@article{WeberSuessJerabeketal., author = {Weber, Markus and Suess, Franz and Jerabek, Seth and Meyer, Matthias and Grifka, Joachim and Renkawitz, Tobias and Dendorfer, Sebastian}, title = {Kinematic pelvic tilt during gait alters functional cup position in total hip arthroplasty}, series = {Journal of Orthopaedic Research}, volume = {40}, journal = {Journal of Orthopaedic Research}, number = {4}, publisher = {Wiley}, issn = {1554-527X}, doi = {10.1002/jor.25106}, pages = {846 -- 853}, abstract = {Static pelvic tilt impacts functional cup position in total hip arthroplasty (THA). In the current study we investigated the effect of kinematic pelvic changes on cup position. In the course of a prospective controlled trial postoperative 3D-computed tomography (CT) and gait analysis before and 6 and 12 months after THA were obtained in 60 patients. Kinematic pelvic motion during gait was measured using Anybody Modeling System. By fusion with 3D-CT, the impact of kinematic pelvic tilt alterations on cup anteversion and inclination was calculated. Furthermore, risk factors correlating with high pelvic mobility were evaluated. During gait a high pelvic range of motion up to 15.6° exceeding 5° in 61.7\% (37/60) of patients before THA was found. After surgery, the pelvis tilted posteriorly by a mean of 4.0 ± 6.6° (p < .001). The pelvic anteflexion led to a mean decrease of -1.9 ± 2.2° (p < .001) for cup inclination and -15.1 ± 6.1° (p < .001) for anteversion in relation to the anterior pelvic plane (APP). Kinematic pelvic changes resulted in a further change up to 2.3° for inclination and up to 12.3° for anteversion. In relation to the preoperative situation differences in postoperative cup position ranged from -4.4 to 4.6° for inclination and from -7.8 to 17.9° for anteversion, respectively. Female sex (p < .001) and normal body weight (p < .001) correlated with high alterations in pelvic tilt. Kinematic pelvic changes highly impact cup anteversion in THA. Surgeons using the APP as reference should aim for a higher anteversion of about 15° due to the functional anteflexion of the pelvis during gait.}, subject = {H{\"u}ftgelenkprothese}, language = {en} } @article{WeberMerleNawabietal., author = {Weber, Markus and Merle, Christian and Nawabi, Danyal H. and Dendorfer, Sebastian and Grifka, Joachim and Renkawitz, Tobias}, title = {Inaccurate offset restoration in total hip arthroplasty results in reduced range of motion}, series = {Scientific Reports}, volume = {10}, journal = {Scientific Reports}, number = {13208}, publisher = {Nature}, doi = {10.1038/s41598-020-70059-1}, pages = {9}, abstract = {Offset restoration in total hip arthroplasty (THA) is associated with postoperative range of motion (ROM) and gait kinematics. We aimed to research into the impact of high offset (HO) and standard stems on postoperative ROM. 121 patients received cementless THA through a minimally-invasive anterolateral approach. A 360° hip ROM analysis software calculated impingement-free hip movement based on postoperative 3D-CTs compared to ROM values necessary for activities of daily living (ADL). The same model was then run a second time after changing the stem geometry between standard and HO configuration with the implants in the same position. HO stems showed higher ROM for all directions between 4.6 and 8.9° (p < 0.001) compared with standard stems but with high interindividual variability. In the subgroup with HO stems for intraoperative offset restoration, the increase in ROM was even higher for all ROM directions with values between 6.1 and 14.4° (p < 0.001) compared to offset underrestoration with standard stems. Avoiding offset underrestoration resulted in a higher amount of patients of over 20\% for each ROM direction that fulfilled the criteria for ADL (p < 0.001). In contrast, in patients with standard stems for offset restoration ROM did increase but not clinically relevant by offset overcorrection for all directions between 3.1 and 6.1° (p < 0.001). Offset overcorrection by replacing standard with HO stems improved ROM for ADL in a low number of patients below 10\% (p > 0.03). Patient-individual restoration of offset is crucial for free ROM in THA. Both over and underrestoration of offset should be avoided.}, language = {en} } @article{VoellnerWeberWeberetal., author = {V{\"o}llner, Florian and Weber, Tim A. and Weber, Markus and Renkawitz, Tobias and Dendorfer, Sebastian and Grifka, Joachim and Craiovan, Benjamin}, title = {A simple method for determining ligament stiffness during total knee arthroplasty in vivo}, series = {Scientific Reports}, volume = {9}, journal = {Scientific Reports}, publisher = {Nature}, doi = {10.1038/s41598-019-41732-x}, pages = {1 -- 8}, abstract = {A key requirement in both native knee joints and total knee arthroplasty is a stable capsular ligament complex. However, knee stability is highly individual and ranges from clinically loose to tight. So far, hardly any in vivo data on the intrinsic mechanical of the knee are available. This study investigated if stiffness of the native ligament complex may be determined in vivo using a standard knee balancer. Measurements were obtained with a commercially available knee balancer, which was initially calibrated in vitro. 5 patients underwent reconstruction of the force-displacement curves of the ligament complex. Stiffness of the medial and lateral compartments were calculated to measure the stability of the capsular ligament complex. All force-displacement curves consisted of a non-linear section at the beginning and of a linear section from about 80 N onwards. The medial compartment showed values of 28.4 ± 1.2 N/mm for minimum stiffness and of 39.9 ± 1.1 N/mm for maximum stiffness; the respective values for the lateral compartment were 19.9 ± 0.9 N/mm and 46.6 ± 0.8 N/mm. A commercially available knee balancer may be calibrated for measuring stiffness of knee ligament complex in vivo, which may contribute to a better understanding of the intrinsic mechanical behaviour of knee joints.}, subject = {Biomechanische Analyse}, language = {en} } @article{BenditzAuerSpoerreretal., author = {Benditz, Achim and Auer, Simon and Sp{\"o}rrer, J.F. and Wolkerstorfer, S. and Grifka, Joachim and S{\"u}ß, Franz and Dendorfer, Sebastian}, title = {Regarding loads after spinal fusion, every level should be seen separately: a musculoskeletal analysis}, series = {European Spine Journal}, volume = {27}, journal = {European Spine Journal}, number = {8}, publisher = {Springer-Verlag}, doi = {10.1007/s00586-018-5476-5}, pages = {1905 -- 1910}, abstract = {The number of spinal fusion surgeries is steadily increasing and biomechanical consequences are still in debate. The aim of this study is to provide biomechanical insights into the sagittal balance of the spine and to compare spinal load before and after spinal fusion. METHOD: The joint reaction forces of 52 patients were analyzed in proximo-distal and antero-posterior direction from the levels T12-L1 to L5-S1 using musculoskeletal simulations. RESULTS: In 104 simulations, pre-surgical forces were equal to post-surgical. The levels L4-L5 and T12-L1, however, showed increased spinal forces compression forces with higher sagittal displacement. Improved restauration of sagittal balance was accompanied by lower spinal load. AP shear stress, interestingly decreased with sagittal imbalance. CONCLUSION: Imbalanced spines have a risk of increased compression forces at Th12-L1. L4-L5 always has increased spinal loads. These slides can be retrieved under Electronic Supplementary Material.}, subject = {Biomechanische Analyse}, language = {en} } @article{WeberDendorferBulstraetal., author = {Weber, Tim A. and Dendorfer, Sebastian and Bulstra, Sjoerd K. and Grifka, Joachim and Verkerke, Gijsbertus Jacob and Renkawitz, Tobias}, title = {Gait six month and one-year after computer assisted Femur First THR vs. conventional THR. Results of a patient- and observer- blinded randomized controlled trial}, series = {Gait \& Posture}, volume = {vol. 49}, journal = {Gait \& Posture}, doi = {10.1016/j.gaitpost.2016.06.035}, pages = {418 -- 425}, abstract = {A prospective randomized controlled trial is presented that is used to compare gait performance between the computer assisted Femur First (CAS FF) operation method and conventional THR (CON). 60 patients underwent a 3D gait analysis of the lower extremity at pre-operative, 6 months post-operative and twelve months post-operative. Detailed verification experiments were facilitated to ensure the quality of data as well as to avoid over-interpreting of the data. The results confirm a similar data-quality as reported in the literature. Walking speed, range of motion and symmetry thereof improved over the follow-up period, without significant differences between the groups. While all parameters do significantly increase over the follow-up period for both groups, there were no significant differences between them at any given time-point. Patients undergoing CAS FF showed a trend to improved hip flexion angle indicating a possible long-term benefit.}, language = {en} } @article{RenkawitzWeberDullienetal., author = {Renkawitz, Tobias and Weber, Tim A. and Dullien, Silvia and Woerner, Michael and Dendorfer, Sebastian and Grifka, Joachim and Weber, Markus}, title = {Leg length and offset differences above 5 mm after total hip arthroplasty are associated with altered gait kinematics}, series = {Gait \& Posture}, volume = {vol. 49}, journal = {Gait \& Posture}, doi = {10.1016/j.gaitpost.2016.07.011}, pages = {196 -- 201}, abstract = {We aimed to investigate the relationship between postoperative leg length/offset (LL/OS) reconstruction and gait performance after total hip arthroplasty (THA). In the course of a prospective randomized controlled trial, 60 patients with unilateral hip arthrosis received cementless THA through a minimally-invasive anterolateral surgical approach. One year post-operatively, LL and global OS restoration were analyzed and compared to the contralateral hip on AP pelvic radiographs. The combined postoperative limb length/OS reconstruction of the operated hip was categorized as restored (within 5 mm) or non-restored (more than 5 mm reduction or more than 5 mm increment). The acetabular component inclination, anteversion and femoral component anteversion were evaluated using CT scans of the pelvis and the femur. 3D gait analysis of the lower extremity and patient related outcome measures (HHS, HOOS, EQ-5D) were obtained pre-operatively, six months and twelve months post-operatively by an observer blinded to radiographic results. Component position of cup and stem was comparable between the restored and non-restored group. Combined LL and OS restoration within 5 mm resulted in higher Froude number (p < 0.001), normalized walking speed (p < 0.001) and hip range-of-motion (ROM) (p = 0.004) during gait twelve months postoperatively, whereas gait symmetry was comparable regardless of LL and OS reconstruction at both examinations. Clinical scores did not show any relevant association between the accuracy of LL or OS reconstruction and gait six/twelve months after THA. In summary, postoperative LL/OS discrepancies larger than 5 mm relate to unphysiological gait kinematics within the first year after THA. DRKS00000739, German Clinical Trials Register.}, language = {en} } @article{RenkawitzWeberSpringorumetal., author = {Renkawitz, Tobias and Weber, Markus and Springorum, H.-R. and Sendtner, E. and Woerner, Michael and Ulm, K. and Weber, Tim and Grifka, Joachim}, title = {Impingement-free range of motion, cup coverage and early clinical results between femur first navigation and conventional total hip arthroplasty: a randomised controlled trial}, series = {Journal of Bone \& Joint Surgery}, volume = {97-B}, journal = {Journal of Bone \& Joint Surgery}, doi = {10.1302/0301-620X.97B7.34729}, pages = {890 -- 898}, abstract = {We report the kinematic and early clinical results of a patient- and observer-blinded randomised controlled trial in which CT scans were used to compare potential impingement-free range of movement (ROM) and acetabular component cover between patients treated with either the navigated 'femur-first' total hip arthroplasty (THA) method (n = 66; male/female 29/37, mean age 62.5 years; 50 to 74) or conventional THA (n = 69; male/female 35/34, mean age 62.9 years; 50 to 75). The Hip Osteoarthritis Outcome Score, the Harris hip score, the Euro-Qol-5D and the Mancuso THA patient expectations score were assessed at six weeks, six months and one year after surgery. A total of 48 of the patients (84\%) in the navigated 'femur-first' group and 43 (65\%) in the conventional group reached all the desirable potential ROM boundaries without prosthetic impingement for activities of daily living (ADL) in flexion, extension, abduction, adduction and rotation (p = 0.016). Acetabular component cover and surface contact with the host bone were > 87\% in both groups. There was a significant difference between the navigated and the conventional groups' Harris hip scores six weeks after surgery (p = 0.010). There were no significant differences with respect to any clinical outcome at six months and one year of follow-up. The navigated 'femur-first' technique improves the potential ROM for ADL without prosthetic impingement, although there was no observed clinical difference between the two treatment groups.}, subject = {H{\"u}ftgelenkprothese}, language = {en} } @article{WeberWeberWoerneretal., author = {Weber, Markus and Weber, Tim A. and Woerner, Michael and Craiovan, Benjamin and Worlicek, Michael and Winkler, Sebastian and Grifka, Joachim and Renkawitz, Tobias}, title = {The impact of standard combined anteversion definitions on gait and clinical outcome within one year after total hip arthroplasty}, series = {International Orthopaedics}, volume = {39}, journal = {International Orthopaedics}, number = {12}, doi = {10.1007/s00264-015-2777-8}, pages = {2323 -- 2333}, abstract = {Different target areas within the concept of combined cup and stem anteversion have been published for total hip arthroplasty (THA). We asked whether component positioning according to eight standard combined anteversion rules is associated with (1) more physiological gait patterns, (2) higher improvement of gait variables and (3) better clinical outcome after THA.In a prospective clinical study, 60 patients received cementless THA through an anterolateral MIS approach in a lateral decubitus position. Six weeks postoperatively, implant position was analysed using 3D-CT by an independent external institute. Preoperatively, six and 12 months postoperatively range of motion, normalized walking speed and hip flexion symmetry index were measured using 3D motion-capture gait analysis. Patient-related outcome measures (HHS, HOOS, EQ-5D) were obtained by an observer blinded to 3D-CT results. Eight combined anteversion definitions and Lewinnek's "safe zone" were evaluated regarding their impact on gait patterns and clinical outcome.Combined cup and stem anteversion according to standard combined anteversion definitions as well as cup placement within Lewinnek's "safe zone" did not influence range of motion, normalized walking speed and/or hip flexion symmetry index six and 12 months after THA. Similarly, increase of gait parameters within the first year after THA was comparable between all eight combined anteversion rules. Clinical outcome measures like HHS, HOOS and EQ-5D did not show any benefit for either of the combined anteversion definitions.Standard combined cup and stem anteversion rules do not improve postoperative outcome as measured by gait analysis and clinical scores within one year after THA.}, subject = {H{\"u}ftgelenkprothese}, language = {en} } @inproceedings{WeberDendorferGrifkaetal., author = {Weber, Tim and Dendorfer, Sebastian and Grifka, Joachim and Weber, Markus and W{\"o}rner, Michael and Dullien, Silvia and Verkerke, Gijsbertus Jacob and Renkawitz, Tobias}, title = {Verbessert die computerassistierte Femur First Operationstechnik f{\"u}r die H{\"u}ftendoprothetik den muskuloskelettalen Lastfall auf das H{\"u}ftgelenk?}, series = {DKOU 2015, Deutscher Kongress f{\"u}r Orthop{\"a}die und Unfallchirurgie 2015}, booktitle = {DKOU 2015, Deutscher Kongress f{\"u}r Orthop{\"a}die und Unfallchirurgie 2015}, language = {de} } @inproceedings{WeberRenkawitzGrifkaetal., author = {Weber, Tim and Renkawitz, Tobias and Grifka, Joachim and Bulstra, Sjoerd K. and Verkerke, Gijsbertus Jacob and Dendorfer, Sebastian}, title = {The musculoskeletal load scenario of computer-assisted Femur-First THR up to one year after surgery}, series = {VI International Conference on Computational Bioengineering, Barcelona, Sept. 2015}, booktitle = {VI International Conference on Computational Bioengineering, Barcelona, Sept. 2015}, language = {en} }