Early Postoperative Activities of Daily Living Do Not Adversely Affect Joint Torques or Translation Regardless of Capsular Condition: A Cadaveric Study

Ryan M Degen; Emma Donnelly; Asra Toobaie; K C Geoffrey Ng; Alan Getgood; Ryan Willing

doi:10.1016/j.arthro.2023.05.037

Early Postoperative Activities of Daily Living Do Not Adversely Affect Joint Torques or Translation Regardless of Capsular Condition: A Cadaveric Study

Arthroscopy. 2024 Feb;40(2):362-370. doi: 10.1016/j.arthro.2023.05.037. Epub 2023 Jun 29.

Authors

Ryan M Degen¹, Emma Donnelly², Asra Toobaie³, K C Geoffrey Ng⁴, Alan Getgood⁵, Ryan Willing⁶

Affiliations

¹ Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario; Bone and Joint Institute, Western University, London, Ontario; Department of Surgery, Western University, London, Ontario. Electronic address: Ryan.degen@lhsc.on.ca.
² Department of Mechanical and Materials Engineering, Western University, London, Ontario.
³ Department of Surgery, Western University, London, Ontario.
⁴ Department of Surgery, Western University, London, Ontario; Department of Medical Biophysics, Western University, London, Ontario; Department of Medical Imaging, Western University, London, Ontario; Robarts Research Institute, London, Ontario.
⁵ Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario; Bone and Joint Institute, Western University, London, Ontario; Department of Surgery, Western University, London, Ontario.
⁶ Department of Mechanical and Materials Engineering, Western University, London, Ontario; Department of Medical Imaging, Western University, London, Ontario; Robarts Research Institute, London, Ontario.

PMID: 37391102
DOI: 10.1016/j.arthro.2023.05.037

Abstract

Purpose: To evaluate the impact of capsular management on joint constraint and femoral head translations during simulated activities of daily living (ADL).

Methods: Using 6 (n = 6) cadaveric hip specimens, the effect of capsulotomies and repair was then evaluated during simulated ADL. Joint forces and rotational kinematics associated with gait and sitting, adopted from telemeterized implant studies, were applied to the hip using a 6-degrees of freedom (DOF) joint motion simulator. Testing occurred after creation of portals, interportal capsulotomy (IPC), IPC repair, T-capsulotomy (T-Cap), partial T-Cap repair, and full T-Cap repair. The anterior-posterior (AP), medial-lateral (ML), and axial compression DOFs were operated in force control, whereas flexion-extension, adduction-abduction, and internal-external rotation were manipulated in displacement control. Resulting femoral head translations and joint reaction torques were recorded and evaluated. Subsequently, the mean-centered range of femoral head displacements and peak signed joint restraint torques were calculated and compared.

Results: During simulated gait and sitting, the mean range of AP femoral head displacements with respect to intact exceeded 1% of the femoral head diameter after creating portals, T-Caps, and partial T-Cap repair (Wilcoxon signed rank P < .05); the mean ranges of ML displacements did not. Deviations in femoral head kinematics varied by capsule stage but were never very large. No consistent trends with respect to alterations in peak joint restrain torques were observed.

Conclusions: In this cadaveric biomechanical study, capsulotomy and repair minimally affected resultant femoral head translation and joint torques during simulated ADLs.

Clinical relevance: The tested ADLs appear safe to perform after surgery, regardless of capsular status, because adverse kinematics were not observed. However, further study is required to determine the importance of capsular repair beyond time-zero biomechanics and the resultant effect on patient-reported outcomes.

MeSH terms

Activities of Daily Living
Biomechanical Phenomena
Cadaver
Hip Joint* / surgery
Humans
Joint Instability* / surgery
Range of Motion, Articular
Torque