The impact of hip implant alignment on muscle and joint loading during dynamic activities

Casey A. Myers; Peter J. Laz; Kevin B. Shelburne; Dana L. Judd; Daniel N. Huff; Joshua D. Winters; Jennifer E. Stevens-Lapsley; Paul J. Rullkoetter

doi:10.1016/j.clinbiomech.2018.02.010

The impact of hip implant alignment on muscle and joint loading during dynamic activities

Casey A. Myers, Peter J. Laz, Kevin B. Shelburne, Dana L. Judd, Daniel N. Huff, Joshua D. Winters, Jennifer E. Stevens-Lapsley, Paul J. Rullkoetter

Athletic Training and Clinical Nutrition

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

Abstract

Background: Component alignment is an important consideration in total hip arthroplasty. The impact of changes in alignment on muscle forces and joint contact forces during dynamic tasks are not well understood, and have the potential to influence surgical decision making. The objectives of this study were to assess the impact of femoral head/stem and cup component placement on hip muscle and joint contact forces during tasks of daily living and to identify which alignment parameters have the greatest impact on joint loading. Methods: Using a series of strength-calibrated, subject-specific musculoskeletal models of patients performing gait, sit-to-stand and step down tasks, component alignments were perturbed and joint contact and muscle forces evaluated. Findings: Based on the range of alignments reported clinically, variation in head/stem anteversion-retroversion had the largest impact of any degree of freedom throughout all three tasks; average contact forces 413.5 (319.1) N during gait, 262.7 (256.4) N during sit to stand, and 572.7 (228.1) N during the step down task. The sensitivity of contact force to anteversion-retroversion of the head/stem was 31.5 N/° for gait, which was similar in magnitude to anterior-posterior position of the cup (34.6 N/m for gait). Additionally, superior-inferior cup alignment resulted in 16.4 (4.9)° of variation in the direction of the hip joint contact force across the three tasks, with the most inferior cup placements moving the force vector towards the cup equator at the point of peak joint contact force. Interpretation: A quantitative understanding of the impact and potential tradeoffs when altering component alignment is valuable in supporting surgical decision making.

Original language	English
Pages (from-to)	93-100
Number of pages	8
Journal	Clinical Biomechanics
Volume	53
DOIs	https://doi.org/10.1016/j.clinbiomech.2018.02.010
State	Published - Mar 2018

Bibliographical note

Funding Information:
This study was supported in part by DePuy Synthes Products, Inc. , the National Institute on Aging of the National Institutes of Health under Award Number T32AG000279 , and by NIH/NCATS Colorado CTSA Grant Number UL1 TR001082 . One or more of the authors (P.R., P.L.) has received funding from DePuy Synthes. One author (P.R.) is a consultant to DePuy Synthes.

Publisher Copyright:
© 2018 Elsevier Ltd

Keywords

Hip arthroplasty
Implant alignment
Joint mechanics
Muscle force
Musculoskeletal modeling

ASJC Scopus subject areas

Biophysics
Orthopedics and Sports Medicine

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10.1016/j.clinbiomech.2018.02.010

Cite this

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title = "The impact of hip implant alignment on muscle and joint loading during dynamic activities",

abstract = "Background: Component alignment is an important consideration in total hip arthroplasty. The impact of changes in alignment on muscle forces and joint contact forces during dynamic tasks are not well understood, and have the potential to influence surgical decision making. The objectives of this study were to assess the impact of femoral head/stem and cup component placement on hip muscle and joint contact forces during tasks of daily living and to identify which alignment parameters have the greatest impact on joint loading. Methods: Using a series of strength-calibrated, subject-specific musculoskeletal models of patients performing gait, sit-to-stand and step down tasks, component alignments were perturbed and joint contact and muscle forces evaluated. Findings: Based on the range of alignments reported clinically, variation in head/stem anteversion-retroversion had the largest impact of any degree of freedom throughout all three tasks; average contact forces 413.5 (319.1) N during gait, 262.7 (256.4) N during sit to stand, and 572.7 (228.1) N during the step down task. The sensitivity of contact force to anteversion-retroversion of the head/stem was 31.5 N/° for gait, which was similar in magnitude to anterior-posterior position of the cup (34.6 N/m for gait). Additionally, superior-inferior cup alignment resulted in 16.4 (4.9)° of variation in the direction of the hip joint contact force across the three tasks, with the most inferior cup placements moving the force vector towards the cup equator at the point of peak joint contact force. Interpretation: A quantitative understanding of the impact and potential tradeoffs when altering component alignment is valuable in supporting surgical decision making.",

keywords = "Hip arthroplasty, Implant alignment, Joint mechanics, Muscle force, Musculoskeletal modeling",

author = "Myers, {Casey A.} and Laz, {Peter J.} and Shelburne, {Kevin B.} and Judd, {Dana L.} and Huff, {Daniel N.} and Winters, {Joshua D.} and Stevens-Lapsley, {Jennifer E.} and Rullkoetter, {Paul J.}",

note = "Funding Information: This study was supported in part by DePuy Synthes Products, Inc. , the National Institute on Aging of the National Institutes of Health under Award Number T32AG000279 , and by NIH/NCATS Colorado CTSA Grant Number UL1 TR001082 . One or more of the authors (P.R., P.L.) has received funding from DePuy Synthes. One author (P.R.) is a consultant to DePuy Synthes. Publisher Copyright: {\textcopyright} 2018 Elsevier Ltd",

year = "2018",

month = mar,

doi = "10.1016/j.clinbiomech.2018.02.010",

language = "English",

volume = "53",

pages = "93--100",

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T1 - The impact of hip implant alignment on muscle and joint loading during dynamic activities

AU - Myers, Casey A.

AU - Laz, Peter J.

AU - Shelburne, Kevin B.

AU - Judd, Dana L.

AU - Huff, Daniel N.

AU - Winters, Joshua D.

AU - Stevens-Lapsley, Jennifer E.

AU - Rullkoetter, Paul J.

N1 - Funding Information: This study was supported in part by DePuy Synthes Products, Inc. , the National Institute on Aging of the National Institutes of Health under Award Number T32AG000279 , and by NIH/NCATS Colorado CTSA Grant Number UL1 TR001082 . One or more of the authors (P.R., P.L.) has received funding from DePuy Synthes. One author (P.R.) is a consultant to DePuy Synthes. Publisher Copyright: © 2018 Elsevier Ltd

PY - 2018/3

Y1 - 2018/3

N2 - Background: Component alignment is an important consideration in total hip arthroplasty. The impact of changes in alignment on muscle forces and joint contact forces during dynamic tasks are not well understood, and have the potential to influence surgical decision making. The objectives of this study were to assess the impact of femoral head/stem and cup component placement on hip muscle and joint contact forces during tasks of daily living and to identify which alignment parameters have the greatest impact on joint loading. Methods: Using a series of strength-calibrated, subject-specific musculoskeletal models of patients performing gait, sit-to-stand and step down tasks, component alignments were perturbed and joint contact and muscle forces evaluated. Findings: Based on the range of alignments reported clinically, variation in head/stem anteversion-retroversion had the largest impact of any degree of freedom throughout all three tasks; average contact forces 413.5 (319.1) N during gait, 262.7 (256.4) N during sit to stand, and 572.7 (228.1) N during the step down task. The sensitivity of contact force to anteversion-retroversion of the head/stem was 31.5 N/° for gait, which was similar in magnitude to anterior-posterior position of the cup (34.6 N/m for gait). Additionally, superior-inferior cup alignment resulted in 16.4 (4.9)° of variation in the direction of the hip joint contact force across the three tasks, with the most inferior cup placements moving the force vector towards the cup equator at the point of peak joint contact force. Interpretation: A quantitative understanding of the impact and potential tradeoffs when altering component alignment is valuable in supporting surgical decision making.

AB - Background: Component alignment is an important consideration in total hip arthroplasty. The impact of changes in alignment on muscle forces and joint contact forces during dynamic tasks are not well understood, and have the potential to influence surgical decision making. The objectives of this study were to assess the impact of femoral head/stem and cup component placement on hip muscle and joint contact forces during tasks of daily living and to identify which alignment parameters have the greatest impact on joint loading. Methods: Using a series of strength-calibrated, subject-specific musculoskeletal models of patients performing gait, sit-to-stand and step down tasks, component alignments were perturbed and joint contact and muscle forces evaluated. Findings: Based on the range of alignments reported clinically, variation in head/stem anteversion-retroversion had the largest impact of any degree of freedom throughout all three tasks; average contact forces 413.5 (319.1) N during gait, 262.7 (256.4) N during sit to stand, and 572.7 (228.1) N during the step down task. The sensitivity of contact force to anteversion-retroversion of the head/stem was 31.5 N/° for gait, which was similar in magnitude to anterior-posterior position of the cup (34.6 N/m for gait). Additionally, superior-inferior cup alignment resulted in 16.4 (4.9)° of variation in the direction of the hip joint contact force across the three tasks, with the most inferior cup placements moving the force vector towards the cup equator at the point of peak joint contact force. Interpretation: A quantitative understanding of the impact and potential tradeoffs when altering component alignment is valuable in supporting surgical decision making.

KW - Hip arthroplasty

KW - Implant alignment

KW - Joint mechanics

KW - Muscle force

KW - Musculoskeletal modeling

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JO - Clinical Biomechanics

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ER -

The impact of hip implant alignment on muscle and joint loading during dynamic activities

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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