of changes in the knee joint stiffness (Figure 3). The PCR and PS models were subject to excess knee joint distraction that exceeded 12 mm and ligament strain greater than 20% before adequate hip joint distraction of 10 mm was achieved. The BCR model remained below 10 mm of knee distraction and 15% ligament strain at 10 mm of hip joint distraction. DISCUSSION: Our study reveals patients undergoing hip distraction with a prior TKA may experience increased soft tissue damage or iatrogenic dislocation due to reduced knee joint stability. The PCR and PS models outline a trend suggesting patients who have undergone ligament sacrificing TKAs experience large reductions in knee joint stability, causing strain levels that are indicative of soft tissue injury. The BCR TKA was indicated to be the safest under the distraction conditions as joint spacing and strain levels were largely reduced comparatively; however, when surpassing 10 mm of knee joint distraction at forces greater than 350 N, the strain levels in the ACL suggest minor injury may occur.

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Section: Discussionmentioning

confidence: 99%

Soft Tissue Mechanics in Hip Distraction after Total Knee Arthroplasty: A Finite Element Analysis

Soehnlen,

Sadeqi,

Kumaran

et al. 2024

Preprint

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Hip Rotation and Femoral Anteversion and Its Influence on Traction Force of the Pulled Limb in Hip Arthroscopy

Gao,

Liu,

Duan

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Several variables may affect the traction force during hip arthroscopy. Specifically, the degree of hip joint rotation may influence the magnitude of traction force during hip arthroscopy. However, there is currently limited research available on this particular issue. Purpose: To quantify the traction force applied to the pulled limb in various traction states and rotational positions. Additionally, the study aimed to investigate potential correlations between femoral anteversion, BMI, anesthesia methods, and the traction force required for hip dislocation. Hypothesis: It was hypothesized that traction force in different traction states and rotational positions would be different and that femoral anteversion, body mass index (BMI), and anesthesia methods may influence the traction force needed. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Patients who attended the sports medicine clinic of our department and underwent arthroscopic surgery for the diagnosis of femoroacetabular impingement between June and December 2022 were retrospectively evaluated. The traction force at the following 6 key timepoints was measured—initial traction, traction to the operable width, after joint puncture, after capsulotomy, at 20 minutes after capsulotomy, and at 40 minutes after capsulotomy. In each state, the hip was rotated to the internal rotational position, external rotational position, and neutral position. The traction force at different states and positions was recorded and analyzed. The differences in traction force between the different joint capsular physical states and rotational positions were tested by analysis of variance and the Tukey method. The Pearson test was used to analyze the correlation between BMI and femoral anteversion in different groups. Results: A total of 41 patients were included in this study. The traction force increased after reaching the operable width and decreased significantly after capsulotomy ( P < .05). Thereafter, the traction force decreased gradually over time ( P < .05). Traction force in the external and internal rotational positions was significantly greater than that in the neutral position, across all states of traction ( P < .05). Furthermore, the difference in traction force between the internal and neutral positions, as well as the difference in traction force between the external and neutral positions, was found to be significantly greater than the difference in traction force between the internal and external rotational positions in all traction states ( P < .05). The difference between the traction forces in different rotational positions of the hip joint exhibited a negative correlation with femoral anteversion (Pearson correlation coefficient of neutral-internal in states 3, 4, and 5 was –0.33, –0.31, –0.31, respectively; P < .05) and a positive correlation with BMI (Pearson correlation coefficient of external-neutral in states 4 and 6 was 0.33 and 0.36, respectively; P < .05). Conclusion: Our findings show that the traction force decreased after joint puncture and capsulotomy and decreased over time during surgery. External or internal rotation increased the traction force. Patients with higher femoral anteversion or lower BMI may need lower traction force. These data may help in minimizing traction forces to help prevent complications due to traction during hip arthroscopy.

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The traction force of the pulled limb in hip arthroscopic surgery is determined by stiffness coefficient which is significantly related to muscle volume

Cited by 2 publications

References 24 publications

Soft Tissue Mechanics in Hip Distraction after Total Knee Arthroplasty: A Finite Element Analysis

Soft Tissue Mechanics in Hip Distraction after Total Knee Arthroplasty: A Finite Element Analysis

Hip Rotation and Femoral Anteversion and Its Influence on Traction Force of the Pulled Limb in Hip Arthroscopy

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