Current Preclinical Testing of New Hip Arthroplasty Technologies Does Not Reflect Real-World Loadings: Capturing Patient-Specific and Activity-Related Variation in Hip Contact Forces

Lunn, David E.; Pieri, Enrico De; Chapman, Graham J.; Lund, Morten Enemark; Redmond, Anthony; Ferguson, Stephen J.

doi:10.1016/j.arth.2019.10.006

Cited by 27 publications

(30 citation statements)

References 45 publications

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“…Moreover, the recruited participants were all rather young, fit, and active and therefore do not represent the general population. Subject demographics, such as age, BMI, and sex, have been previously shown to relate to HCFs ( De Pieri et al, 2019 ; Lunn et al, 2020 ). We did not find any statistically significant correlation between femoral torsion values and age or BMI in our investigated cohort, nor did we find a statistically significant difference between torsional values of males and females.…”

Section: Discussionmentioning

confidence: 99%

“…The qualitative evaluation of the muscle lever arms suggested that the effect of these torsional deformities might be more pronounced for pathological ranges of femoral torsion, when the moment-generating capacity of the abductor muscles is substantially reduced. This study was also limited to an analysis of gait, which represents the most commonly performed daily activity ( Morlock et al, 2001 ); however, musculoskeletal modeling can be used to accurately assess HCFs during various activities of daily living ( De Pieri et al, 2019 ; Lunn et al, 2020 ), in which patients with hip pathologies could present more physical impairments ( Diamond et al, 2015 ; Kierkegaard et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

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Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

Pieri

Friesenbichler

List

et al. 2021

Front. Bioeng. Biotechnol.

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Hip osteoarthritis may be caused by increased or abnormal intra-articular forces, which are known to be related to structural articular cartilage damage. Femoral torsional deformities have previously been correlated with hip pain and labral damage, and they may contribute to the onset of hip osteoarthritis by exacerbating the effects of existing pathoanatomies, such as cam and pincer morphologies. A comprehensive understanding of the influence of femoral morphotypes on hip joint loading requires subject-specific morphometric and biomechanical data on the movement characteristics of individuals exhibiting varying degrees of femoral torsion. The aim of this study was to evaluate hip kinematics and kinetics as well as muscle and joint loads during gait in a group of adult subjects presenting a heterogeneous range of femoral torsion by means of personalized musculoskeletal models. Thirty-seven healthy volunteers underwent a 3D gait analysis at a self-selected walking speed. Femoral torsion was evaluated with low-dosage biplanar radiography. The collected motion capture data were used as input for an inverse dynamics analysis. Personalized musculoskeletal models were created by including femoral geometries that matched each subject’s radiographically measured femoral torsion. Correlations between femoral torsion and hip kinematics and kinetics, hip contact forces (HCFs), and muscle forces were analyzed. Within the investigated cohort, higher femoral antetorsion led to significantly higher anteromedial HCFs during gait (medial during loaded stance phase and anterior during swing phase). Most of the loads during gait are transmitted through the anterior/superolateral quadrant of the acetabulum. Correlations with hip kinematics and muscle forces were also observed. Femoral antetorsion, through altered kinematic strategies and different muscle activations and forces, may therefore lead to altered joint mechanics and pose a risk for articular damage. The method proposed in this study, which accounts for both morphological and kinematic characteristics, might help in identifying in a clinical setting patients who, as a consequence of altered femoral torsional alignment, present more severe functional impairments and altered joint mechanics and are therefore at a higher risk for cartilage damage and early onset of hip osteoarthritis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

Pieri

Friesenbichler

List

et al. 2021

Front. Bioeng. Biotechnol.

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“…Future work should therefore aim to include various combinations of anatomical morphologies and implant placements, possibly based on clinical observations, and investigate them in a larger representative population and during different daily activities. 35,36…”

Section: Discussionmentioning

confidence: 99%

Contact force path in total hip arthroplasty: effect of cup medialisation in a whole-body simulation

et al. 2020

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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.

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“…For instance, the regulatory preclinical testing standard ISO 14242-1 prescribes a simplified gait cycle, with a vertical load and sinusoidal waveforms for the rotation angles. As discussed in Lunn et al 1 and Fabry et al, 2 current preclinical tests of HAs are able to capture neither the variation in loads and kinematics of daily activities, nor the one among patients, although this is becoming more and more important: indeed, hip arthroplasty is performed in increasingly younger patients, 3 whose implants can be subjected to high loads, for example during sporting activities. Though the literature counts many studies on experimental wear tests, most of them are based on simplified walking conditions and only rarely different motor tasks, such as jogging, are considered.…”

Section: Introductionmentioning

confidence: 99%

“…4,18 Regarding the first issue, musculoskeletal (MSK) modelling represents a valuable option to estimate joint loads starting from non-invasive motion analysis. 1,[19][20][21] This approach is adopted in the present study with the aim to define a general procedure for wear prediction of MoP HAs, which could be used in in silico pre-clinical trials, investigating the effect of several daily living activities on wear. Motion analysis data collected for a subject with a right HA during walking, fast walking, lunge, squat and stair negotiation from the dataset provided by Lunn et al 1,22 and LLJ 23 are given as input to an MSK model developed in OpenSim to estimate both joint angles and joint reaction forces.…”

Section: Introductionmentioning

confidence: 99%

Combination of musculoskeletal and wear models to investigate the effect of daily living activities on wear of hip prostheses

Mattei

Tomasi

Artoni

et al. 2021

Proceedings of the Institution of Mechanical Engineers, Part J:

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Numerical wear predictions are gaining increasing interest in many engineering applications, as they allow to simulate complex operative conditions not easily replicable in the laboratory. As far as hip prostheses are concerned, most of the wear models in the literature are based on the simulation of gait (recommended also in experimental wear tests), since gait is considered the most frequent and important motor task to recover after arthroplasty. However, since joint prostheses have been increasingly implanted in younger people, high loads and potentially severe conditions, e.g. due to sporting activities, should also be considered for a more reliable wear assessment of these implants. In this study, we propose a profitable combination of musculoskeletal and analytical wear modelling for the prediction of wear caused by common daily activities in metal-on-plastic hip arthroplasties. Several motion analysis data available in the literature (walking, fast walking, lunge, squat, stair negotiation) were selected and the effects of such motor tasks on prosthesis wear were investigated, both separately and in combination. Additionally, for comparative purposes, wear prediction for simplified gait conditions prescribed by the ISO 14242 standard, were also considered. Results suggest that this latter case produces lower wear depth and volume with respect to a relatively demanding combination of the selected daily activities. The preliminary results of the present study represent a first step towards the auspicious goal of validating the proposed procedure for in silico trials of hip arthroplasties.

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Current Preclinical Testing of New Hip Arthroplasty Technologies Does Not Reflect Real-World Loadings: Capturing Patient-Specific and Activity-Related Variation in Hip Contact Forces

Cited by 27 publications

References 45 publications

Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

Contact force path in total hip arthroplasty: effect of cup medialisation in a whole-body simulation

Combination of musculoskeletal and wear models to investigate the effect of daily living activities on wear of hip prostheses

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