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Hip contact force and pressure in cam femoroaceteabular impingement syndrome
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Abnormal hip biomechanics associated to different hip conditions often lead to premature
articular damage and malfunction. Therefore, understanding hip biomechanics is extremely
important not only for assessing joint function but also for hip preservation and reconstruction
surgery.
In femoroacetabular impingement syndrome (FAIS), abnormal morphology and joint
biomechanics can lead to articular damage and premature joint degeneration. Surgical
treatment of FAIS, with adequate morphology correction and treatment of associated
intraarticular pathology, significantly improves clinical outcomes, but few studies focus on the
biomechanical outcome. The research on the intraoperative assessment of hip joint
biomechanics is even more limited.
The main motivation for this thesis is the intraoperative evaluation of femoroacetabular
contact force (CF) and pressure (CP) in the arthroscopic treatment of cam FAIS. We believe
that assessing post-cam resection CF and CP can aid in identifying inadequate restoration of
contact biomechanics. By detecting this intraoperatively, it may be possible to correct it
during the initial surgery, potentially reducing the need for revision procedures and
improving outcomes.
We review the relevant anatomy, joint biomechanics, and imaging techniques essential for
the diagnosis and treatment of FAIS. Our original research includes a structured review of hip
CF and CP, based on both in vivo and cadaver studies. Through this review, we identified
that there was no specific medical device to measure hip CF or CP in hip arthroscopy, and
no standardised methodology had been published for assessing contact biomechanics in
arthroscopic hip surgery.
Recognising these gaps in current knowledge, we designed and produced a dual-device
system to measure femoroacetabular CF and the axial load applied to the thigh during
arthroscopic hip surgery. Cadaver testing confirmed the functionality of these devices, and
we established the surgical technique for performing these measurements using the PC initial
access technique in hip arthroscopy. In further research, we compared the new devices for
evaluating CF with an intracranial pressure (ICP) microsensor for assessing CP as a control
device in cadavers with cam morphology.
Additionally, we explore the advancements in FAIS imaging and the arthroscopic treatment
of FAIS using initial access to the peripheral compartment, which has been our preferred
approach.
The research conducted for this thesis suggests that:
First, there was no specific device or standardised methodology to access
femoroacetabular contact biomechanics in arthroscopic hip surgery.
Second, the dual-device system, comprising one device specifically designed to measure
femoroacetabular CF in arthroscopic hip surgery and another to control the applied axial
load, allows for real-time measurement of CF across different joint positions in cadaveric
hip arthroscopy.
Third, the described surgical technique and standardised methodology enable the
measurement of the anterosuperior femoroacetabular CF in the arthroscopic cam
resection.
Fourth, the ICP microsensor used for CP evaluation is fragile and difficult to handle, with
saturation occurring at 30º and 60º of hip flexion. At 80º of hip flexion, the anterosuperior
CP was significantly lower after cam resection.
Fifth, the novel hip-specific device is functional and detected a decrease in the
normalised anterosuperior femoroacetabular CF after arthroscopic cam resection across
all tested joint positions. At 80º of hip flexion and 15º of internal rotation, the CF
decreased by 26% following cam resection.
Sixth, the concept of intraoperatively assessing CF and CP offers a promising approach
to verify improvements in joint biomechanics following arthroscopic cam resection.
Seventh, the hip arthroscopy technique with initial access to the PC has favourable
clinical outcomes (79.4% of patients achieved the MCID, and 63.8% reached the PASS
for the NAHS) without an increase in complication or reoperation rates.
Eight, this arthroscopic technique is versatile and can be particularly advantageous when
the pathology is primarily located in the PC or when access to the central compartment
is challenging.
The hip-specific device for measuring CF in arthroscopy has only been used in cadaver
surgery and research settings. In the future, the integration of 3D pre-operative planning,
navigation, and intraoperative contact biomechanics measurement may be used in different
surgical interventions, such as acetabular rim trimming, cam resection, osteotomies, and
labral repair or reconstruction. The real-time data provided by navigation and contact
biomechanics can be used to optimise the precision of intraoperative corrections.
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Palavras-chave
Hip Femoroacetabular Impingement Cam Arthroscopy Femoral Osteoplasty Biomechanics Contact Pressure