Bioengineering Hip Research: Why it's important to your Practice and

What's Next Vail Hip SymposiumJanuary 15th, 2015

Vail, CO

Robert F. LaPrade, MD, PhDChief Medical Officer

Steadman Philippon Research InstituteDeputy Director, Sports Medicine FellowshipComplex Knee and Sports Medicine Surgeon

The Steadman Clinic Vail, COAdjunct Professor, University of MinnesotaAffiliate Faculty, Colorado State University

DisclosuresI, Robert F. LaPrade, have relevant financial relationships to be discussed, directly or indirectly, referred to or illustrated with or without recognition within the presentation as follows:

• Editorial Boards for AJSM & KSSTA• AOSSM Board• Chair, AOSSM Research Committee• Consultant : Arthrex, Smith & Nephew• AOSSM Research Grant• OREF Career Development Grant; OREF Clinical

Research Award 2013• Health East Norway Research Grant• Minnesota Medical Foundation Grants• AOSSM: Chair, Research Committee, AOSSM

Board

The Steadman Philippon Research Institute is a 501(c)(3) non-profit institution supported financially by private donations and corporate support from the following entities: • Smith & Nephew • Arthrex, Inc.• Siemens Medical Solutions USA, Inc.• ConMed Linvatec• Össur Americas• Synthes• Ceterix Orthopaedics, Inc. • AANA• University of Oslo• The Steadman Clinic• Vail Valley Medical Center

Translational Biomechanics Research Model

Components

Quantitative Anatomy

Biomechanics

Clinical Outcomes

How do we improve our understanding of the complex anatomy of the hip?-Quantitative descriptions of clinically pertinent hip anatomy

Hip Research Pyramid: Anatomy

Hip Research Pyramid: Acetabular Anatomy

Philippon MJ, Michalski MP, Campbell KJ, Goldsmith MT, Devitt BM, Wijdicks CA, LaPrade RF. An anatomical study of the acetabulum with clinical applications to hip arthroscopy. J Bone Joint Surg Am. 2014 Oct 15;96(20):1673-82.

Acetabular Anatomy• Direct Head of Rectus

Femoris; Superior Facet ASIS- 137.6 mm2

• AIIS Ridge- 8.9 mm2

• Indirect head RF, closest at 12:30; 5.1 mm

Acetabular Anatomy“A new clock-face @ 3:00”

The center of the anterior labral sulcus (psoas-u)- a reliable landmark, previously 3:30, TAL = 6:00 (Philippon 2007, Blankenbacker 2007)

Hip Research Pyramid: Anatomy of the Proximal Femur

Anatomy of the Proximal FemurReliable Osseous Landmarks:

1. Superomedial Border of the Greater Trochanter

2. Femoral Head-Neck Junction

3. Vastus Tubercle

Anatomy of the Proximal Femur-

Quantitative AnatomyGluteus medius: Superomedial footprint Post. Tip of GT- 17.0 mm Lateral footprint anteriorinferior VT- 17.1 mmGluteus minimus: Center of footprint anteroinferior VT- 22.9 mm

Capsular Thickness

Capsule:• Thickest at 2 o’clock position

• Maximal thickness: 8.3 mm• Thinnest at 10 o’clock position

• Minimal thickness: 4.1 mm

Acetabular Labrum

• Acetabular labrum• Secondary stabilizer

to external rotation and anterior translation

• Iliofemoral ligament• Significant role in

limiting external rotation and anterior translation

Bi-plane fluroscopy: Test hip motion in intact and sectioned states

The Ligamentum Teres

Ligamentum teres:• Yield Load: 75 N• Ulitmate failure load: 204 N• Mechanism of failure: Tearing at fovea

capitis

The Proximal Hamstring- Anatomy, structural properties

and repair techniquesConjoined tendon- Semi T, long head of biceps

Semimebranosus

Proximal hamstring tendon avulsion5 small anchors (1164 N) > 2 large anchors (474 N) or 2 small anchors (543 N)Conclusion: Aggressive post-op early ROM and WB with 5 small anchor repair

Bioengineering Hip Research: What’s Next

• Biomechanical robotic studies investigating:

• Injury patterns • Reconstruction and repair techniques

Conclusions• Quantitative anatomy- improved understanding of the

complex anatomy of the hip and surrounding structures

• Biomechanical research- emerging research understanding injury patterns and validating/improving surgical techniques

• Clinical implications- hip anatomical and biomechanical research is increasing rapidly and will lead to anatomic repairs/reconstructions and ultimately improved patient outcomes

Steadman Philippon Research Institute

Thank You