Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

Abstract

Hip osteoarthritis may be caused by increased or abnormal intra-articular forces, which are known to be related to structural articular cartilage damage. Femoral torsional deformities have previously been correlated with hip pain and labral damage, and they may contribute to the onset of hip osteoarthritis by exacerbating the effects of existing pathoanatomies, such as cam and pincer morphologies. A comprehensive understanding of the influence of femoral morphotypes on hip joint loading requires subject-specific morphometric and biomechanical data on the movement characteristics of individuals exhibiting varying degrees of femoral torsion. The aim of this study was to evaluate hip kinematics and kinetics as well as muscle and joint loads during gait in a group of adult subjects presenting a heterogeneous range of femoral torsion by means of personalized musculoskeletal models. Thirty-seven healthy volunteers underwent a 3D gait analysis at a self-selected walking speed. Femoral torsion was evaluated with low-dosage biplanar radiography. The collected motion capture data were used as input for an inverse dynamics analysis. Personalized musculoskeletal models were created by including femoral geometries that matched each subject’s radiographically measured femoral torsion. Correlations between femoral torsion and hip kinematics and kinetics, hip contact forces (HCFs), and muscle forces were analyzed. Within the investigated cohort, higher femoral antetorsion led to significantly higher anteromedial HCFs during gait (medial during loaded stance phase and anterior during swing phase). Most of the loads during gait are transmitted through the anterior/superolateral quadrant of the acetabulum. Correlations with hip kinematics and muscle forces were also observed. Femoral antetorsion, through altered kinematic strategies and different muscle activations and forces, may therefore lead to altered joint mechanics and pose a risk for articular damage. The method proposed in this study, which accounts for both morphological and kinematic characteristics, might help in identifying in a clinical setting patients who, as a consequence of altered femoral torsional alignment, present more severe functional impairments and altered joint mechanics and are therefore at a higher risk for cartilage damage and early onset of hip osteoarthritis.

Increased Femoral Anteversion Does Not Lead to Increased Joint Forces During Gait in a Cohort of Adolescent Patients

“… Passmore et al (2018) compared hip and knee loading using generic and subject-specific musculoskeletal models in a cohort of adolescent patients with increased femoral anteversion and increased tibial torsion, and predicted increased mediolateral patellofemoral joint contact forces when using subject-specific models. In a heterogeneous cohort of 37 healthy and asymptomatic adults (range: −7° retroversion to +38° anteversion), De Pieri et al (2021) found significant correlations between higher femoral anteversion and higher anterior (swing phase) and medial (loaded stance phase) hip contact forces during gait. Furthermore, modelling patient-specific femoral anteversion was also shown to be particularly important for the analysis of patients affected by cerebral palsy, who often present torsional bony deformities ( Kainz et al, 2020 ; Kainz et al, 2021 ; Veerkamp et al, 2021 ).…”

“… Ejnisman et al (2013) investigated hips with FAI and reported that patients with femoral anteversion greater than 15° were 2.2 times more likely to have labral tears. Furthermore, alterations of the femoral torsional morphology could affect the orientation of the hip intra-articular forces ( De Pieri et al, 2021 ), which could be associated with the spatial distribution of the acetabular cartilage damage observed during adulthood, especially in concomitance with other morphological alterations, such as cam and pincer deformities that characterize FAI syndrome ( Pascual-Garrido et al, 2019 ).…”

“…Since surgical corrections are taken into consideration for pediatric and adolescent patients before the onset of secondary orthopedic problems, it is particularly important to investigate potentially pathological joint mechanics in this specific demographic cohort. In order to gain a better understanding of hip and knee joint loading, musculoskeletal modelling can be used to assess intra-articular loads while accounting for both subject-specific morphological and kinematic characteristics ( De Pieri et al, 2021 ). Passmore et al (2018) compared hip and knee loading using generic and subject-specific musculoskeletal models in a cohort of adolescent patients with increased femoral anteversion and increased tibial torsion, and predicted increased mediolateral patellofemoral joint contact forces when using subject-specific models.…”

Altered Muscle Contributions are Required to Support the Stance Limb During Voluntary Toe-Walking

“…However, due to the reduced number of markers on the foot segment, the motions of the ankle joint complex were simplified by neglecting subtalar inversion and eversion, which could affect the prediction of muscle activations ( Jinha et al, 2006 ). Additionally, bone morphology variability in the transversal and frontal planes could also affect the prediction of muscle activations and forces ( Passmore et al, 2018 ; Kainz et al, 2020 ; Martelli et al, 2020 ; De Pieri et al, 2021 ; Modenese et al, 2021 ; Veerkamp et al, 2021 ).…”

Sensitivity of musculoskeletal models to variation in muscle architecture parameters

“…While the Charles et al (2019) data includes pennation angle, we lacked the data to relate the orientations of the AnyBody muscle elements to the Charles et al full muscles. We also did not address other areas of interindividual variation that could impact joint reaction and muscle forces, including variability in bone shape (e.g., pelvic shape (Cox, 2021), femoral torsion (De Pieri et al, 2021)), muscle origin and insertion locations (e.g., tibialis anterior (Zielinska et al, 2021), popliteus (Berthaume, Barnes, Athwal, & Willinger, 2020)), or even the presence or absence of anatomical elements (e.g. fabella (Berthaume & Bull, 2020), plantaris (Olewnik et al, 2020)).…”