Influence of contact hip stress on the outcome of surgical treatment of hips affected by avascular necrosis

Unfavorable hip stress distribution after Legg-Calvé-Perthes syndrome: a 25-year follow-up of 135 hips

To study the effect of hip and pelvis geometry on development of the hip after Perthes disease, we determined the resultant hip force and contact hip stress distribution in a population of 135 adult hips of patients who had been treated for Perthes disease in childhood. Contra-lateral hips with no record of disease were taken as the control population. Biomechanical parameters were determined by mathematical models for resultant hip force in one-legged stance and for contact hip stress, which use as an input the geometrical parameters assessed from anteroposterior radiographs. The mathematical model for stress was upgraded to account for the deviation of the femoral head shape from spherical. No differences were found in resultant hip force and in peak contact hip stress between the hips that were in childhood subject to Perthes disease and the control population, but a considerable (148%) and significant (p < 0.001) difference was found in the contact hip stress gradient index, expressing an unfavorable, steep decrease of contact stress at the lateral acetabular rim. This finding indicates an increased risk of early coxarthritis in hips subject to Perthes disease.

Impact of triple pelvic osteotomy on contact stress pressure distribution in the hip joint

PURPOSE

We studied changes of contact stress distribution in the hip joint after Tonnis triple pelvic osteotomy applied in the treatment of dysplasia and hip joint incongruence in adolescents.

METHODS

In a group of 75 patients, 54 (72 %) female, who underwent surgery by triple pelvic osteotomy in adolescence for developmental disorder of the hip and avascular necrosis of the femoral head, a three-dimensional hip joint model was used based on the radiography of the pelvis with hips. The following biomechanical parameters were calculated: resultant hip force normalised to body weight (R/Wb), inclination of the resultant hip force (θ-R), the position of the stress pole (θ), peak contact hip stress (Pmax), and peak contact hip stress normalised to body weight (Pmax/Wb). Gait quality was also assessed.

RESULTS

After surgery the Wiberg CE angle was increased by 17.85° (114 %), resultant hip force normalised to body weight (R/Wb) was decreased by 0.107 (3.3 %), the position of the stress pole was shifted medially by 27.59° (63.5 %), and peak contact hip stress normalised to body weight (Pmax/Wb) was decreased by 2249.74 (55.9 %). Waddling gait was reduced from 17 (23.9 %) to four cases (5.6 %). All changes were statistically highly significant (p<0.01).

CONCLUSIONS

The effect of Tonnis triple pelvic osteotomy lies in the improvement of stress distribution across the acetabular cartilage of the hip joint, thus slowing down the degenerative damage of the hip joint.

The role of obesity, biomechanical constitution of the pelvis and contact joint stress in progression of hip osteoarthritis

OBJECTIVE

The aim of our study was to explore whether earlier hip arthroplasty for idiopathic osteoarthritis (OA) might be explained by enlarged contact stress in the hip joint, and to what amount can that be attributed to obesity and biomechanical constitution of the pelvis.

METHOD

Fifty subjects were selected from a list of consecutive recipients of hip endoprosthesis due to idiopathic OA; standard pelvic radiographs made years prior to surgery were the main selection criteria. For 65 hips resultant hip force and peak contact hip stress normalized to the body weight (R/Wb and p(max)/Wb) were determined from the radiographs with the HIPSTRESS method. Body weight and body mass index (BMI) were obtained with an interview. Regression analysis was used to correlate parameters of obesity (body weight, BMI), biomechanical constitution of the pelvis (R/Wb, p(max)/Wb) and mechanical loading within the hip joint (R, p(max)) with age at hip arthroplasty.

RESULTS

Younger age at hip arthroplasty was associated with higher body weight (P=0.009), higher peak contact hip stress normalized to the body weight - p(max)/Wb (P=0.019), higher resultant hip force -R (P=0.027) and larger peak contact hip stress - p(max) (P<0.001), but not with BMI (P=0.121) or R/Wb (P=0.614).

CONCLUSION

Our results suggest that enlarged contact stress (p(max)) plays an important role in rapid progression of hip OA with both obesity (increased body weight) and unfavorable biomechanical constitution of the pelvis (greater p(max)/Wb) contributing.

Higher peak contact hip stress predetermines the side of hip involved in idiopathic osteoarthritis

BACKGROUND

Biomechanical parameters of the hip have been suggested to have an important influence on the development of osteoarthritis. We aimed to find out whether higher stress is generated in a hip that subsequently results in earlier hip arthroplasty compared to the contralateral hip in the same subject.

METHODS

Standard anterior-posterior pelvic radiographs with no or subtle radiological signs of hip osteoarthritis, of 59 female patients, who underwent hip arthroplasty for primary osteoarthritis years later, were selected from the archives. For each subject peak contact hip stress of the hip with earlier arthroplasty and of the contralateral hip (pair of hips), was calculated from the radiographically obtained geometrical parameters with the HIPSTRESS program, which is based on a three-dimensional biomechanical model of the resultant hip force in the one-legged stance and a three-dimensional mathematical model of the contact hip stress distribution. Differences in peak contact hip stress within pairs of hips were determined for subjects with unilateral (22 pairs of hips) and bilateral disease (37 pairs of hips) by using paired-samples T-test.

FINDINGS

In the population of subjects with unilateral osteoarthritis, average peak contact hip stress was significantly higher (P = 0.007) in hips with arthroplasty (2.44 kPa/N) than in contralateral hips (2.32 kPa/N). In the population of subjects with bilateral osteoarthritis, average peak contact hip stress was significantly higher (P<0.001) in hips with earlier arthroplasty (2.54 kPa/N) than in contralateral hips (2.35 kPa/N).

INTERPRETATION

Results are consistent with the hypothesis that higher peak contact hip stress results in earlier hip arthroplasty due to faster development of idiopathic osteoarthritis.

Association between contact hip stress and RSA-measured wear rates in total hip arthroplasties of 31 patients

BACKGROUND

The main concern in the long run of total hip replacements is aseptic loosening of the prosthesis. Optimization of the biomechanics of the hip joint is necessary for optimization of long-term success. A widely implementable tool to predict biomechanical consequences of preoperatively planned reconstructions still has to be developed. A potentially useful model to this purpose has been developed previously. The aim of this study is to quantify the association between the estimated hip joint contact force by this biomechanical model and RSA-measured wear rates in a clinical setting.

METHODS

Thirty-one patients with a total hip replacement were measured with RSA, the gold standard for clinical wear measurements. The reference examination was done within 1 week of the operation and the follow-up examinations were done at 1, 2 and 5 years. Conventional pelvic X-rays were taken on the same day. The contact stress distribution in the hip joint was determined by the computer program HIPSTRESS. The procedure for the determination of the hip joint contact stress distribution is based on the mathematical model of the resultant hip force in the one-legged stance and the mathematical model of the contact stress distribution. The model for the force requires as input data, several geometrical parameters of the hip and the body weight, while the model for stress requires as input data, the magnitude and direction of the resultant hip force. The stress distribution is presented by the peak stress-the maximal value of stress on the weight-bearing area (p(max)) and also by the peak stress calculated with respect to the body weight (p(max)/W(B)) which gives the effect of hip geometry. Visualization of the relations between predicted values by the model and the wear at different points in the follow-up was done using scatterplots. Correlations were expressed as Pearson r values.

RESULTS

The predicted p(max) and wear were clearly correlated in the first year post-operatively (r = 0.58, p = 0.002), while this correlation is weaker after 2 years (r = 0.19, p = 0.337) and 5 years (r = 0.24, p = 0.235). The wear values at 1, 2 and 5 years post-operatively correlate with each other in the way that is expected considering the wear velocity curve of the whole group. The correlation between the predicted p(max) values of two observers who were blinded for each other's results was very good (r = 0.93, p < 0.001).

CONCLUSION

We conclude that the biomechanical model used in this paper provides a scientific foundation for the development of a new way of constructing preoperative biomechanical plans for total hip replacements.

Slotted acetabular augmentation for the treatment of residual hip dysplasia in adults: early results of 12 patients

INTRODUCTION

Different pelvic osteotomies and various shelf procedures are used for the operative treatment of hip dysplasia. Slotted acetabular augmentation (SAA) is a well-established technique for the treatment of children and adolescents with hip dysplasia. It has not been widely accepted for treating hip dysplasia in adults although good outcomes have been reported with other augmentation techniques in adults.

MATERIALS AND METHODS

Since 1997, SAA has been used for the prevention of hip arthrosis in 14 dysplastic hips in 12 female patients. The median age at operation was 38.5 (17-42) years; the median follow-up period was 4 (1-8) years. The patients were evaluated on the basis of radiographic, biomechanical and clinical data prior to surgery and at follow-up.

RESULTS

The median centre-edge angle of Wiberg increased from 9 degrees (1-26) before the operation to 43 degrees (31-55) at the latest follow-up (P < 0.001). The median peak stress on the weight-bearing area of the hip, calculated mathematically, was reduced from 14.9 (6.3-28-1) MPa prior to the operation to 4.1 (3-6.1) MPa at the latest follow-up (P < 0.001); the median Harris Hip Score increased from 60 (45-98) points preoperatively to 93 (49-100) points at the follow-up (P < 0.001). There was no difference between the preoperative and follow-up hip joint-space width (P = 0.2).

CONCLUSION

There were no postoperative complications. In our series, the procedure has proved reliable and safe. Its advantages include symptomatic pain relief, adequate acetabular roof coverage and reduced peak stress on the weight bearing area of the hip. It can be used to postpone the development of hip arthrosis in adults with acetabular dysplasia.

Contact stress in hips with osteonecrosis of the femoral head

Contact stress distribution in the articular surface of the hip is considered a factor in the development of osteoarthritis, a common complication in hips with aseptic necrosis of the femoral head. We present evidence supporting the hypothesis that osteoarthritis in hips with aseptic necrosis of the femoral head can be caused by elevated contact stress related to the reduced load-bearing ability of the necrotic bone. By using a previously validated mathematical model, we observed that hip contact stress may increase considerably if the load-bearing capacity of the necrotic lesion is decreased, if the size of the necrotic segment is increased, and if the necrotic segment is located more laterally. These effects are affected by the intrinsic shape of the hip. As the estimated values of stress in hips with osteonecrosis are in the range obtained by the same method in dysplastic hips, osteoarthritis in hips with osteonecrosis can be caused by elevated contact stress.

High contact hip stress is related to the development of hip pathology with increasing age

BACKGROUND

High contact hip stress is believed to be one of the key biomechanical factors involved in the hip cartilage degeneration and osteoarthritis. Accordingly, with increasing age high contact hip stress is expected to cause elimination of subjects from the population of healthy hips, but its predictive value has not been evaluated so far. The objective of the paper is to investigate whether the exposure of healthy hips to estimated high contact hip stress is related to the development of hip pathology with increasing age.

METHODS

A cross-sectional age- and gender-matched analysis of the peak contact hip stress calculated from pelvic geometry was made in 103 adult subjects with healthy hips. The peak contact hip stress was calculated from anterior-posterior pelvic radiographs of healthy hips by using a mathematical model of the human hip in the static one-legged stance.

FINDINGS

In both female and male population, the average values of the peak contact hip stress normalized to the body weight are significantly higher and the values are also more dispersed in younger subjects when compared to older subjects.

INTERPRETATION

The hip joints which remain healthy in the old age have lower average estimated peak contact hip stress. These results are consistent with the explanation that subjects with high estimated peak contact hip stress are more likely to develop hip disease in the course of life.