Gait alterations to effectively reduce hip contact forces

Wesseling, Mariska; Groote, Friedl De; Meyer, Christophe; Corten, Kristoff; Simon, Jean‐Pierre; Desloovere, Kaat; Jonkers, Ilse

doi:10.1002/jor.22852

Cited by 75 publications

(83 citation statements)

References 39 publications

(61 reference statements)

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“…Previous studies indirectly validated and compared their results with contact forces from instrumented prostheses [7,14,26]. Our contact forces were marginally higher than those from instrumented prostheses, but differences in population characteristics, age, walking speed, and activity level should be considered [7,25,28,58,61]. Fourth, although we improved subject-specific bone material properties to examine FAI, we did not examine biphasic cartilage properties or consolidation, which should be considered in future studies along with dynamic responses [3,27,51].…”

Section: Discussionmentioning

confidence: 86%

“…We retrospectively examined the participants' terminal stance phase and remarked that both asymptomatic participants along with the control participant with high femoral neck-shaft angle all had higher hip extensions. Interestingly, both symptomatic individuals had small hip extensions during terminal stance, which may have been limited by capsular ligaments or perhaps indicate a protective mechanism to minimize anterior hip contact forces [25,61]. This could be a neuromuscular adaptation mechanism to avoid pain by altering the direction and magnitude of the force vectors [30].…”

Section: Discussionmentioning

confidence: 97%

“…This may predispose to early labral damage and perhaps explain why some asymptomatic individuals do not experience early symptoms. Although the cam morphology rarely impinges at lower amplitudes of motion, the effect of a lower femoral neck-shaft angle and shortened abductor may contribute to more adverse contact loading to stabilize the pelvis during level walking [58,61,62]. We retrospectively examined the participants' terminal stance phase and remarked that both asymptomatic participants along with the control participant with high femoral neck-shaft angle all had higher hip extensions.…”

Section: Discussionmentioning

confidence: 99%

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Increased Hip Stresses Resulting From a Cam Deformity and Decreased Femoral Neck-Shaft Angle During Level Walking

Mantovani

Lamontagne

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background It is still unclear why many individuals with a cam morphology of the hip do not experience pain. It was recently reported that a decreased femoral neck-shaft angle may also be associated with hip symptoms. However, the effects that different femoral neck-shaft angles have on hip stresses in symptomatic and asymptomatic individuals with cam morphology remain unclear.Questions/purposes We examined the effects of the cam morphology and femoral neck-shaft angle on hip stresses during walking by asking: (1) Are there differences in hip stress characteristics among symptomatic patients with cam morphology, asymptomatic individuals with cam morphology, and individuals without cam morphology? (2) What are the effects of high and low femoral neck-shaft angles on hip stresses? Methods Six participants were selected, from a larger cohort, and their cam morphology and femoral neck-shaft angle parameters were measured from CT data. Two participants were included in one of three groups: (1) symptomatic with cam morphology; (2) asymptomatic with a cam morphology; and (3) asymptomatic control with no cam morphology with one participant having the highest femoral neck-shaft angle and the other participant having the lowest in each subgroup. Subject-specific finite element models were reconstructed and simulated during the stance phase, near pushoff, to examine maximum shear stresses on the acetabular cartilage and labrum. Results The symptomatic group with cam morphology indicated high peak stresses (6.3-9.5 MPa) compared with the asymptomatic (5.9-7.0 MPa) and control groups (3.8-4.0 MPa). Differences in femoral neck-shaft angle influenced both symptomatic and asymptomatic groups; participants with the lowest femoral neck-shaft angles had higher peak stresses in their respective subgroups. There were no differences among control models. Conclusions Our study suggests that the hips of individuals with a cam morphology and varus femoral neck angle may be subjected to higher mechanical stresses than those with a normal femoral neck angle. Clinical Relevance Individuals with a cam morphology and decreased femoral neck-shaft angle are likely to experience severe hip stresses. Although asymptomatic

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Increased Hip Stresses Resulting From a Cam Deformity and Decreased Femoral Neck-Shaft Angle During Level Walking

Mantovani

Lamontagne

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Reduced hip adduction in combination with an increased external rotation as well as an excessive pelvic obliquity resulted in a more vertical orientation of the hip contact forces . On the other hand, alterations in kinetics were related to changes in the magnitude of hip contact force, where increased hip adduction moments increased hip contact forces . These high contact forces were found to lead to larger contact patches .…”

mentioning

confidence: 97%

“…19 On the other hand, alterations in kinetics were related to changes in the magnitude of hip contact force, where increased hip adduction moments increased hip contact forces. 20,21 These high contact forces were found to lead to larger contact patches. 22 Therefore, both magnitude and orientation of the hip contact force are important parameters when evaluating the risk of edge loading as for a similar orientation of the contact force vector, the risk of edge loading can increase when the magnitude of the contact force increases.…”

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confidence: 99%

Gait alterations can reduce the risk of edge loading

Wesseling

Meyer

Groote

et al. 2015

Journal Orthopaedic Research

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Following metal-on-metal hip arthroplasty, edge loading (i.e., loading near the edge of a prosthesis cup) can increase wear and lead to early revision. The position and coverage angle of the prosthesis cup influence the risk of edge loading. This study investigates the effect of altered gait patterns, more specific hip, and pelvis kinematics, on the orientation of hip contact force and the consequent risk of antero-superior edge loading using muscle driven simulations of gait. With a cup orientation of 25˚anteversion and 50˚inclination and a coverage angle of 168˚, many gait patterns presented risk of edge loading. Specifically at terminal double support, 189 out of 405 gait patterns indicated a risk of edge loading. At this time instant, the high hip contact forces and the proximity of the hip contact force to the edge of the cup indicated the likelihood of the occurrence of edge loading. Although the cup position contributed most to edge loading, altering kinematics considerably influenced the risk of edge loading. Increased hip abduction, resulting in decreasing hip contact force magnitude, and decreased hip extension, resulting in decreased risk on edge loading, are gait strategies that could prevent edge loading. ß

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Unilateral hip osteoarthritis: The effect of compensation strategies and anatomic measurements on frontal plane joint loading

et al. 2016

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In order to reduce pain caused by the affected hip joint, unilateral hip osteoarthritis patients (HOAP) adopt characteristic gait patterns. However, it is unknown if the knee and hip joint loading in the non-affected (limb ) and the affected (limb ) limb differ from healthy controls (HC) and which gait parameters correlate with potential abnormal joint loading. Instrumented 3D-gait analysis was performed on 18 HOAP and 18 sex, age, and height matched HC. The limb showed greater first and second peak external hip adduction moments (first HAM: +15%, p = 0.014; second HAM: +15%, p = 0.021, respectively), than seen in HC. In contrast, the second peak external knee adduction moment (KAM) in the limb is reduced by about 23% and 30% compared to the limb and HC, respectively. Furthermore, our patients showed characteristic gait compensation strategies including reduced peak vertical forces (pvF), a greater foot progression angle (FPA), and reduced knee range of motion (ROM) in the limb . The limb was 5.6 ± 3.8 mm shorter than the limb . Results of stepwise regression analyses showed that increased first pvF explain 16% of first HAM alterations, whereas knee ROM and FPA explain 39% of second KAM alterations. We therefore expect an increased rate of progression of OA in the hip joint of the limb and suggest that the shift in the medial-to-lateral knee joint load distribution may impact the rate of progression of OA in the limb . The level of evidence is III. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1764-1773, 2017.

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Gait alterations to effectively reduce hip contact forces

Cited by 75 publications

References 39 publications

Increased Hip Stresses Resulting From a Cam Deformity and Decreased Femoral Neck-Shaft Angle During Level Walking

Increased Hip Stresses Resulting From a Cam Deformity and Decreased Femoral Neck-Shaft Angle During Level Walking

Gait alterations can reduce the risk of edge loading

Unilateral hip osteoarthritis: The effect of compensation strategies and anatomic measurements on frontal plane joint loading

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