A multi-scale modelling framework combining musculoskeletal rigid-body simulations with adaptive finite element analyses, to evaluate the impact of femoral geometry on hip joint contact forces and femoral bone growth

Kainz, Hans; Killen, Bryce A.; Wesseling, Mariska; Pitto, Lorenzo; Aznar, José Manuel García; Shefelbine, Sandra J.; Jonkers, Ilse

doi:10.1371/journal.pone.0235966

Cited by 47 publications

(70 citation statements)

References 43 publications

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“…The hip JRFs trend monotonically increasing with anteversion angle is consistent with those reported by Kainz et al [10] using a commercial bone-deformation tool and by Heller et al [9] using a different MSK modelling approach. Our hip JRF magnitudes are comparable to [5, 10] and, as in those studies, they are larger than in vivo measurements [1]. In previous literature this overestimation has been attributed to the simplified anatomical representation of the hip muscle anatomy [15].…”

Section: Discussionsupporting

confidence: 90%

“…A systematic quantification of the impact of this lack of personalization on the accuracy of joint reaction forces (JRFs) is unavailable in previous MSK modelling literature [7]. For example, femoral anteversion, the angle between the femoral neck axis and the posterior condylar axis, has been previously shown to affect muscle moment arms in children affected by cerebral palsy [8] and to influence the hip JRFs in hip replacement patients [9] and typically developing children [10], however, its effect on the knee and ankle joints remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Dependency of Lower Limb Joint Reaction Forces on Femoral Anteversion

Modenese

Barzan

Carty

2021

Preprint

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Background: Musculoskeletal (MSK) models based on literature data are meant to represent a generic anatomy and are a popular tool employed by biomechanists to estimate the internal loads occurring in the lower limb joints, such as joint reaction forces (JRFs). However, since these models are normally just linearly scaled to an individual's anthropometry, it is unclear how their estimations would be affected by the personalization of key features of the MSK anatomy, one of which is the femoral anteversion angle. Research Question: How are the lower limb JRF magnitudes computed through a generic MSK model affected by changes in the femoral anteversion Methods: We developed a bone-deformation tool in MATLAB (shared at https://simtk.org/projects/bone_deformity) and used it to create a set of seven OpenSim models spanning from 2° femoral retroversion to 40° anteversion. We used these models to simulate the gait of an elderly individual with an instrumented prosthesis implanted at their knee joint (5th Grand Challenge dataset) and quantified both the changes in JRFs magnitude due to varying the skeletal anatomy and their accuracy against the correspondent in vivo measurements at the knee joint. Results: Hip and knee JRF magnitudes were affected by the femoral anteversion with variations from the unmodified generic model up to 11.7±5.5% at the hip and 42.6±31.0% at the knee joint. The ankle joint was unaffected by the femoral geometry. The MSK models providing the most accurate knee JRFs (root mean squared error: 0.370±0.069 body weight, coefficient of determination: 0.764±0.104, largest peak error: 0.36±0.16 body weight) were those with the femoral anteversion angle closer to that measured on the segmented bone of the individual. Significance: Femoral anteversion substantially affects hip and knee JRFs estimated with generic MSK models, suggesting that personalizing key MSK anatomical features might be necessary for accurate estimation of JRFs with these models.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Dependency of Lower Limb Joint Reaction Forces on Femoral Anteversion

Modenese

Barzan

Carty

2021

Preprint

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“…A multi-scale modelling approach, which combines musculoskeletal simulations with mechanobiological finite element analysis, can be used to predict femoral growth trends (Carriero et al, 2011;Kainz et al, 2020;Yadav et al, 2016). Carriero et al (2011) simulated femoral growth and confirmed increased NSA and AVA in three children with CP when compared to a TD child.…”

Section: Introductionmentioning

confidence: 99%

ESB Clinical Biomechanics Award 2020: Pelvis and hip movement strategies discriminate typical and pathological femoral growth – Insights gained from a multi-scale mechanobiological modelling framework

Kainz

Killen

Campenhout

et al. 2021

Clinical Biomechanics

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Background: Many children with cerebral palsy (CP) develop skeletal deformities during childhood. So far, it is unknown why some children with CP develop bony deformities whereas others do not. The aims of this study were to (i) investigate what loading characteristics lead to typical and pathological femoral growth, and (ii) evaluate why some children with CP develop femoral deformities whereas other do not. Methods: A multi-scale mechanobiological modelling workflow was used to simulate femoral growth based on three-dimensional motion capture data of six typically developing children and 16 children with CP. Based on the growth results, the participants with CP were divided into two groups: typical growth group and pathological growth group. Gait kinematics and femoral loading were compared between simulations resulting in typical growth and those resulting in pathologic growth. Findings: Hip joint contact forces were less posteriorly-oriented in the pathological growth simulations compared to the typical ones. Compared to the typically developing participants, the CP group with pathological femoral growth presented increased knee flexion and no hip extension. The CP group with simulated typical growth presented similar sagittal plane joint kinematics but differed in the frontal plane pelvic and hip movement strategy, which normalized the hip joint contact force and therefore contributed to typical femoral growth trends. Interpretation: Our simulation results identified specific gait features, which may contribute to pathological femoral growth. Furthermore, the hip joint contact force orientation in the sagittal plane seems to be the dominant factor for determining femoral growth simulations.

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“…Consequently, there is a lack of understanding in the variability of bone and joint forces due to different anatomies [ 20 ]. The ability to explore intra-personal variations within multiple subjects is necessary to investigate how individual anatomical parameters, motion patterns, and other factors (such as age and weight) affect the bone and joint force estimations [ 26 ], and subsequently how these would influence the predicted strain patterns on the femur, when combined with an individual specific organ level finite element model of the bone.…”

Section: Introductionmentioning

confidence: 99%

Femoral neck strain prediction during level walking using a combined musculoskeletal and finite element model approach

et al. 2021

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Recently, coupled musculoskeletal-finite element modelling approaches have emerged as a way to investigate femoral neck loading during various daily activities. Combining personalised gait data with finite element models will not only allow us to study changes in motion/movement, but also their effects on critical internal structures, such as the femur. However, previous studies have been hampered by the small sample size and the lack of fully personalised data in order to construct the coupled model. Therefore, the aim of this study was to build a pipeline for a fully personalised multiscale (body-organ level) model to investigate the strain levels at the femoral neck during a normal gait cycle. Five postmenopausal women were included in this study. The CT and MRI scans of the lower limb, and gait data were collected for all participants. Muscle forces derived from the body level musculoskeletal models were used as boundary constraints on the finite element femur models. Principal strains were estimated at the femoral neck region during a full gait cycle. Considerable variation was found in the predicted peak strain among individuals with mean peak first principal strain of 0.24% ± 0.11% and mean third principal strain of -0.29% ± 0.24%. For four individuals, two overall peaks of the maximum strains were found to occur when both feet were in contact with the floor, while one individual had one peak at the toe-off phase. Both the joint contact forces and the muscular forces were found to substantially influence the loading at the femoral neck. A higher correlation was found between the predicted peak strains and the gluteus medius (R2 ranged between 0.95 and 0.99) than the hip joint contact forces (R2 ranged between 0.63 and 0.96). Therefore, the current findings suggest that personal variations are substantial, and hence it is important to consider multiple subjects before deriving general conclusions for a target population.

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A multi-scale modelling framework combining musculoskeletal rigid-body simulations with adaptive finite element analyses, to evaluate the impact of femoral geometry on hip joint contact forces and femoral bone growth

Cited by 47 publications

References 43 publications

Dependency of Lower Limb Joint Reaction Forces on Femoral Anteversion

Dependency of Lower Limb Joint Reaction Forces on Femoral Anteversion

ESB Clinical Biomechanics Award 2020: Pelvis and hip movement strategies discriminate typical and pathological femoral growth – Insights gained from a multi-scale mechanobiological modelling framework

Femoral neck strain prediction during level walking using a combined musculoskeletal and finite element model approach

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