Abstract
During hip replacement surgery the hip centre may become offset from its natural position and it is important to investigate the effect of this on the musculoskeletal system. Johnston et al [1] found that medialisation of the hip centre reduced the hip joint moment, hip contact and abductor force using a musculoskeletal model with hip centre displacements in 10mm increments. More recently an in vivo study found that the range of displacement of the hip centre of rotation was from 4.4mm laterally to 19.1mm medially [2]. To investigate the hypothesis that medialisation of the hip centre reduces the hip contact force, a musculoskeletal model of a single gait cycle was analysed using three scenarios with the hip in the neutral position and with it displaced by 10mm medially and laterally.
The lower limb musculoskeletal model included 162 Hill type muscle units in each leg and uses a muscle recruitment criterion based on minimising the squared muscle activities, where the muscle activity is the muscle force divided by the muscle’s maximum potential force. The maximum potential force is affected by the length of the muscle unit and the muscle’s tendons each are calibrated to give the correct length in its neutral position. The same gait analysis data from one normal walking cycle was applied to each modelled scenario and the resultant hip joint moment, hip contact force and muscle forces were calculated. The abductor muscles forces were summed and the peak force at heel strike reported. The peak resultant hip moments and the peak hip contact forces at heel strike are also reported and compared between the different scenarios. The scenarios were each run twice, once with the muscle tendon lengths calibrated for the hip in the altered position and subsequently with the muscle tendon lengths maintained from the neutral hip position.
For the medialising of the femoral head, the hip contact force and the peak abductor force were reduced by 4% and 2% respectively compared the neutral position. However if the tendon lengths of the muscles were maintained from the neutral position, the medial displacement model had a 3% higher hip contact force and a 6% larger abductor force than calculated for the neutral position. Although the peak resultant hip joint moment increases with a lateral displacement by 3%, the peak abductor force and peak hip contact force have a reduced force of 3% compared to the neutral hip. Using the muscle tendon lengths calibrated for the hip in the original position produces a 3% increase in the hip contact and abductor force for the lateralised femoral head.
This study has shown that the hip contact force and abductor force depend on the calibration of the muscle’s tendon lengths. Using the model with muscles calibrated for the altered hip centre produced the hypothesed reduction in hip contact force. However, maintaining the tendon lengths from the neutral position had a significant effect the calculated forces. The hip contact and abductor forces increased in the models with the original tendon lengths and the effect was also found to be greater when the hip was displaced medially.
Correspondence should be addressed to Diane Przepiorski at ISTA, PO Box 6564, Auburn, CA 95604, USA. Phone: +1 916-454-9884; Fax: +1 916-454-9882; E-mail: ista@pacbell.net
References:
1 Johnston, et al, Reconstruction Of The Hip. A Mathematical Approach To Determine Optimum Relationships. JBJS(Am.), 1979. 61(5): p.639–652. Google Scholar
2 Wan, et al, The Influence of Acetabular Component Position on Wear in Total Hip Arthroplasty. J. Arthrop, 2008. 23(1): p.51–56. Google Scholar
