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Measuring functional outcome after total hip replacement with subject-specific hip joint loading
(2012)
Total hip replacement is an often-performed orthopedic surgical procedure; the amount of procedures undertaken will increase since our life expectancy is growing. In order to optimize function, hip biomechanics should be restored to as near normal as possible. The goal of this pilot study was to determine whether or not it is feasible to compute the vectorial hip reaction force pathways on the head of the prosthesis and the force angles relative to the cup of the prosthesis that occur during gait in total hip replacement patients, serving as an objective measurement of the functional outcome following hip replacement. A three-dimensional gait analysis, measuring ground reaction forces and kinematics, was performed. The data retrieved from the gait analysis was used as the input for the musculoskeletal model to compute vectorial joint reaction forces for data processing. To evaluate the position and orientation of the joint reaction forces, the force path, as well as the force angles for the operated and non-operated joint, has been calculated during the stance phase of the specific leg. The force path for subject 2 on the non-operated side is only located in the posterior-lateral quarter, as is the force path for subject 1. In contrast to this subject, the force path for subject 2 at the operated hip joint can be found only within the anterior quarter of the head of the implant, where it is nearly equally distributed in the medio-lateral half of the prosthesis head. The force-inclination angles on the cup of subject 1, with respect to the plane of the socket face, indicates that the force vector is mainly positioned in the same quadrant when compared with subject 2 (in a cup-fixed coordinate system). The force-anteversion angle behaves similarly to the force-inclination angle, even when the effects are not as pronounced. The proposed methods in this article are aiming to define two functional outcomes of total hip replacement that are related to wear and rim loading. It is accepted that wear is not only a function of time, but a function of use. Owing to the methods listed in this article, we are able to determine a) the applied force and b) the sliding distance (force pathway) in a subject-specific manner. The computed hip-reaction force angles and the distance to the rim cup are a measurement for cup or rim loading, and occurs in the so-called safe-zones. This method may well give us insight into the biomechanical situation during gait, after receiving total hip replacement, that we need to fully understand the mechanisms acting on a hip joint and to prove a possible increase of functional outcome after receiving total hip replacement.
Influence of minimally invasive total hip replacement on hip reaction forces and their orientations
(2014)
Minimally invasive surgery (MIS) is becoming increasingly popular. Supporters claim that the main advantages of MIS total hip replacement (THR) are less pain and a faster rehabilitation and recovery. Critics claim that safety and efficacy of MIS are yet to be determined. We focused on a biomechanical comparison between surgical standard and MIS approaches for THR during the early recovery of patients. A validated, parameterized musculoskeletal model was set to perform a squat of a 50th percentile healthy European male. A bilateral motion was chosen to investigate effects on the contralateral side. Surgical approaches were simulated by excluding the incised muscles from the computations. Resulting hip reaction forces and their symmetry and orientation were analyzed. MIS THR seemed less influential on the symmetry index of hip reaction forces between the operated and nonoperated leg when compared to the standard lateral approach. Hip reaction forces at peak loads of the standard transgluteal approach were 24% higher on the contralateral side when compared to MIS approaches. Our results suggest that MIS THR contributes to a greater symmetry of hip reaction forces in absolute value as well as force-orientation following THR.
In the last few years, increasingly kicks to the head were observed as a criminal offense. This study examined the
influence of age, shoe type and kicking direction on the severity of head trauma.
Male test persons were divided into two groups “Old” and “Young”. Both groups were equipped with light
sneakers and combat boots. A standard laboratory crash dummy was used to simulate the victim’s body. First, the
dummy’s head, free floating above the ground, was kicked vertically. Second, the dummy’s head was kicked
horizontally. Established injury criteria were used to quantify the injury risk.
No influence concerning the type of foot wear and no difference between the groups “Old” and “Young” could be
found. For all analyses, kicking vertically generally lead to a higher risk for the subject compared to kicking
horizontally.
In this study, only the integral effect of the kicks could be analyzed. A detailed injury pattern cannot directly be
derived from the data. Nevertheless, the presented data show the massive potential of injuries associated with head
kicks.
Effect of the fractured calcaneus's peripheral fragment displacement on the triceps surae function
(2015)
The gold standard for the analysis of human kinematics and kinetics is a camera-based motion capture system in combination with force measurement platforms. Alternatively, inertial measurement units can be utilized to obtain human kinematics, while ground reaction forces are computed from full body dynamics. This setup represents a system independent from the spatial confinement of a gait laboratory. The aim of this study is the comparison of the two methods by the investigation of lower limb kinematics and the resulting joint reaction forces within the ankle-, knee- and hip joints. For this purpose, human motion during gait was captured simultaneously by both measurement techniques. 13 trials from 8 different test subjects were evaluated in total. IMU data was processed with a quaternion based Kalman Filter. The data sets were implemented into a musculoskeletal simulation program in order to drive a virtual human body model. Each sensor was aligned to the gravitational and magnetic field vectors of the earth. The angles of flexions, extensions and rotations were analyzed to determine kinematic differences. Joint reaction forces defined kinetic dissimilarities. The overall kinematic differences of both models yielded root mean square errors of 7.62°, 6.02°, 4.95°, 2.79°, 2.38° and 3.56° for ankle flexion, subtalar eversion, knee flexion, hip external rotation, hip abduction and hip flexion, respectively. The proximo-distal differences in force peaks between the models yielded overall for the ankle, 57.33 %Bodyweight(BW) ± 46.86 %BW (16.66 %(Maximum peak to peak) ± 13.62 %) for the knee 37.09 %BW ± 29.33 %BW (17.65 % ± 15.44 %) and 32.03 %BW ± 24.33 %BW (15.6 % ± 12.54 %) for the hip. The overall outcome of this work investigated an approach independent of the common setup of the gait laboratory, thus enabling a cheaper and more flexible technology as an alternative. However, kinematic and thus kinetic differences remain rather large. Future work aims to improve the contact criterion for the calculation of the ground reaction forces and the implementation of a full-body calibration algorithm for the IMU system in order to counteract magnetic field disturbances.
Contact force path in total hip arthroplasty: effect of cup medialisation in a whole-body simulation
(2020)
Background:
Cup medialisation down to the true acetabular floor in total hip arthroplasty with a compensatory femoral offset increase seems to be mechanically advantageous for the abductor muscles due to the relocation of the lever arms (body weight lever arm decreased, abductor lever arm increased). However, limited information is currently available about the effects of this reconstruction type at the head cup interface, compared to an anatomical reconstruction that maintains the natural lever arms. Through a whole-body simulation analysis, we compared medialised versus anatomical reconstruction in THA to analyse the effects on: (1) contact force magnitude at the head cup interface; (2) contact force path in the cup; and (3) abductor activity.
Methods:
Musculoskeletal simulations were performed to calculate the above-mentioned parameters using inverse dynamics analysis. The differences between the virtually implanted THAs were calculated to compare the medialised versus anatomical reconstruction.
Results:
Cup medialisation with compensatory femoral offset increase led to: (1) a reduction in contact force magnitude at the head cup interface up to 6.6%; (2) a similar contact force path in the cup in terms of sliding distance and aspect ratio; and (3) a reduction in abductor activity up to 17.2% (gluteus medius).
Conclusions:
In our opinion, these potential biomechanical gains do not generally justify a fully medialised reconstruction, especially in younger patients that are more likely to undergo revision surgery in their lifetime. Cup medialisation should be performed until sufficient press fit and bony coverage of a properly sized and oriented cup can be achieved.