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Original question
I am preparing my presentation for symposium in Berlin on February
13, on the pre-operative planning of total hip replacement. Using
the hip-Op and related technologies we are looking at how the
variability of the implant positioning during planning affects
biomechanical parameters such as skeletal range of motion of implant
fitting.
One thing we computed is how the rest length of the hip muscle
changes because of the relocation of the joint centre due to the
total hip replacement. We got some nice numbers, but I am in trouble
with their interpretation. What is the maximum % increase in length
that we can consider acceptable, i.e. done without damaging the
muscle or producing major pain?
I tried a medline search but I need some initial focus or I get lost
in the mare magnum of the muscle Biomechanics literature. Help ....
Thanks to all those who replied. Many asked me to post the summary,
so here I am. Rather than listing all replies, I shall put a brief
summary and a list of references I found useful. by the way, Berlin
conference was of great interest, my compliments to Georg Duda and
all Berlin colleagues.
Brief Summary
the relationship between the rest length and force expressed by a
muscle is regulated by the so-called Blix curve. This curve shows
that there is a range of initial lengths within the muscle is able to
exhibit the maximum force, while for lower or higher lengths the
force is reduced. So far I could not find a systematic collection of
Blix curves for hip human muscles, so I had to use generic
information derive from other muscles, especially those wrapping the
wrist.
The second effect of passive lengthening is the risk of damage. Here
I found only a generic indication that above 40% lengthening some
damage occur.
the third and most clinical effect, is the relationship between leg
distraction during hip reduction and neurological complications. It
appears that distractions higher than 3-4 cm may produce these
complications. How this translate to the single muscle is unclear.
In our model each muscle changed its length equally of less than the
total dislocation, so for a dislocation of 21 mm the highest change
was 22 mm, computed for the iliacus.
References
5 Caiozzo, V. J., Utkan, A., Chou, R., Khalafi, A., Chandra,
H., Baker, M., Rourke, B., Adams, G., Baldwin, K. and Green, S.
Effects of distraction on muscle length: mechanisms involved in
sarcomerogenesis. Clin Orthop, 2002 (403 Suppl), S133-45.
7 Delp, S. L., Komattu, A. V. and Wixson, R. L. Superior
displacement of the hip in total joint replacement: effects of
prosthetic neck length, neck-stem angle, and anteversion angle on the
moment-generating capacity of the muscles. J Orthop Res, 1994, 12
(6), 860-70.
8 Delp, S. L. and Zajac, F. E. Force- and moment-generating
capacity of lower-extremity muscles before and after tendon
lengthening. Clin Orthop, 1992 (284), 247-59.
9 Dhillon, M. S. and Nagi, O. N. Sciatic nerve palsy associated
with total hip arthroplasty. Ital J Orthop Traumatol, 1992, 18 (4),
521-6.
11 Edwards, B. N., Tullos, H. S. and Noble, P. C. Contributory
factors and etiology of sciatic nerve palsy in total hip
arthroplasty. Clin Orthop, 1987 (218), 136-41.
12 Ferber, R., Osternig, L. and Gravelle, D. Effect of PNF
stretch techniques on knee flexor muscle EMG activity in older
adults. J Electromyogr Kinesiol, 2002, 12 (5), 391-7.
13 Friden, J. and Lieber, R. L. Mechanical considerations in the
design of surgical reconstructive procedures. J Biomech, 2002, 35
(8), 1039-45.
14 Herzog, W. and ter Keurs, H. E. A method for the
determination of the force-length relation of selected in-vivo human
skeletal muscles. Pflugers Arch, 1988, 411 (6), 637-41.
15 Hoy, M. G., Zajac, F. E. and Gordon, M. E. A musculoskeletal
model of the human lower extremity: the effect of muscle, tendon, and
moment arm on the moment-angle relationship of musculotendon
actuators at the hip, knee, and ankle. J Biomech, 1990, 23 (2),
157-69.
16 Ichinose, Y., Kawakami, Y., Ito, M. and Fukunaga, T.
Estimation of active force-length characteristics of human vastus
lateralis muscle. Acta Anat (Basel), 1997, 159 (2-3), 78-83.
17 Jerosch, J., Steinbeck, J., Stechmann, J. and Guth, V.
Influence of a high hip centre on abductor muscle function. Arch
Orthop Trauma Surg, 1997, 116 (6-7), 385-389.
21 Lieber, R. L. Skeletal Muscle is a Biological Example of a
Linear Electro-Active Actuator. In Proceedings of SPIE's 6th Annual
International Symposium on Smart Structures and Materials, San Diego,
1999, p^pp. 3669-03.
22 Lieber, R. L. and Friden, J. Intraoperative measurement and
biomechanical modeling of the flexor carpi ulnaris-to-extensor carpi
radialis longus tendon transfer. J Biomech Eng, 1997, 119 (4), 386-91.
23 Maganaris, C. N. Force-length characteristics of in vivo
human skeletal muscle. Acta Physiol Scand, 2001, 172 (4), 279-85.
24 McGrory, B. J., Morrey, B. F., Cahalan, T. D., An, K. N. and
Cabanela, M. E. Effect of femoral offset on range of motion and
abductor muscle strength after total hip arthroplasty. J Bone Joint
Surg Br, 1995, 77 (6), 865-9.
29 Spalding, T. J. Effect of femoral offset on motion and
abductor muscle strength after total hip arthroplasty. J Bone Joint
Surg Br, 1996, 78 (6), 997-8.
30 Spoor, C. W., van Leeuwen, J. L., de Windt, F. H. and Huson,
A. A model study of muscle forces and joint-force direction in normal
and dysplastic neonatal hips. J Biomech, 1989, 22 (8-9), 873-84.
31 Stea, S., Bordini, B., Sudanese, A. and Toni, A. Register of
hip prosthesis at Rizzoli Institute: eleven years’ experience. Acta
Orthop Scand, 2002, 73 (S305), 43-45.
32 Thomsen, M. N., Breusch, S. J., Aldinger, P. R., Gortz, W.,
Lahmer, A., Honl, M., Birke, A. and Nagerl, H. Robotically-milled
bone cavities: a comparison with hand-broaching in different types of
cementless hip stems. Acta Orthop Scand, 2002, 73 (4), 379-85.
33 Vasavada, A. N., Delp, S. L., Maloney, W. J., Schurman, D. J.
and Zajac, F. E. Compensating for changes in muscle length in total
hip arthroplasty. Effects on the moment generating capacity of the
muscles. Clin Orthop, 1994 (302), 121-33.
34 Viceconti, M., Testi, D., Simeoni, M. and Zannoni, C. An
automated method to position prosthetic components within multiple
anatomical spaces. Comput Methods Programs Biomed, 2003, 70 (2),
121-7.
35 Willems, M. E. and Huijing, P. A. Hip joint position and
architecture of rat semimembranosus muscle: implications for
length-force characteristics. Acta Anat (Basel), 1995, 152 (1), 56-65.
Lat minute addition (I have not read it yet):
R.M. Aspden and R.W. Porter. Nerve traction during correction of knee
flexion deformity. A case report and calculation. Journal of Bone and
Joint Surgery 76-B: 471-473, 1994.
--
--------------------------------------------------
MARCO VICECONTI, PhD (viceconti@tecno.ior.it)
Laboratorio di Tecnologia Medica tel. 39-051-6366865
Istituti Ortopedici Rizzoli fax. 39-051-6366863
via di barbiano 1/10, 40136 - Bologna, Italy
Tiger! Tiger! Burning bright in the forest of the night,
what immortal hand or eye could frame thy fearful symmetry?
--------------------------------------------------
Opinions expressed here do not necessarily reflect those of my employer
---------------------------------------------------------------
To unsubscribe send SIGNOFF BIOMCH-L to LISTSERV@nic.surfnet.nl
For information and archives: http://isb.ri.ccf.org/biomch-l
---------------------------------------------------------------
I am preparing my presentation for symposium in Berlin on February
13, on the pre-operative planning of total hip replacement. Using
the hip-Op and related technologies we are looking at how the
variability of the implant positioning during planning affects
biomechanical parameters such as skeletal range of motion of implant
fitting.
One thing we computed is how the rest length of the hip muscle
changes because of the relocation of the joint centre due to the
total hip replacement. We got some nice numbers, but I am in trouble
with their interpretation. What is the maximum % increase in length
that we can consider acceptable, i.e. done without damaging the
muscle or producing major pain?
I tried a medline search but I need some initial focus or I get lost
in the mare magnum of the muscle Biomechanics literature. Help ....
Thanks to all those who replied. Many asked me to post the summary,
so here I am. Rather than listing all replies, I shall put a brief
summary and a list of references I found useful. by the way, Berlin
conference was of great interest, my compliments to Georg Duda and
all Berlin colleagues.
Brief Summary
the relationship between the rest length and force expressed by a
muscle is regulated by the so-called Blix curve. This curve shows
that there is a range of initial lengths within the muscle is able to
exhibit the maximum force, while for lower or higher lengths the
force is reduced. So far I could not find a systematic collection of
Blix curves for hip human muscles, so I had to use generic
information derive from other muscles, especially those wrapping the
wrist.
The second effect of passive lengthening is the risk of damage. Here
I found only a generic indication that above 40% lengthening some
damage occur.
the third and most clinical effect, is the relationship between leg
distraction during hip reduction and neurological complications. It
appears that distractions higher than 3-4 cm may produce these
complications. How this translate to the single muscle is unclear.
In our model each muscle changed its length equally of less than the
total dislocation, so for a dislocation of 21 mm the highest change
was 22 mm, computed for the iliacus.
References
5 Caiozzo, V. J., Utkan, A., Chou, R., Khalafi, A., Chandra,
H., Baker, M., Rourke, B., Adams, G., Baldwin, K. and Green, S.
Effects of distraction on muscle length: mechanisms involved in
sarcomerogenesis. Clin Orthop, 2002 (403 Suppl), S133-45.
7 Delp, S. L., Komattu, A. V. and Wixson, R. L. Superior
displacement of the hip in total joint replacement: effects of
prosthetic neck length, neck-stem angle, and anteversion angle on the
moment-generating capacity of the muscles. J Orthop Res, 1994, 12
(6), 860-70.
8 Delp, S. L. and Zajac, F. E. Force- and moment-generating
capacity of lower-extremity muscles before and after tendon
lengthening. Clin Orthop, 1992 (284), 247-59.
9 Dhillon, M. S. and Nagi, O. N. Sciatic nerve palsy associated
with total hip arthroplasty. Ital J Orthop Traumatol, 1992, 18 (4),
521-6.
11 Edwards, B. N., Tullos, H. S. and Noble, P. C. Contributory
factors and etiology of sciatic nerve palsy in total hip
arthroplasty. Clin Orthop, 1987 (218), 136-41.
12 Ferber, R., Osternig, L. and Gravelle, D. Effect of PNF
stretch techniques on knee flexor muscle EMG activity in older
adults. J Electromyogr Kinesiol, 2002, 12 (5), 391-7.
13 Friden, J. and Lieber, R. L. Mechanical considerations in the
design of surgical reconstructive procedures. J Biomech, 2002, 35
(8), 1039-45.
14 Herzog, W. and ter Keurs, H. E. A method for the
determination of the force-length relation of selected in-vivo human
skeletal muscles. Pflugers Arch, 1988, 411 (6), 637-41.
15 Hoy, M. G., Zajac, F. E. and Gordon, M. E. A musculoskeletal
model of the human lower extremity: the effect of muscle, tendon, and
moment arm on the moment-angle relationship of musculotendon
actuators at the hip, knee, and ankle. J Biomech, 1990, 23 (2),
157-69.
16 Ichinose, Y., Kawakami, Y., Ito, M. and Fukunaga, T.
Estimation of active force-length characteristics of human vastus
lateralis muscle. Acta Anat (Basel), 1997, 159 (2-3), 78-83.
17 Jerosch, J., Steinbeck, J., Stechmann, J. and Guth, V.
Influence of a high hip centre on abductor muscle function. Arch
Orthop Trauma Surg, 1997, 116 (6-7), 385-389.
21 Lieber, R. L. Skeletal Muscle is a Biological Example of a
Linear Electro-Active Actuator. In Proceedings of SPIE's 6th Annual
International Symposium on Smart Structures and Materials, San Diego,
1999, p^pp. 3669-03.
22 Lieber, R. L. and Friden, J. Intraoperative measurement and
biomechanical modeling of the flexor carpi ulnaris-to-extensor carpi
radialis longus tendon transfer. J Biomech Eng, 1997, 119 (4), 386-91.
23 Maganaris, C. N. Force-length characteristics of in vivo
human skeletal muscle. Acta Physiol Scand, 2001, 172 (4), 279-85.
24 McGrory, B. J., Morrey, B. F., Cahalan, T. D., An, K. N. and
Cabanela, M. E. Effect of femoral offset on range of motion and
abductor muscle strength after total hip arthroplasty. J Bone Joint
Surg Br, 1995, 77 (6), 865-9.
29 Spalding, T. J. Effect of femoral offset on motion and
abductor muscle strength after total hip arthroplasty. J Bone Joint
Surg Br, 1996, 78 (6), 997-8.
30 Spoor, C. W., van Leeuwen, J. L., de Windt, F. H. and Huson,
A. A model study of muscle forces and joint-force direction in normal
and dysplastic neonatal hips. J Biomech, 1989, 22 (8-9), 873-84.
31 Stea, S., Bordini, B., Sudanese, A. and Toni, A. Register of
hip prosthesis at Rizzoli Institute: eleven years’ experience. Acta
Orthop Scand, 2002, 73 (S305), 43-45.
32 Thomsen, M. N., Breusch, S. J., Aldinger, P. R., Gortz, W.,
Lahmer, A., Honl, M., Birke, A. and Nagerl, H. Robotically-milled
bone cavities: a comparison with hand-broaching in different types of
cementless hip stems. Acta Orthop Scand, 2002, 73 (4), 379-85.
33 Vasavada, A. N., Delp, S. L., Maloney, W. J., Schurman, D. J.
and Zajac, F. E. Compensating for changes in muscle length in total
hip arthroplasty. Effects on the moment generating capacity of the
muscles. Clin Orthop, 1994 (302), 121-33.
34 Viceconti, M., Testi, D., Simeoni, M. and Zannoni, C. An
automated method to position prosthetic components within multiple
anatomical spaces. Comput Methods Programs Biomed, 2003, 70 (2),
121-7.
35 Willems, M. E. and Huijing, P. A. Hip joint position and
architecture of rat semimembranosus muscle: implications for
length-force characteristics. Acta Anat (Basel), 1995, 152 (1), 56-65.
Lat minute addition (I have not read it yet):
R.M. Aspden and R.W. Porter. Nerve traction during correction of knee
flexion deformity. A case report and calculation. Journal of Bone and
Joint Surgery 76-B: 471-473, 1994.
--
--------------------------------------------------
MARCO VICECONTI, PhD (viceconti@tecno.ior.it)
Laboratorio di Tecnologia Medica tel. 39-051-6366865
Istituti Ortopedici Rizzoli fax. 39-051-6366863
via di barbiano 1/10, 40136 - Bologna, Italy
Tiger! Tiger! Burning bright in the forest of the night,
what immortal hand or eye could frame thy fearful symmetry?
--------------------------------------------------
Opinions expressed here do not necessarily reflect those of my employer
---------------------------------------------------------------
To unsubscribe send SIGNOFF BIOMCH-L to LISTSERV@nic.surfnet.nl
For information and archives: http://isb.ri.ccf.org/biomch-l
---------------------------------------------------------------