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Instructional Course Lectures 2024Although total hip arthroplasty (THA) has proved to be a successful surgical procedure, both prosthetic and bone impingement resulting in dislocation continue to occur.... (Review)
Review
Although total hip arthroplasty (THA) has proved to be a successful surgical procedure, both prosthetic and bone impingement resulting in dislocation continue to occur. Studies have shown that spine pathology resulting in lumbar stiffness and hip arthritis often coexist. Spinopelvic mobility patterns during postural changes affect three-dimensional acetabular component position, which affects the incidence of prosthetic impingement and THA instability. Several spinopelvic risk factors that may affect THA stability have been identified. Numerous reports recommend performing a preoperative spinopelvic mobility analysis to identify risk factors and adjust acetabular component position accordingly to lessen the risk of impingement. In doing so, acetabular component position is individualized based on spinopelvic mobility patterns. Additionally, functional femoral anteversion, affected by individual femoral rotation patterns during dynamic activities, may contribute to the incidence of impingement. It is important to review the interrelationship between spine and pelvic mobility and how it relates to THA and may reduce the incidence of instability.
Topics: Humans; Acetabulum; Arthroplasty, Replacement, Hip; Joint Dislocations; Pelvis; Spine
PubMed: 38090893
DOI: No ID Found -
Location of the ovaries in children and efficacy of gonadal shielding in hip and pelvis radiography.Journal of Orthopaedic Science :... Sep 2023Patients with hip disorders undergo multiple radiographic examinations, so gonadal radiation risk should be minimized. Inaccurate shield placement, including obscuring...
BACKGROUND
Patients with hip disorders undergo multiple radiographic examinations, so gonadal radiation risk should be minimized. Inaccurate shield placement, including obscuring landmarks, has been widely reported, and some studies reported that covering the true pelvis was inappropriate to shield young girls' ovaries. However, no reports on ovaries in Asian patients identified on magnetic resonance imaging exist. We aimed to identify the location of the ovaries in Japanese children and assess the efficacy of gonadal shielding.
METHODS
Female patients aged ≤16 years who underwent magnetic resonance imaging for hip disorders that displayed at least one ovary were included. Sixty ovaries from 31 patients were classified into two age groups: <2 years and >2 years, and the ovaries' position was classified according to the following four zones on the anteroposterior pelvic radiograph: zone 1 (true pelvis) - area surrounded by the line of the anterior superior iliac spines, inner side walls of the ilium, and symphysis pubis; zone 2 - areas lateral to zone 1; zone 3 - sacral area superior to zone 1; and zone 4 - areas lateral to zone 3. The ovaries' position was analyzed according to age group.
RESULTS
Thirty-one ovaries in 16 patients were <2 years, and 29 ovaries in 15 patients were >2 years. Thirteen ovaries in the true pelvis, 18 ovaries in the false pelvis were <2 years, and 27 in the true pelvis and 2 in the false pelvis were in >2 years. In girls aged <2 years, most ovaries in the false pelvis were located in zone 3.
CONCLUSIONS
Girls aged >2 years mostly have their ovaries in the true pelvis, and ovaries in infants tend to be located superior to the true pelvis. Covering the true pelvis is plausible for shielding ovaries. Shields should be placed slightly more cranially than the true pelvis for infants.
Topics: Infant; Child; Humans; Female; Child, Preschool; Ovary; Radiography; Pelvis; Radiation Protection; Magnetic Resonance Imaging
PubMed: 35989157
DOI: 10.1016/j.jos.2022.07.012 -
Orthopaedics & Traumatology, Surgery &... Feb 2024Motion in the spine, pelvis and hips which make up the spinopelvic femoral complex (SPFC) implies mechanical relationships that help maintain trunk balance and optimize... (Review)
Review
INTRODUCTION
Motion in the spine, pelvis and hips which make up the spinopelvic femoral complex (SPFC) implies mechanical relationships that help maintain trunk balance and optimize hip functionThe aim of this study was to understand the physiology of the SPFC and evaluate the dysfunctions of the SPFC and their implications for total hip arthroplasty considering the hip-spine relationship.
METHODS
A review of relevant and comprehensive studies on this subject is reported in order to highlight a pathophysiology that integrates the description of the evaluations of the spine-pelvic and hip parameters and recommendations for the kinematic planning of the THA procedure. The primary objective was to determine which type of hip-spine relationship has the highest risk for THA complications and to become proficient in selecting the priority surgical intervention when both the hip and spine are affected. Finally, this review attempted to assist hip surgeons with surgical technique, tools, implant selection, and goals of planning a THA that requires personalized kinematic alignment. Determine the influence of THA on these kinematics and the effect of stiffness of the lumbopelvic complex on the risk of THA failure.
RESULTS
When a person sits, the pelvis goes into retroversion and the acetabulum opens forward. This frees the femoral head and neck to allow hip flexion. The opposite - pelvic anteversion - occurs when a person stands. When pelvic mobility is limited, the hip must increase its range of motion to accommodate these posture changes. Disturbances in spinal and pelvic kinematics lead to abnormal hip function, which may contribute to complications following total hip arthroplasty (THA).
CONCLUSION
A precise evaluation of the parameters governing the SPFC must be taken into account in order to best optimize the placement and choice of THA implants.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Arthroplasty, Replacement, Hip; Spine; Acetabulum; Pelvis; Posture
PubMed: 38000509
DOI: 10.1016/j.otsr.2023.103773 -
Radiographics : a Review Publication of... Jan 2024Endometriosis is a common condition that mostly affects people assigned as female at birth. The most common clinical symptom of endometriosis is pain. Although the...
Endometriosis is a common condition that mostly affects people assigned as female at birth. The most common clinical symptom of endometriosis is pain. Although the mechanism for this pain is poorly understood, in some cases, the nerves are directly involved in endometriosis. Endometriosis is a multifocal disease, and the pelvis is the most common location involved. Nerves in the pelvis can become entrapped and involved in endometriosis. Pelvic nerves are visible at pelvic MRI, especially when imaging planes and sequences are tailored for neural evaluation. In particular, high-spatial-resolution anatomic imaging including three-dimensional isotropic imaging and contrast-enhanced three-dimensional short inversion time inversion-recovery (STIR) fast spin-echo sequences are useful for nerve imaging. The most commonly involved nerves are the sciatic, obturator, femoral, pudendal, and inferior hypogastric nerves and the inferior hypogastric and lumbosacral plexuses. Although it is thought to be rare, the true incidence of nerve involvement in endometriosis is not known. Symptoms of neural involvement include pain, weakness, numbness, incontinence, and paraplegia and may be constant or cyclic (catamenial). Early diagnosis of neural involvement in endometriosis is important to prevent irreversible nerve damage and chronic sensorimotor neuropathy. Evidence of irreversible damage can also be seen at MRI, and radiologists should evaluate pelvic nerves that are commonly involved in endometriosis in their search pattern and report template to ensure that this information is incorporated into treatment planning.
Topics: Infant, Newborn; Humans; Female; Endometriosis; Pelvis; Pain; Peripheral Nervous System Diseases; Magnetic Resonance Imaging
PubMed: 38170677
DOI: 10.1148/rg.230106 -
Spine Deformity Mar 2024There is great controversy about the etiologic origin of adolescent idiopathic scoliosis. Multiple theories have been suggested, including metabolic aspects, endocrine... (Review)
Review
PURPOSE
There is great controversy about the etiologic origin of adolescent idiopathic scoliosis. Multiple theories have been suggested, including metabolic aspects, endocrine dysfunction, neurological central abnormalities, genetic predisposition and epigenetic factors involved in the development of scoliosis. However, there has always been speculations based on human biomechanical behavior.
METHODS
In this article, we performed a literature review on the biomechanical traits of human posture, and the proposed theories that explain the special characteristics present in idiopathic scoliosis.
RESULTS
The current theory on the etiopathogeneis of AIS suggests that dorsally directed shear loads acting on a preexisting axial plane rotation, in a posteriorly inclined sagittal plane of a growing patient, together with disc maturation, collagen quality at this phase of development and immaturity of proprioception, is the perfect scenario to spark rotational instability and create the three-dimensional deformity that defines idiopathic scoliosis.
CONCLUSION
The unique spinal alignment of human bipedalism, gravity and muscle forces acting straight above the pelvis to preserve an upright balance, and the instability of the soft tissue in a period of growth development, is an appealing cocktail to try to explain the genesis of this condition in humans.
Topics: Adolescent; Humans; Scoliosis; Spine; Kyphosis; Rotation; Pelvis
PubMed: 37975988
DOI: 10.1007/s43390-023-00787-7 -
European Journal of Orthopaedic Surgery... Jul 2023Open pelvic fractures (OPFs) are uncommon but potentially lethal traumatic injuries. Often caused by high energy blunt trauma, they can cause severe injury to abdominal... (Review)
Review
INTRODUCTION
Open pelvic fractures (OPFs) are uncommon but potentially lethal traumatic injuries. Often caused by high energy blunt trauma, they can cause severe injury to abdominal and pelvic structures. We sought to conduct a review of the literature in order to ascertain the rates of genitourinary injury and vaginal laceration after OPF and the rates of resulting infection and mortality.
METHODS
A review of PubMed was conducted to identify studies reporting the rates of genitourinary injury from OPF. Study characteristics, patient characteristics, and outcomes were collected. The data were pooled, and descriptive statistics were obtained.
RESULTS
Eight studies encompassing 343 patients were included. Average age was 35.1 years (10-85.9), 28% were female, and the average Injury Severity Score was 26.5 (4-75). 95.5% of patients had a blunt mechanism of injury. Motor vehicle collision (23.9%), motorcycle accident (19.7%), and pedestrian struck (19.3%) were the most common etiologies. Overall mortality and infection rates were 31.2% and 18.7%, respectively. 19.7% of patients suffered an injury to the genitourinary system, and 32.4% of females sustained a vaginal laceration.
DISCUSSION
OPFs have the potential for extremely high morbidity and mortality. While much research has been done to prevent early mortality from hemorrhage, there is comparatively little research into late mortality stemming from infection and sepsis. Intravenous antibiotics are the mainstay of treatment, and local antibiotics usage has been encouraged. In patients with a vaginal laceration, it is important to provide antibiotic coverage for vaginal flora.
Topics: Humans; Female; Adult; Male; Lacerations; Pelvic Bones; Fractures, Open; Pelvis; Injury Severity Score
PubMed: 36209481
DOI: 10.1007/s00590-022-03388-8 -
Current Sports Medicine Reports Aug 2023
Topics: Humans; Thigh; Pelvis; Hip Injuries; Hip Joint
PubMed: 37549209
DOI: 10.1249/JSR.0000000000001086 -
Canadian Association of Radiologists... Nov 2023The Canadian Association of Radiologists (CAR) Endometriosis Working Group was tasked with providing guidance and benchmarks to ensure the quality of technique and... (Review)
Review
The Canadian Association of Radiologists (CAR) Endometriosis Working Group was tasked with providing guidance and benchmarks to ensure the quality of technique and interpretation for advanced imaging modalities associated with diagnosing endometriosis. This practice statement provides an overview of the state of the art of advanced pelvic ultrasound in the diagnosis and mapping of pelvic endometriosis. While acknowledging that advanced pelvic ultrasound in some practices falls within the scope of clinical colleagues rather than imaging departments, the statement seeks to guide radiologists interested in implementing these techniques into their practice for patients referred for evaluation and diagnosis of endometriosis. The statement covers indications, some components of the ultrasound assessment and technique, reporting, and recommendations for starting an ultrasound endometriosis evaluation program.
Topics: Female; Humans; Canada; Endometriosis; Pelvis; Sensitivity and Specificity; Ultrasonography
PubMed: 37042803
DOI: 10.1177/08465371231165986 -
Journal of Magnetic Resonance Imaging :... Jan 2024Abbreviated MRI (AMRI) protocols rely on the acquisition of a limited number of sequences tailored to a specific question. The main objective of AMRI protocols is to... (Review)
Review
Abbreviated MRI (AMRI) protocols rely on the acquisition of a limited number of sequences tailored to a specific question. The main objective of AMRI protocols is to reduce exam duration and costs, while maintaining an acceptable diagnostic performance. AMRI is of increasing interest in the radiology community; however, challenges limiting clinical adoption remain. In this review, we will address main abdominal and pelvic applications of AMRI in the liver, pancreas, kidney, and prostate, including diagnostic performance, pitfalls, limitations, and cost effectiveness will also be discussed. Level of Evidence: 3 Technical Efficacy Stage: 3.
Topics: Male; Humans; Magnetic Resonance Imaging; Abdomen; Liver Neoplasms; Pelvis
PubMed: 37144673
DOI: 10.1002/jmri.28764 -
BMJ Military Health Oct 2023Underbody blast loading can result in injuries to the pelvis and the lumbosacral spine. The purpose of this study was to determine human tolerance in this region based...
INTRODUCTION
Underbody blast loading can result in injuries to the pelvis and the lumbosacral spine. The purpose of this study was to determine human tolerance in this region based on survival analysis.
METHODS
Twenty-six unembalmed postmortem human surrogate lumbopelvic complexes were procured and pretest medical images were obtained. They were fixed in polymethylmethacrylate at the cranial end and a six-axis load cell was attached. The specimens were aligned in a seated soldier posture. Impacts were applied to the pelvis using a custom vertical accelerator. The experimental design consisted of non-injury and injury tests. Pretest and post-test X-rays and palpation were done following non-injury test, and after injury test medical imaging and gross dissections were done. Injuries were scored using the Abbreviated Injury Scale (AIS). Axial and resultant forces were used to develop human injury probability curves (HIPCs) at AIS 3+ and AIS 4 severities using survival analysis. Then ±95% CI was computed using the delta method, normalised CI size was obtained, and the quality of the injury risk curves was assigned adjectival ratings.
RESULTS
At the 50% probability level, the resultant and axial forces at the AIS 3+ level were 6.6 kN and 5.9 kN, and at the AIS 4 level these were 8.4 kN and 7.5 kN, respectively. Individual injury risk curves along with ±95% CIs are presented in the paper. Increased injury severity increased the HIPC metrics. Curve qualities were in the good and fair ranges for axial and shear forces at all probability levels and for both injury severities.
CONCLUSIONS
This is the first study to develop axial and resultant force-based HIPCs defining human tolerance to injuries to the pelvis from vertical impacts using parametric survival analysis. Data can be used to advance military safety under vertical loading to the seated pelvis.
Topics: Humans; Probability; Radiography; Pelvis; Posture; Cadaver
PubMed: 34711674
DOI: 10.1136/bmjmilitary-2021-001863