Hip kinematics and kinetics in total hip replacement patients stratified by age and functional capacity

Dynamic Acetabular Cup Orientation during Gait: A Study of Fast- and Slow-Walking Total Hip Replacement Patients

The dynamic orientation of total hip replacement acetabular cups during walking may vary substantially from their assumed position at surgical implantation and may vary between individuals. The scale of this effect is of interest for both pre-clinical device testing and for pre-operative surgical planning. This work aimed to evaluate (1) patient variation in dynamic cup orientation; (2) whether walking speed was a candidate proxy measure for the dynamic cup orientation; and (3) the relationships between dynamic cup orientation angles and planar pelvic angles. Pelvic movement data for patients with fast (20 patients) and slow (19 patients) self-selected walking speeds were used to calculate acetabular cup inclination and version angles through gait. For aim 1, the range and extremes of acetabular cup orientation angles were analysed for all patients. A large patient-to-patient variation was found in the ranges of both inclination angle (1° to 11°) and version angle (4° to 18°). The version angle was typically retroverted in comparison to the implantation position (greatest deviation 27°). This orientation is substantially different to the static, 0° version, simplifying assumptions in pre-clinical 'edge loading' testing. For aim 2, the cup orientation angles were compared between the fast- and slow-walking groups using statistical parametric mapping. The only significant differences observed were for cup version angle, during ~12% of the gait cycle before toe-off (p < 0.05). Therefore, self-selected walking speed, in isolation, is not a sufficient proxy measure for dynamic acetabular orientation. For aim 3, correlations were recorded between the acetabular cup orientation angles and the planar pelvic angles. The cup inclination angle during gait was strongly correlated (Spearman's coefficient -1) with pelvic obliquity alone, indicating that simple planar assessment could be used to anticipate inclination angle range. The cup version angle was correlated with both pelvic rotation and tilt (Spearman's coefficient 0.8-1), indicating that cup version cannot be predicted directly from any single pelvic movement. This complexity, along with the interaction between inclination angle and range of version angle, supports the use of computational tools to aid clinical understanding.

Construction and Properties of High-Toughness Soft-Soft Interfaces Based on the Adhesion of Natural Polyphenols

Artificial joint replacement is the most effective way to treat osteoarthritis. However, these artificial joints are too stiff with high interfacial contact stress and poor surface lubrication, resulting in stress shielding and severe wear and tear lead to an extremely high failure rate. At present, hydrogels are considered the most promising substitute for artificial joint prostheses owing to their good biocompatibility, adjustable mechanical properties, and excellent flexibility. Nevertheless, a traditional single-layer hydrogel has poor bearing capacity and lubrication, which are far from the properties of natural articular cartilage. The high strength and low friction properties of natural articular cartilage are based on its own multilayer fibrous structure. Therefore, by simulating the multilayer structure of natural cartilage, a bilayer bionic cartilage hydrogel was prepared; that is, the upper hydrogel realized excellent lubrication and the lower hydrogel realized high load-bearing capacity. However, the interface binding of bilayer hydrogels is a challenge at present. Therefore, the interfacial adhesion of the bilayer hydrogel is improved by adding tannic acid (TA) based on the adhesion of the natural polyphenol structure. The average interfacial toughness reaches 3650 J/m2, and the average interfacial shear force reaches 800 kPa. In the preparation of the bilayer hydrogel, taking advantage of the coordination reaction between TA and metal cations, Fe3+ is further added to endow the bilayer hydrogel with excellent mechanical properties and good sliding friction performance. Therefore, this work opens up a new way to construct cartilage-like materials with high toughness and a soft-soft interface.

Multiscale biomechanics of the biphasic articular cartilage in the natural hip joint during routine activities

BACKGROUND AND OBJECTIVE

The investigation of the biomechanical behaviour of the articular cartilage (AC) under physiological loading is important to understand the joint function and onset of pathologies. This study aimed to develop a multiscale computational modelling approach and apply the approach to investigate the time-dependant biphasic behaviour of the AC in the natural hip joint under repetitive physiological loading over 80 cycles amongst six routine activities.

METHODS

A subject-specific musculoskeletal multibody dynamics (MBD) model was developed based on the anthropometry and motion capture data collected for a male subject. A corresponding FE model of the natural hip joint with biphasic AC was created based on the bone geometries exported from the MBD model. A multiscale computational modelling was then developed to couple the MBD model and the FE model and used to investigate the time-dependant biphasic behaviour of the AC under subject-specific physiological loading over 80 cycles amongst six routine activities.

RESULTS

The results showed that for all the activities considered, the interstitial fluid pressure in the AC supported over 80% of the loading. The maximum values of the peak contact pressure and peak fluid pressure for the whole cycle increased firstly and then remained stable over time from the 1st cycle to the 80th cycle. At these instants, the contact areas were located at the centre region of the AC. By contrast, when the contact area was located at the edge of the AC, these peak pressures were found to increase over time for some of the activities (squat, ascending stairs, descending stairs) but decrease for the other activities (normal walking, standing up, sitting down).

CONCLUSION

This study for the first time developed a multiscale computational modelling approach to couple a musculoskeletal MBD model of the body and a detailed FE model of the natural hip joint with biphasic AC, which enabled the evaluation of time-dependant biphasic behaviour of the AC under realistic physiological loading conditions. The study may have important implications in biomechanical studies of human cartilage to understand the joint function and biomechanical factors related to joint disease, and to support the development of cartilage substitution.

Optimal designs and surgical technique for hip and knee joint replacement: The best is yet to come!

Over the last three decades, there have been significant advancements in knee and hip replacement technology. The implants and the surgical technology we now have to aid in their implantation are advancing and improving functional outcomes and survivorship. Despite these advancements, there are still issues with patient satisfaction, functional limitations, and early revisions due to instability and aseptic loosening. This article reviews the state of current technology in hip and knee replacement implant design and surgical technique, and reviews some of the current implant designs and surgical technologies that may be able to solve some of the most common issues in the knee and hip replacement surgery.

Friction RandomPOD-A new method for friction measurement in noncyclic, multidirectional, dynamic pin-on-disk tests for orthopaedic bearing materials

The 16-station, computer-controlled RandomPOD wear test device was re-designed into a friction measurement device, Friction RandomPOD. The motion was implemented by a servo-electric x-y-stage and the load was proportional-pneumatic. The direction of sliding, velocity (v), acceleration, and the magnitude of the load (L) varied randomly and continuously. The nominal contact pressure p varied between 0 and 2.4 MPa and v between 0 and 40 mm/s. In the first version of the device, the frictional force components were continuously measured by two miniature load cells in two perpendicular directions. In the second version, the measurement was done with a three-axial, commercial load cell. The resultant frictional force was divided by the instantaneous load in order to obtain the coefficient of friction (μ) at a frequency of 200 Hz. Due to the light and accurate design of the device, vibrations were absent in the measured signals although the measurements were most dynamic. Hence no filtering was needed. Serum lubricated polyethylene/CoCr tests revealed non-symmetric distributions of μ, friction power P_μ, and μ vs. pv.

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

BACKGROUND

Total hip arthroplasty (THA) implants are routinely tested for their tribological performance through regulatory preclinical wear testing (eg, ISO-14242). The standardized loading conditions defined in these tests consist of simplified waveforms, which do not specifically represent in vivo loads in different groups of patients. The aim of this study is to investigate, through musculoskeletal modeling, patient-specific and activity-related variation in hip contact forces (HCFs) in a large cohort of THA patients during common activities of daily living (ADLs).

METHODS

A total of 132 THA patients participated in a motion-capture analysis while performing different ADLs, including walk, fast walk, stair ascent, and descent (locomotor); sit to stand, stand to sit, squat, and lunge (nonlocomotor). HCFs were then calculated using the AnyBody Modeling System and qualitatively compared across all activities. The influence of gender on HCFs was analyzed through statistical parametric mapping analysis.

RESULTS

Systematic differences were found in HCF magnitudes and individual components in both locomotor and nonlocomotor ADLs. The qualitative analysis of the ADLs revealed a large range and a large variability in forces experienced at the hip during different activities. Significant differences in the 3-dimensional loading patterns were observed between males and females across most activities.

CONCLUSION

THA patients present a large variability in the forces experienced at the hip joint during their daily life. The interpatient variation might partially explain the heterogeneity observed in implant survival rates. A more extensive preclinical implant testing standard under clinically relevant loading conditions has been advocated to better predict and avoid clinical wear problems.