Background:The greater trochanter marker is commonly used in 3-dimensional(3D) models;however,its influence on hip and knee kinematics during gait is unclear.Understanding the influence of the greater trochanter marke...Background:The greater trochanter marker is commonly used in 3-dimensional(3D) models;however,its influence on hip and knee kinematics during gait is unclear.Understanding the influence of the greater trochanter marker is important when quantifying frontal and transverse plane hip and knee kinematics,parameters which are particularly relevant to investigate in individuals with conditions such as patellofemoral pain,knee osteoarthritis,anterior cruciate ligament(ACL) injury,and hip pain.The aim of this study was to evaluate the effect of including the greater trochanter in the construction of the thigh segment on hip and knee kinematics during gait.Methods:3D kinematics were collected in 19 healthy subjects during walking using a surface marker system.Hip and knee angles were compared across two thigh segment definitions(with and without greater trochanter) at two time points during stance:peak knee flexion(PKF) and minimum knee flexion(Min KF).Results:Hip and knee angles differed in magnitude and direction in the transverse plane at both time points.In the thigh model with the greater trochanter the hip was more externally rotated than in the thigh model without the greater trochanter(PKF:-9.34°± 5.21° vs.1.40°± 5.22°,Min KF:-5.68°± 4.24° vs.5.01°± 4.86°;p < 0.001).In the thigh model with the greater trochanter,the knee angle was more internally rotated compared to the knee angle calculated using the thigh definition without the greater trochanter(PKF:14.67°± 6.78° vs.4.33°± 4.18°,Min KF:10.54°± 6.71° vs.-0.01°± 2.69°;p < 0.001).Small but significant differences were detected in the sagittal and frontal plane angles at both time points(p < 0.001).Conclusion:Hip and knee kinematics differed across different segment definitions including or excluding the greater trochanter marker,especially in the transverse plane.Therefore when considering whether to include the greater trochanter in the thigh segment model when using a surface markers to calculate 3D kinematics for movement assessment,it is important to have a clear understanding of the effect of different marker sets and segment models in use.展开更多
Objective: To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non union in revision total hip arthroplasty with tension band fixation. Methods: A retrospe...Objective: To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non union in revision total hip arthroplasty with tension band fixation. Methods: A retrospective review of 295 revision total hip operations performed between 1992 and 1998 was undertaken. Twenty hips of 19 patients with comminuted fractures or nonunion of the greater trochanter were stabilized with tension band technique. Multiple 2.0 mm k wires and tension band wires were placed through the intact cortex distally and the abductor tendon proximally in the pattern "8". Results: The average follow up was 30 months. The Harris Hip Score improved on average from 45 preoperatively to 89 at follow up. Sixteen hips with intra operative trochanteric fracture through osteolytic bone and four hips with symptomatic trochanteric nonunion were approached with tension band fixation. Perioperative loss of fixation in one patient required a repeated surgery. The same fixation at the second operation achieved an uneventful healing. Two patients had a 2 cm proximal migration of one K wire without loss of bony fixation. The trochanteric fractures healed with no further proximal wire migration. One patient had loss of fixation with trochanteric escape at 6 weeks post operatively. The patient has abductor weakness with Trendleburg limp but without pain. On average, radiographic examination showed that healing occurred at 16.6 weeks postoperatively. Six patients developed grade 1 heterotopic ossification and two patients grade 3. All were asymptomatic. None of the 19 patients experienced a dislocation during the follow up. Conclusions: Tension band fixation for greater trochanter can enhance the success rate of revision total hip arthroplasty without a deficient abductor mechanism.展开更多
基金the National Institute of Child Health and Human Development (No.NICHD,No.R15HD059080,and No.R15HD059080-01A1S1)
文摘Background:The greater trochanter marker is commonly used in 3-dimensional(3D) models;however,its influence on hip and knee kinematics during gait is unclear.Understanding the influence of the greater trochanter marker is important when quantifying frontal and transverse plane hip and knee kinematics,parameters which are particularly relevant to investigate in individuals with conditions such as patellofemoral pain,knee osteoarthritis,anterior cruciate ligament(ACL) injury,and hip pain.The aim of this study was to evaluate the effect of including the greater trochanter in the construction of the thigh segment on hip and knee kinematics during gait.Methods:3D kinematics were collected in 19 healthy subjects during walking using a surface marker system.Hip and knee angles were compared across two thigh segment definitions(with and without greater trochanter) at two time points during stance:peak knee flexion(PKF) and minimum knee flexion(Min KF).Results:Hip and knee angles differed in magnitude and direction in the transverse plane at both time points.In the thigh model with the greater trochanter the hip was more externally rotated than in the thigh model without the greater trochanter(PKF:-9.34°± 5.21° vs.1.40°± 5.22°,Min KF:-5.68°± 4.24° vs.5.01°± 4.86°;p < 0.001).In the thigh model with the greater trochanter,the knee angle was more internally rotated compared to the knee angle calculated using the thigh definition without the greater trochanter(PKF:14.67°± 6.78° vs.4.33°± 4.18°,Min KF:10.54°± 6.71° vs.-0.01°± 2.69°;p < 0.001).Small but significant differences were detected in the sagittal and frontal plane angles at both time points(p < 0.001).Conclusion:Hip and knee kinematics differed across different segment definitions including or excluding the greater trochanter marker,especially in the transverse plane.Therefore when considering whether to include the greater trochanter in the thigh segment model when using a surface markers to calculate 3D kinematics for movement assessment,it is important to have a clear understanding of the effect of different marker sets and segment models in use.
文摘Objective: To explore the clinical efficacy of the treatment of comminuted trochanteric fractures and trochanteric osteotomy non union in revision total hip arthroplasty with tension band fixation. Methods: A retrospective review of 295 revision total hip operations performed between 1992 and 1998 was undertaken. Twenty hips of 19 patients with comminuted fractures or nonunion of the greater trochanter were stabilized with tension band technique. Multiple 2.0 mm k wires and tension band wires were placed through the intact cortex distally and the abductor tendon proximally in the pattern "8". Results: The average follow up was 30 months. The Harris Hip Score improved on average from 45 preoperatively to 89 at follow up. Sixteen hips with intra operative trochanteric fracture through osteolytic bone and four hips with symptomatic trochanteric nonunion were approached with tension band fixation. Perioperative loss of fixation in one patient required a repeated surgery. The same fixation at the second operation achieved an uneventful healing. Two patients had a 2 cm proximal migration of one K wire without loss of bony fixation. The trochanteric fractures healed with no further proximal wire migration. One patient had loss of fixation with trochanteric escape at 6 weeks post operatively. The patient has abductor weakness with Trendleburg limp but without pain. On average, radiographic examination showed that healing occurred at 16.6 weeks postoperatively. Six patients developed grade 1 heterotopic ossification and two patients grade 3. All were asymptomatic. None of the 19 patients experienced a dislocation during the follow up. Conclusions: Tension band fixation for greater trochanter can enhance the success rate of revision total hip arthroplasty without a deficient abductor mechanism.