The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform
Wilson Marques - One of the best experts on this subject based on the ideXlab platform.
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damage to the superior gluteal nerve after direct lateral approach to the hip
Clinical Orthopaedics and Related Research, 2007Co-Authors: Celso Herminio Ferraz Picado, Flavio Luis Garcia, Wilson MarquesAbstract:The superior gluteal nerve may be damaged during total hip arthroplasty. We prospectively studied 40 patients who had total hip arthroplasties using the Hardinge direct lateral approach to the hip to determine any correlation between superior gluteal nerve damage and abductor function. We used the Trendelenburg Test to clinically evaluate abductor function preoperatively and 1 year postoperatively. We evaluated superior gluteal nerve function by electromyography preoperatively and at 4, 8, and 12 weeks until its normalization over a maximum of 24 weeks postoperatively. The Trendelenburg Test was positive in 20 patients (50%) preoperatively and in 10 patients (25%) 1 year postoperatively. Seventeen patients (42.5%) had damage to the superior gluteal nerve visible on the first electromyographic evaluation performed 4 weeks postoperatively; three (7.5%) of these patients showed changes when reevaluated 6 months postoperatively; only one of the three patients had a positive Trendelenburg Test 1 year postoperatively. Nine of the 37 patients with normal electromyography results had positive Trendelenburg Tests. Our results suggest there are frequent electromyographic signs of damage to the superior gluteal nerve using the direct lateral approach to the hip. However, the damage tends to improve spontaneously and does not seem to cause clinically apparent abductor insufficiency.
Luís P. Cardinali - One of the best experts on this subject based on the ideXlab platform.
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CLINICAL RESEARCH Does Trochanteric Transfer Eliminate the Trendelenburg Sign in Adults?
2015Co-Authors: Flávio L. Garcia, Celso H. F. Picado, Luís P. CardinaliAbstract:Background Premature closure of the proximal femoral growth plate results in coxa brevis, which usually is asso-ciated with insufficiency of the hip abductors. Distal and lateral transfer of the greater trochanter sometimes is rec-ommended to correct this problem. Most of what is known arises from studies of children and adolescents. Questions/purposes We asked whether this procedure in adults with coxa brevis would eliminate hip abductor insufficiency and would improve their hip function based on the Harris hip score (HHS). Patients and Methods We prospectively followed 11 patients, aged 19 to 55 years (mean, 40 years) who had distal and lateral trochanteric transfer. All patients had pain and a positive Trendelenburg Test before surgery. This Test was performed at the laTest followup by three observers and the interobserver reliability was determined by the kappa coefficient. The HHS was obtained before surgery and at the laTest followup. The minimum followup was 25 months (mean, 52 months; range, 25–77 months). Results Insufficiency of the hip abductors was eliminated in seven (according to two observers) and eight (according to one observer) of the 11 patients after surgery; the kappa coefficient ranged from 0.79 to 1.0. The mean HHS improved from 64 points preoperatively to 76 points at the final followup. The two patients with preexisting severe osteoarthritis of the hip had the worst final scores and persisted with a positive Trendelenburg Test at the final followup. Conclusions Distal and lateral transfer of the greater trochanter can eliminate insufficiency of the hip abductors and improve joint function in adult patients with coxa brevis and we believe should be considered for patients without severe osteoarthritis of the hip. Level of Evidence Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence
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Does Trochanteric Transfer Eliminate the Trendelenburg Sign in Adults?
Clinical Orthopaedics and Related Research®, 2011Co-Authors: Flávio L. Garcia, Celso H. F. Picado, Luís P. CardinaliAbstract:Background Premature closure of the proximal femoral growth plate results in coxa brevis, which usually is associated with insufficiency of the hip abductors. Distal and lateral transfer of the greater trochanter sometimes is recommended to correct this problem. Most of what is known arises from studies of children and adolescents. Questions/purposes We asked whether this procedure in adults with coxa brevis would eliminate hip abductor insufficiency and would improve their hip function based on the Harris hip score (HHS). Patients and Methods We prospectively followed 11 patients, aged 19 to 55 years (mean, 40 years) who had distal and lateral trochanteric transfer. All patients had pain and a positive Trendelenburg Test before surgery. This Test was performed at the laTest followup by three observers and the interobserver reliability was determined by the kappa coefficient. The HHS was obtained before surgery and at the laTest followup. The minimum followup was 25 months (mean, 52 months; range, 25–77 months). Results Insufficiency of the hip abductors was eliminated in seven (according to two observers) and eight (according to one observer) of the 11 patients after surgery; the kappa coefficient ranged from 0.79 to 1.0. The mean HHS improved from 64 points preoperatively to 76 points at the final followup. The two patients with preexisting severe osteoarthritis of the hip had the worst final scores and persisted with a positive Trendelenburg Test at the final followup. Conclusions Distal and lateral transfer of the greater trochanter can eliminate insufficiency of the hip abductors and improve joint function in adult patients with coxa brevis and we believe should be considered for patients without severe osteoarthritis of the hip. Level of Evidence Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
M. J. Beynon - One of the best experts on this subject based on the ideXlab platform.
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The Application of NCaRBS to the Trendelenburg Test and Total Hip Arthroplasty Outcome
Annals of Biomedical Engineering, 2015Co-Authors: Gemma Marie Whatling, C. A. Holt, M. J. BeynonAbstract:This paper compares the frontal plane hip function of subject’s known to have had hip arthroplasty via either the lateral (LA) or posterior (PA) surgical approaches and a group of subjects associated with no pathology (NP). This is investigated through the Trendelenburg Test using 3D motion analysis and classification. Here, a recent development on the Classification and Ranking Belief Simplex (CaRBS) technique, able to undertake n -state classification, so termed NCaRBS is employed. The relationship between post-operative hip function measured during a Trendelenburg Test using three patient characteristics (pelvic obliquity, frontal plane hip moment and frontal plane hip power) of LA, PA and NP subjects are modelled together. Using these characteristics, the classification accuracy was 93.75% for NP, 57.14% for LA, 38.46% for PA. There was a clear distinction between NP and post-surgical function. 3/6 LA subjects and 6/8 PA subjects were misclassified as having NP function, implying that greater function is restored following the PA to surgery. NCaRBS achieved a higher accuracy (65.116%) than through a linear discriminant analysis (48.837%). A Neural Network with two-nodes achieved the same accuracy (65.116%) and as expected was further improved with three-nodes (69.767%). A valuable benefit to the employment of the NCaRBS technique is the graphical exposition of the contribution of patient characteristics to the classification analysis.
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The Application of NCaRBS to the Trendelenburg Test and Total Hip Arthroplasty Outcome
2015Co-Authors: Gemma Marie Whatling, C. A. Holt, M. J. BeynonAbstract:Associate Editor Sean S. Kohles oversaw the review of this article. Abstract—This paper compares the frontal plane hip func-tion of subject’s known to have had hip arthroplasty via either the lateral (LA) or posterior (PA) surgical approaches and a group of subjects associated with no pathology (NP). This is investigated through the Trendelenburg Test using 3D motion analysis and classification. Here, a recent develop-ment on the Classification and Ranking Belief Simplex (CaRBS) technique, able to undertake n-state classification, so termed NCaRBS is employed. The relationship between post-operative hip function measured during a Trendelen-burg Test using three patient characteristics (pelvic obliquity, frontal plane hip moment and frontal plane hip power) of LA, PA and NP subjects are modelled together. Using these characteristics, the classification accuracy was 93.75 % for NP, 57.14 % for LA, 38.46 % for PA. There was a clear distinction between NP and post-surgical function. 3/6 LA subjects and 6/8 PA subjects were misclassified as having NP function, implying that greater function is restored following the PA to surgery. NCaRBS achieved a higher accuracy (65.116%) than through a linear discriminant analysis (48.837%). A Neural Network with two-nodes achieved the same accuracy (65.116%) and as expected was further improved with three-nodes (69.767%). A valuable benefit to the employment of the NCaRBS technique is the graphical exposition of the contribution of patient characteristics to the classification analysis. Keywords—N-state classification, Dempster–Shafer theory (DST) of evidence, Ignorance, Pignistic probability, Total hip arthroplasty
Akira Maeyama - One of the best experts on this subject based on the ideXlab platform.
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Hip Abductor Strengths After Total Hip Arthroplasty Via the Lateral and Posterolateral Approaches
The Journal of arthroplasty, 2009Co-Authors: Takahiko Kiyama, Masatoshi Naito, Tuyoshi Shinoda, Akira MaeyamaAbstract:A retrospective control study was carried out to compare the postoperative hip abductor strengths after primary total hip arthroplasties via the lateral (lateral group; 38 hips) and posterolateral (posterior group; 40 hips) approaches. At a minimum of 2 years after total hip arthroplasty, abductor muscle strength was evaluated qualitatively by the Trendelenburg Test and quantitatively using a dynamometer. The ratio of normalized strength of the reconstructed side to that of the nonoperated side was calculated (strength ratio). The Trendelenburg Test was positive in 10 of 38 patients in the lateral group and in 11 of 40 patients in the posterior group. The average strength ratios of the lateral and posterior groups were 86.1% and 87.3%, respectively (P = .67). Strength ratio was positively correlated to femoral offset within both groups.
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Effect of superior placement of the hip center on abductor muscle strength in total hip arthroplasty.
The Journal of arthroplasty, 2008Co-Authors: Takahiko Kiyama, Masatoshi Naito, Hiroshi Shitama, Akira MaeyamaAbstract:We evaluated 100 limbs in 50 patients who had undergone unilateral primary total hip arthroplasty with a normal contralateral hip. The 50 patients were divided into 2 groups by postoperative acetabular cup position, specifically by inferior and superior placement (inferior and superior groups). Hip abductor muscle strength was evaluated qualitatively by the modified Trendelenburg Test and quantitatively by handheld dynamometer. The ratio of normalized strength of the reconstruction side to that of the nonoperated side was calculated (strength ratio). The modified Trendelenburg Test was positive in 5 of 23 patients in the inferior group and 11 of 27 in the superior group (P < .05). The strength ratio of the superior group was decreased by 7.7% in comparison with that of the inferior group (P < .01).
W F Cashman - One of the best experts on this subject based on the ideXlab platform.
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damage to the superior gluteal nerve after the hardinge approach to the hip
Journal of Bone and Joint Surgery-british Volume, 1996Co-Authors: M. Ramesh, N. Mccarthy, A. Jarvis, J M Obyrne, K Mahalingham, W F CashmanAbstract:We studied prospectively 81 consecutive patients undergoing hip surgery using the Hardinge (1982) approach. The abductor muscles of the hip in these patients were assessed electrophysiologically and clinically by the modified Trendelenburg Test. Power was measured using a force plate. We performed assessment at two weeks, and at three and nine months after operation. At two weeks we found that 19 patients (23%) showed evidence of damage to the superior gluteal nerve. By three months, five of these had recovered. The nine patients with complete denervation at three months showed no signs of recovery when reassessed at nine months. Persistent damage to the nerve was associated with a positive Trendelenburg Test.
