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Bioengineering Hip Research: Why it's important to your Practice and
What's Next Vail Hip SymposiumJanuary 15th, 2015
Vail, CO
Robert F. LaPrade, MD, PhDChief Medical Officer
Steadman Philippon Research InstituteDeputy Director, Sports Medicine FellowshipComplex Knee and Sports Medicine Surgeon
The Steadman Clinic Vail, COAdjunct Professor, University of MinnesotaAffiliate Faculty, Colorado State University
DisclosuresI, Robert F. LaPrade, have relevant financial relationships to be discussed, directly or indirectly, referred to or illustrated with or without recognition within the presentation as follows:
• Editorial Boards for AJSM & KSSTA• AOSSM Board• Chair, AOSSM Research Committee• Consultant : Arthrex, Smith & Nephew• AOSSM Research Grant• OREF Career Development Grant; OREF Clinical
Research Award 2013• Health East Norway Research Grant• Minnesota Medical Foundation Grants• AOSSM: Chair, Research Committee, AOSSM
Board
The Steadman Philippon Research Institute is a 501(c)(3) non-profit institution supported financially by private donations and corporate support from the following entities: • Smith & Nephew • Arthrex, Inc.• Siemens Medical Solutions USA, Inc.• ConMed Linvatec• Össur Americas• Synthes• Ceterix Orthopaedics, Inc. • AANA• University of Oslo• The Steadman Clinic• Vail Valley Medical Center
Translational Biomechanics Research Model
Components
Quantitative Anatomy
Biomechanics
Clinical Outcomes
How do we improve our understanding of the complex anatomy of the hip?-Quantitative descriptions of clinically pertinent hip anatomy
Hip Research Pyramid: Anatomy
Hip Research Pyramid: Acetabular Anatomy
Philippon MJ, Michalski MP, Campbell KJ, Goldsmith MT, Devitt BM, Wijdicks CA, LaPrade RF. An anatomical study of the acetabulum with clinical applications to hip arthroscopy. J Bone Joint Surg Am. 2014 Oct 15;96(20):1673-82.
Acetabular Anatomy• Direct Head of Rectus
Femoris; Superior Facet ASIS- 137.6 mm2
• AIIS Ridge- 8.9 mm2
• Indirect head RF, closest at 12:30; 5.1 mm
Acetabular Anatomy“A new clock-face @ 3:00”
The center of the anterior labral sulcus (psoas-u)- a reliable landmark, previously 3:30, TAL = 6:00 (Philippon 2007, Blankenbacker 2007)
Hip Research Pyramid: Anatomy of the Proximal Femur
Anatomy of the Proximal FemurReliable Osseous Landmarks:
1. Superomedial Border of the Greater Trochanter
2. Femoral Head-Neck Junction
3. Vastus Tubercle
Anatomy of the Proximal Femur-
Quantitative AnatomyGluteus medius: Superomedial footprint Post. Tip of GT- 17.0 mm Lateral footprint anteriorinferior VT- 17.1 mmGluteus minimus: Center of footprint anteroinferior VT- 22.9 mm
Capsular Thickness
Capsule:• Thickest at 2 o’clock position
• Maximal thickness: 8.3 mm• Thinnest at 10 o’clock position
• Minimal thickness: 4.1 mm
Acetabular Labrum
• Acetabular labrum• Secondary stabilizer
to external rotation and anterior translation
• Iliofemoral ligament• Significant role in
limiting external rotation and anterior translation
Bi-plane fluroscopy: Test hip motion in intact and sectioned states
The Ligamentum Teres
Ligamentum teres:• Yield Load: 75 N• Ulitmate failure load: 204 N• Mechanism of failure: Tearing at fovea
capitis
The Proximal Hamstring- Anatomy, structural properties
and repair techniquesConjoined tendon- Semi T, long head of biceps
Semimebranosus
Proximal hamstring tendon avulsion5 small anchors (1164 N) > 2 large anchors (474 N) or 2 small anchors (543 N)Conclusion: Aggressive post-op early ROM and WB with 5 small anchor repair
Bioengineering Hip Research: What’s Next
• Biomechanical robotic studies investigating:
• Injury patterns • Reconstruction and repair techniques
Conclusions• Quantitative anatomy- improved understanding of the
complex anatomy of the hip and surrounding structures
• Biomechanical research- emerging research understanding injury patterns and validating/improving surgical techniques
• Clinical implications- hip anatomical and biomechanical research is increasing rapidly and will lead to anatomic repairs/reconstructions and ultimately improved patient outcomes
Steadman Philippon Research Institute
Thank You