The association between periacetabular osteotomy reorientation and hip joint reaction reaction forces in two subgroups of acetabular dysplasia

JOURNAL OF BIOMECHANICS

卷:98

Article

Gaffney, Brecca M. M.¹  Clohisy, John C.²  Van Dillen, Linda R.^1,2  Harris, Michael D.^1,2,3 

[1] Washington Univ, Sch Med, Program Phys Therapy, 4444 Forest Pk Ave,Suite 1101, St Louis, MO 63108 USA

[2] Washington Univ, Sch Med, Dept Orthopaed Surg, St Louis, MO USA

[3] Washington Univ, Dept Mech Engn & Mat Sci, St Louis, MO USA

关键词: Acetabular dysplasia;    Hip;    Periacetabular osteotomy;    Probabilistic analyses;    Musculoskeletal modeling;    Joint reaction force;   

DOI  :  10.1016/j.jbiomech.2019.109464

来源: Elsevier

【 摘 要 】

Acetabular dysplasia is primarily characterized by an altered acetabular geometry that results in deficient coverage of the femoral head, and is a known cause of hip osteoarthritis. Periacetabular osteotomy (PAO) is a surgical reorientation of the acetabulum to normalize coverage, yet its effect on joint loading is unknown. Our objective was to establish how PAO, simulated with a musculoskeletal model and probabilistic analysis, alters hip joint reaction forces (JRF) in two representative patients of two different acetabular dysplasia subgroups: anterolateral and posterolateral coverage deficiencies. PAO reorientation was simulated within the musculoskeletal model by adding three surgical degrees of freedom to the acetabulum relative to the pelvis (acetabular adduction, acetabular extension, medial translation of the hip joint center). Monte Carlo simulations were performed to generate 2000 unique PAO reorientations for each patient; from which 99% confidence bounds and sensitivity factors were calculated to assess the influence of input variability (PAO reorientation) on output (hip JRF) during gait. Our results indicate that reorientation of the acetabulum alters the lines of action of the hip musculature. Specifically, as the hip joint center was medialized, the moment arm of the hip abductor muscles was increased, which in turn increased the mechanical force-generating capacity of these muscles and decreased joint loading. Independent of subgroup, hip JRF was most sensitive to hip joint center medialization. Results from this study improve understanding of how PAO reorientation affects muscle function differently dependent upon acetabular dysplasia subgrouping and can be used to inform more targeted surgical interventions. (C) 2019 Elsevier Ltd. All rights reserved.

【 授权许可】

Free