Edge loading causes clinical problems for hard-on-hard hip replacements, and edge loading wear scars are present on the majority of retrieved components. We asked the question: are the lines of action of hip joint muscles such that edge loading can occur in a well-designed, well-positioned acetabular cup? A musculoskeletal model, based on cadaveric lower limb geometry, was used to calculate for each muscle, in every position within the complete range of motion, whether its contraction would safely pull the femoral head into the cup or contribute to edge loading. The results show that all the muscles that insert into the distal femur, patella, or tibia could cause edge loading of a well-positioned cup when the hip is in deep flexion. Patients frequently use distally inserting muscles for movements requiring deep hip flexion, such as sit-to-stand. Importantly, the results, which are supported by in vivo data and clinical findings, also show that risk of edge loading is dramatically reduced by combining deep hip flexion with hip abduction. Patients, including those with sub-optimally positioned cups, may be able to reduce the prevalence of edge loading by rising from chairs or stooping with the hip abducted.
|van Arkel, R. J., Modenese, L., Phillips, A. and Jeffers, J. R. (2013), Hip Abduction Can Prevent Posterior Edge Loading of Hip Replacements. Journal of Orthopaedic Research 31, 1172-1179. (2013) View|
|Phillips, A. T. M., Villette, C. C. and Modenese, L. Femoral bone mesoscale structural architecture prediction using musculoskeletal and finite element modelling. International Biomechanics 2, 43-61 (2015) View|
Through much of the anatomical and clinical literature bone is studied with a focus on its structural architecture, while it is rare for bone to be modelled using a structural mechanics as opposed to a continuum mechanics approach in the engineering literature. A novel mesoscale structural model of the femur is presented in which truss and shell elements are used to represent trabecular and cortical bone, respectively. Structural optimisation using a strain-based bone adaptation algorithm is incorporated within a musculoskeletal and finite element modelling framework to predict the structure of the femur subjected to two loading scenarios; a single load case corresponding to the frame of maximum hip joint contact force during walking and a full loading regime consisting of multiple load cases from five activities of daily living. The use of the full loading regime compared to the single load case has a profound influence on the predicted trabecular and cortical structure throughout the femur, with dramatic volume increases in the femoral shaft and the distal femur, and regional increases at the femoral neck and greater trochanter in the proximal femur. The mesoscale structural model subjected to the full loading regime shows agreement with the observed structural architecture of the femur while the structural approach has potential application in bone fracture prediction, prevention and treatment. The mesoscale structural approach achieves the synergistic goals of computational efficiency similar to a macroscale continuum approach and a resolution nearing that of a microscale continuum approach.