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Arthroplasty Today Dec 2023Intraoperative pelvic motion during total hip arthroplasty (THA) in the supine position affects acetabular cup placement and occurs at each step of THA; however, there...
BACKGROUND
Intraoperative pelvic motion during total hip arthroplasty (THA) in the supine position affects acetabular cup placement and occurs at each step of THA; however, there are no reports of pelvic motion changes during each stage of THA via the direct anterior approach (DAA). This study aimed to evaluate pelvic motion at each step of THA through the DAA.
METHODS
From March to October 2022, 71 hips were prospectively measured for intraoperative pelvic tilt and axial rotation during THA through the DAA at a single center. These parameters were measured during each surgical step using the augmented reality-hip navigation system.
RESULTS
Both pelvic tilt and axial rotation were maximal during acetabular cup placement. The mean intraoperative pelvic tilt and axial rotation during cup placement were 4.8 ± 2.6° (95% confidence interval, 4.19-5.41°) and 4.2 ± 3.3° (95% confidence interval, 3.42-4.98°), respectively. The effects of the acetabular retractor and cup impactor on pelvic tilt and axial rotation were comparable. Spearman's correlation tests showed significant correlation between axial rotation and body mass index (r = -0.444, = .00011).
CONCLUSIONS
The pelvis tilts forward and rotates toward the surgical side during THA through the DAA. The effects of the acetabular retractor and cup impactor on pelvic motion are comparable. Cup implantation must take into account pelvic movement, and it must be recognized that the pelvis is moving at that time, even with only the acetabular retractor inserted, compared to before the skin incision.
PubMed: 38023653
DOI: 10.1016/j.artd.2023.101251 -
The Journal of Orthopaedic and Sports... Aug 2018Background Femoroacetabular impingement (FAI) syndrome may affect gait kinematics differently between males and females. Objectives To investigate whether individuals...
Background Femoroacetabular impingement (FAI) syndrome may affect gait kinematics differently between males and females. Objectives To investigate whether individuals with FAI syndrome have different hip and pelvic motion during gait, at their preferred speed and a prescribed speed, compared to individuals of the same sex without pain. Methods Twenty-one participants (11 males and 10 females) with FAI syndrome and 41 participants (19 males and 22 females) without hip pain were included in this case-control laboratory study. There were no differences between the 2 groups in age, body mass index, and activity score. Kinematic data for all participants were collected while walking at a preferred speed and at 1.25 m/s. For sex and walking speed, linear regression analyses were used to examine the effect of group and the interaction of group by limb. Results At both speeds, males with FAI syndrome walked with more than 6° less peak hip extension (P≤.018), 5° greater anterior pelvic tilt (P≤.020), and 5° less posterior pelvic tilt (P≤.018) compared to males without hip pain. Females with FAI syndrome walked with 2° less hip extension (P≤.012) and at least 3° more hip adduction (P<.001) in the more painful hip than in the less painful hip at both speeds. Conclusion Males and females with FAI syndrome have different gait alterations when compared to a same-sex comparison group. In males, differences were between groups. In females with FAI syndrome, differences were between the more painful and the less painful limb. J Orthop Sports Phys Ther 2018;48(8):649-658. Epub 22 May 2018. doi:10.2519/jospt.2018.7913.
Topics: Adult; Biomechanical Phenomena; Case-Control Studies; Female; Femoracetabular Impingement; Gait; Hip; Humans; Male; Pelvis; Self Report; Sex Factors; Thigh; Young Adult
PubMed: 29787694
DOI: 10.2519/jospt.2018.7913 -
Medicine May 2023To investigate the characteristics of pelvic floor surface electromyography parameters on the basis of Glazer assessment in women 42 days postpartum, and to analyze the... (Randomized Controlled Trial)
Randomized Controlled Trial
To investigate the characteristics of pelvic floor surface electromyography parameters on the basis of Glazer assessment in women 42 days postpartum, and to analyze the predictive value of surface electromyography (sEMG) in postpartum stress urinary incontinence. This is a retrospective study. Three thousand twenty-nine females in total who were screened 42 days postpartum in Jinniu District Maternal and Children's Health Hospital of Chengdu from January 2019 to December 2020 were selected, and were randomly allocated into stress urinary incontinence (SUI) (n = 509) and the non-SUI group (n = 2520). Pelvic floor surface electromyography was performed by the same physiotherapists. The evaluation parameters included the average EMG value in the pre-resting baseline, the maximum sEMG value, the rising time, the descent time in the fast-twitch phase, and the average sEMG value in the slow-twitch phase. Mean value and modifiability of EMG value in post-resting stage. The disparities of the mentioned parameters hereinabove in the SUI and non-SUI groups were made comparison, and the relationship between stress urinary incontinence and sEMG parameters was analyzed by multiple logistic regression analysis. The prevalence of SUI was 16.8% in women 42 days after delivery. Body mass index and vaginal delivery were risk factors for SUI. Among the sEMG parameters of the SUI group and the non-SUI group, the maximum EMG values in the fast-twitch phase (28.81 ± 14.41 vs 30.41 ± 15.15), the rising time in the fast-twitch phase (0.55 ± 0.36 vs 0.51 ± 0.30), and the Phase descent time (0.76 ± 0.76 vs 0.68 ± 0.65), mean slow-twitch phase EMG (17.82 ± 10.10 vs 19.69 ± 15.62), slow-twitch phase variability (0.28 ± 0.12 vs 0.26 ± 0.10), are statistically different (P < .05). In the SUI group, body mass index (estimated parameter = 0.029, P = .023), mean EMG during slow-twitch phase (estimated parameter = -0.013, P = .004) were relevant to stress urinary incontinence after delivery. The sEMG based on Glazer protocol indicates the activity of slow-twitch muscle fibers in SUI patients are decreased, and there is a correlation with the occurrence of stress urinary incontinence. sEMG can be applied as a quantitative evaluation tool of the pelvic floor analysis in postpartum SUI.
Topics: Child; Humans; Female; Electromyography; Urinary Incontinence, Stress; Cross-Sectional Studies; Pelvic Floor; Retrospective Studies; Postpartum Period; Muscular Diseases
PubMed: 37233412
DOI: 10.1097/MD.0000000000033851 -
Journal of Emergencies, Trauma, and... 2019Morel-Lavallee lesion (MLL) is an infrequent or underreported serious consequence of closed degloving injuries. We aimed to describe the clinical presentation and...
INTRODUCTION
Morel-Lavallee lesion (MLL) is an infrequent or underreported serious consequence of closed degloving injuries. We aimed to describe the clinical presentation and management of pelvic MLL in obese patients.
MATERIALS AND METHODS
A retrospective analysis was conducted for pelvic trauma patients with a diagnosis of MLL between 2010 and 2012. Patients' demographics, presentations, management, and outcomes were analyzed and compared based on the body mass index (BMI) and injury severity.
RESULTS
Of 580 patients with pelvic region injuries, 183 (31.5%) had MLL with a mean age of 30.1 ± 12.2 years. The majority (75.4%) of MLL patients had a BMI ≥30 and 44% patients had pelvic fracture. Based on the initial clinical examination, MLL was diagnosed in 84% of patients and clinically missed in 16% of patients. Nonoperative management (NOM) was performed in 93.4% of patients, while primary surgical intervention was indicated in 6.6% of patients. Failed NOM was observed in seven cases, of them five were obese. The overall mortality in MLL patients was 12.6% and the frequency of deaths was nonsignificantly higher in Grade I obese patients. Multivariate analysis showed that injury severity score (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.05-1.50) and Glasgow coma scale (OR: 0.72, 95% CI: 0.56-0.92) were the predictors of mortality in patients with MLL irrespective of BMI.
CONCLUSIONS
One-third of pelvic region injuries have MLL and three-quarter of them are obese. This significant association of obesity and MLL needs further prospective evaluation.
PubMed: 31057283
DOI: 10.4103/JETS.JETS_37_18 -
Fertility and Sterility Jun 2022To identify metabolites in presurgical blood associated with risk of persistent postsurgical pelvic pain 1 year after endometriosis surgery in adolescent and young adult... (Observational Study)
Observational Study
OBJECTIVE
To identify metabolites in presurgical blood associated with risk of persistent postsurgical pelvic pain 1 year after endometriosis surgery in adolescent and young adult patients.
DESIGN
Prospective observational study within the Women's Health Study: From Adolescence to Adulthood, a US-based longitudinal cohort of adolescents and women enrolled from 2012-2018.
SETTING
Two tertiary care hospitals.
PATIENT(S)
Laparoscopically confirmed endometriosis patients (n = 180) with blood collected before their endometriosis surgery. Of these, 77 patients additionally provided blood samples 5 weeks to 6 months after their surgery. We measured plasma metabolites using liquid chromatography tandem mass spectrometry, and a total of 390 known metabolites were included in our analysis.
INTERVENTION(S)
None.
MAIN OUTCOME MEASURE(S)
Persistent postsurgical pelvic pain, defined as severe, life-impacting pelvic pain 1 year after endometriosis surgery.
RESULT(S)
Most patients (>95%) were at stage I/II of the revised American Society for Reproductive Medicine classification. Their average age at diagnosis was 18.7 years, with 36% reporting persistent postsurgical pelvic pain. Of the 21 metabolites in presurgical blood that were associated with risk of persistent postsurgical pelvic pain, 19 metabolites, which were mainly lipid metabolites, were associated with increased risk. Only 2 metabolites-pregnenolone sulfate (odds ratio = 0.64, 95% confidence interval = 0.44-0.92) and fucose (odds ratio = 0.69, 95% confidence interval = 0.47-0.97)-were associated with decreased risk. Metabolite set enrichment analysis revealed that higher levels of lysophosphatidylethanolamines (false discovery rate = 0.01) and lysophosphatidylcholines (false discovery rate = 0.01) in presurgical blood were associated with increased risk of persistent postsurgical pelvic pain.
CONCLUSION(S)
Our results suggest that dysregulation of multiple groups of lipid metabolites may play a role in the persistence of pelvic pain postsurgery among young endometriosis patients.
Topics: Adolescent; Adult; Endometriosis; Female; Humans; Laparoscopy; Lipids; Pain, Postoperative; Pelvic Pain; Pelvis; Young Adult
PubMed: 35367064
DOI: 10.1016/j.fertnstert.2022.02.012 -
International Urogynecology Journal May 2017Pelvic floor muscle rehabilitation is a widely utilized, but often challenging therapy for pelvic floor disorders, which are prevalent in older women. Regimens involving...
INTRODUCTION AND HYPOTHESIS
Pelvic floor muscle rehabilitation is a widely utilized, but often challenging therapy for pelvic floor disorders, which are prevalent in older women. Regimens involving the use of appendicular muscles, such as the obturator internus (OI), have been developed for strengthening of the levator ani muscle (LAM). However, changes that lead to potential dysfunction of these alternative targets in older women are not well known. We hypothesized that aging negatively impacts OI architecture, the main determinant of muscle function, and intramuscular extracellular matrix (ECM), paralleling age-related alterations in LAM.
METHODS
OI and LAM were procured from three groups of female cadaveric donors (five per group): younger (20 - 40 years), middle-aged (41 - 60 years), and older (≥60 years). Architectural predictors of the excursional (fiber length, L ), force-generating (physiological cross-sectional area, PCSA) and sarcomere length (L ) capacity of the muscles, and ECM collagen content (measure of fibrosis) were determined using validated methods. The data were analyzed using one-way ANOVA and Tukey's post-hoc test with a significance level of 0.05, and linear regression.
RESULTS
The mean ages of the donors in the three groups were 31.2 ± 2.3 years, 47.6 ± 1.2 years, and 74.6 ± 4.2 years (P < 0.005). The groups did not differ with respect to parity or body mass index (P > 0.5). OI L and L were not affected by aging. Age >60 years was associated with a substantial decrease in OI PCSA and increased collagen content (P < 0.05). Reductions in OI and LAM force-generating capacities with age were highly correlated (r = 0.9).
CONCLUSIONS
Our findings of age-related decreases in predicted OI force production and fibrosis suggest that these alterations should be taken into consideration, when designing pelvic floor fitness programs for older women.
Topics: Adult; Age Factors; Aged; Aging; Analysis of Variance; Cadaver; Collagen; Female; Humans; Middle Aged; Muscle, Skeletal; Pelvic Floor; Pelvic Floor Disorders
PubMed: 27704154
DOI: 10.1007/s00192-016-3167-5 -
JPMA. the Journal of the Pakistan... Apr 2023To determine the efficacy of whole-body vibration in the treatment of postnatal constipation. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To determine the efficacy of whole-body vibration in the treatment of postnatal constipation.
METHODS
The prospective, randomised, single-blind, pre-post, controlled trial was conducted from December 2020 to May 2021 at the outpatient clinic of the Obstetrics and Gynaecology Department, Kafrelsheikh University Hospital, Egypt, and comprised women with complaint of postnatal constipation. They were randomised into two groups. Group A was subjected to whole-body vibration in addition to diet instructions, pelvic floor exercises and static abdominal exercisesforsix weeks. Group B wassubjected to pelvic floor exercises,static abdominal exercises and diet instructions. Constipation symptom questionnaire and patient assessment of constipation quality of life questionnaire were used at baseline and post-intervention. Data was analysed using SPSS 25.
RESULTS
Of the 40 women, 20(50%) were in each of the 2 groups. Group A mean age was 24.88±2.22 years, while it was 24±2.25 years in Group B. Age, height and body mass index were not significantly different between the groups (p>0.05). There was significant improvement in Group A quality of life and constipation severity (p<0.05).
CONCLUSIONS
Whole-body vibration had positive impact on postpartum women's constipation symptoms and quality of life.
RCT REGISTRATION
NCT05286476, Link: https://clinicaltrials.gov/ct2/show/NCT05286476.
Topics: Pregnancy; Humans; Female; Young Adult; Adult; Quality of Life; Vibration; Single-Blind Method; Prospective Studies; Pelvic Floor; Constipation; Exercise Therapy
PubMed: 37482821
DOI: 10.47391/JPMA.EGY-S4-3 -
European Journal of Sport Science Jul 2023In a running single-leg jump (RSLJ) for distance, the generation of vertical velocity without loss of horizontal velocity during the take-off phase is ideal, but...
In a running single-leg jump (RSLJ) for distance, the generation of vertical velocity without loss of horizontal velocity during the take-off phase is ideal, but difficult; however, we hypothesized that the pelvic rotation in the frontal plane achieved it. Here we show the effect of each segment rotation on the horizontal and vertical kinetic energies ( and ) of the centre of mass (CoM) during the take-off phase of an RSLJ for distance. We collected kinematic and ground-reaction-force data during RSLJs for distance by nine male long jumpers, involving an approximately 20-m approach in an outdoor field. We determined the components of the and changes due to each segment movement. Elevation of the pelvic free-leg side increased (0.53±0.16 J/kg, 9±3% of the total change). Pelvic axial rotation decreased , while pelvic elevation did not affect it (0.01±0.02 J/kg, no significant difference from zero). In contrast, forward rotations of the stance-leg shank and thigh decreased while simultaneously increasing . The results showed that pelvic elevation increased the vertical CoM velocity without causing a loss in horizontal velocity, although the lower-limb segments' effects on the vertical and horizontal velocities exhibited a trade-off, as previously speculated. RSLJs for distance have been frequently assumed as sagittal movements. However, our findings highlight the importance of three-dimensional pelvic movement, particularly in the frontal plane, for controlling both the vertical and horizontal velocities.l We show the effect of each segment rotation on the horizontal and vertical kinetic energies ( and ) of the centre of mass during the take-off phase of a running single-leg jump for distance.l Elevation of the pelvic free-leg side increased but did not decrease , while the forward rotations of the stance-leg thigh and shank decreased , while simultaneously increasing .l We highlight the importance of pelvic movement in the frontal plane for controlling both the vertical and horizontal velocities with single-leg stance.
Topics: Male; Humans; Leg; Lower Extremity; Running; Movement; Pelvis; Biomechanical Phenomena
PubMed: 35465845
DOI: 10.1080/17461391.2022.2070779 -
Experimental and Therapeutic Medicine Apr 2018Accessory spleen (AS) usually presents as an isolated asymptomatic mass of splenic tissue separated from the body of the actual spleen. Multiple pelvic ASs are more...
Accessory spleen (AS) usually presents as an isolated asymptomatic mass of splenic tissue separated from the body of the actual spleen. Multiple pelvic ASs are more unusual than single pelvic AS. The present study reported on the rare case of multiple pelvic AS. A 39-year-old Chinese woman presented at our hospital with complaints of abdominal pain for one week. A large pelvic mass behind the uterus was identified on ultrasound examination. Multiple AS in the pelvis was primarily considered during the operation and confirmed by histopathological examination after the surgery. The literature in English language was also reviewed by retrieving studies on AS published over the past 30 years, and it was discussed how to diagnose and treat pelvic AS. In conclusion, to the best of our knowledge, the present study provided the first case report of multiple pelvic AS. The gynecologist should be aware of the rare possibility of an AS in patients with abdominal and pelvic complaints and/or a pelvic mass. Pelvic AS is generally determined during radiological investigations or during open or laparoscopic surgeries.
PubMed: 29581749
DOI: 10.3892/etm.2018.5903 -
Ginekologia Polska 2023The aim of this study is to examine the effects of delivery type and birth weight on pelvic floor structure using muscle defects, uterus-vagina angles and landmarks in...
OBJECTIVES
The aim of this study is to examine the effects of delivery type and birth weight on pelvic floor structure using muscle defects, uterus-vagina angles and landmarks in pelvic magnetic resonance imaging (MRI).
MATERIAL AND METHODS
This is a retrospective study. Pelvic MR images of 38 vaginal deliveries and 62 cesarean section patients who met the study criteria were analyzed. Pubococcygeal line, H line, M line were marked on MR images, uterus cervix, cervix upper vagina, upper and middle vagina, middle and lower vagina angles, urogenital hiatus width, levator hiatus width, obturator internus muscle area, levator ani defect was measured. The urinary incontinence and pelvic organ prolapse examination findings were recorded. The patients' age, body mass index (BMI), parity, delivery type, maximum birth weight questions were asked. The data of both groups were compared.
RESULTS
Uterocervical angle and levator ani muscle defect was significantly higher in the vaginal delivery group (p < 0.001). In the vaginal delivery group, a significant positive correlation was found between the parity and the levator ani muscle defect (r = 0.552), (p = 0.000). A significant negative correlation was found between the parity and the uterocervical angle (r = -0.337), (p = 0.039). A significant negative correlation was found between maximum birth weight and cervix upper vagina angle (r = -0.365) (p = 0.024). In the vaginal delivery group, a negative significant correlation was found between birth weight and obturator internus muscle area (r = -0.378), (p = 0.019).
CONCLUSIONS
These results show that cesarean section exposes the pelvic floor to less trauma and suggest that cesarean section may protect the pelvic floor.
Topics: Pregnancy; Humans; Female; Cesarean Section; Retrospective Studies; Pelvic Floor; Birth Weight; Magnetic Resonance Imaging
PubMed: 36477780
DOI: 10.5603/GP.a2022.0140