In vivo loading on the hip joint in patients with total hip replacement performing gymnastics and aerobics exercises

AbstractA further increase in the number of total hip arthroplasty (THA) is predicted, in particular the number of young THA patients has raised and with it their demands. There is no standardized evidence-based rehabilitation program and no reliable guidelines for sports activities after THA. Stretching and strengthening gymnastics are routinely performed in rehabilitation and aerobics as a sport after THA. The aim of the investigation was to determine the in vivo force and moments acting on the hip prosthesis during gymnastics and aerobic exercises to provide a source for evidence-based recommendations. Hip joint loads were measured in six patients with instrumented hip implants. The resulting force FRes, bending moment MBend at the neck and torsional moment MTors at the stem were examined during seven strengthening (with two different resistance bands) and four stretching gymnastic exercises and seven aerobic exercises with and without an aerobic step board compared to the loads during the reference activity walking. The stretching and strengthening gymnastics exercises and the aerobic exercises with and without a board demonstrated in their median peak force and moments mostly lower or similar values compared to walking. Significantly increased loads were recorded for the flexor stretching exercise in monopod stand (Fres and MBend), the strengthening abduction exercise on the chair (MTors) and the strengthening flexion exercise with the stronger resistance band (MTors). We also found a significant increase in median peak values in aerobic exercises with a board for the "Basic Step" (ipsilateral started Fres and MTors; contralateral started MTors), "Kickstep ipsilateral started" (Fres and MTors) and "Over the Top contralateral started" (Fres). The in vivo loads in THA patients during frequently performed stretching, strengthening and aerobic exercises were demonstrated for the first time. It was proved that stretching gymnastic exercises are safe in terms of resulting force, bending and torque moments for THA patients, although an external assistance for stabilization may be considered. Strengthening gymnastics exercises are reliable in terms of Fres, MBend and MTors, but, based on our data, we recommend to adhere to the communicated specific postoperative restrictions and select the resistance bands with lower tension. Aerobic exercises without an aerobic board can be considered as reliable activity in terms of force and moments for THA patients. Aerobic exercises with a board are not recommended for the early postoperative period and in our opinion need to be adapted to the individual muscular and coordinative resources.

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Acoustic Vibration and Mechanical In Vivo Analysis of the Hip Joint After a Total Hip Arthroplasty

ASME 2007 Summer Bioengineering Conference ◽

10.1115/sbc2007-175137 ◽

2007 ◽

Author(s):

D. A. Glaser ◽

R. D. Komistek ◽

H. E. Cates ◽

M. Mahfouz

Keyword(s):

Femoral Head ◽

Total Hip Replacement ◽

Hip Joint ◽

Hip Replacement ◽

Acoustic Vibration ◽

Valuable Insight ◽

Acetabular Cup ◽

Total Hip ◽

Resonance Frequencies

The major complications following total hip replacement (THA) are implant loosening, dislocation, instability, fracture and infection. It is hypothesized that vibration, in the range of the resonance frequencies, may cause pain, bone degeneration and fracture. A further understanding of the physical response resulting from impact during femoral head sliding may lead to valuable insight pertaining to THA failure. Therefore, the first objective of this present study was to determine if frequencies propagating through the hip joint near resonant frequencies may lead to wear or loosening of the components. Recently, studies found that femoral head sliding, often referred to as hip separation, between the acetabulum cup and the femoral head does occur, which may also play a role in complications observed with THA today, but a the effects of hip separation and the causes of its occurrence has not been studied as jet. Therefore, the second objective of this study was to determine if a sound sensor, externally attached, could be used to correlate impact loading sounds from femoral head sliding in the acetabular cup. Additional objective of this study was to develop a mathematical model that better simulates the in vivo loading conditions of total hip replacement patients using in vivo fluoroscopic and ground reaction data as input.

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Biomechanical Modeling of Hip Joint Prosthesis

World Tribology Congress III, Volume 2 ◽

10.1115/wtc2005-64276 ◽

2005 ◽

Author(s):

M. C. Gaspar ◽

A. Mateus ◽

C. Pereira ◽

F. V. Antunes

Keyword(s):

Finite Element ◽

Hip Joint ◽

Laser Scanning ◽

Hip Prosthesis ◽

Element Model ◽

Geometrical Model ◽

Elastic Behavior ◽

Joint Prosthesis ◽

Element Analysis

In this work a Bombelli cementless isoelastic RM total hip prosthesis was considered. It was implanted over a course of 14 years on the patient and studied subsequently to its chirurgical replacement. Computed Tomography, radiographies and 3-D laser scanning were used to assess the prosthesis geometry, while the original femur anatomy was modeled based on 2-D radiographies taken at different stages of the in-vivo implant of the prosthesis. A finite element model was developed, based on the generated 3-D geometrical model, considering a linear elastic behavior and typical loading conditions. This analysis allowed determining stress and strain fields throughout bone-prosthesis contact surface and critical areas in terms of micromovements. The developed procedure, consisting of 3-D scanning, generation of geometrical 3-D models and finite element analysis, results in a powerful tool to follow-up and predict failure mechanisms in hip joint prosthesis.

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IN VIVO MEASUREMENTS OF THE FRICTION MOMENT IN TOTAL HIP JOINT PROSTHESES DURING WALKING

Journal of Biomechanics ◽

10.1016/s0021-9290(12)70269-5 ◽

2012 ◽

Vol 45 ◽

pp. S268 ◽

Cited By ~ 4

Author(s):

Philipp Damm ◽

Robert Ackermann ◽

Alwina Bender ◽

Friedmar Graichen ◽

Georg Bergmann

Keyword(s):

Hip Joint ◽

Total Hip ◽

In Vivo Measurements ◽

Friction Moment ◽

Joint Prostheses

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The Utility of Digital Linear Tomosynthesis Imaging of Total Hip Joint Arthroplasty with Suspicion of Loosening: A Prospective Study in 40 Patients

BioMed Research International ◽

10.1155/2013/594631 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 19

Author(s):

Jan H. Göthlin ◽

Mats Geijer

Keyword(s):

Total Hip Arthroplasty ◽

Prospective Study ◽

Hip Joint ◽

Hip Arthroplasty ◽

Clinical Utility ◽

Hip Prosthesis ◽

Joint Arthroplasty ◽

Acetabular Cup ◽

Total Hip ◽

A Prospective Study

Aim. The clinical utility of digital linear tomosynthesis in musculoskeletal applications has been validated in only a few reports. Technical performance and utility in hip prosthesis imaging have been discussed in technical reports, but no clinical evaluation has been reported. The purpose of the current study was to assess the added clinical utility of digital linear tomosynthesis compared to radiography in loosening of total hip joint arthroplasty.Materials and Methods. In a prospective study, radiography and digital tomosynthesis were performed in 40 consecutive patients with total hip arthroplasty referred for suspect prosthesis loosening. Tomosynthesis images were compared to anterior-posterior (AP) and cross-table lateral radiographs regarding demarcation and extent of demineralization and osteolysis. Further noted were skeletal fractures, cement fractures, fragmentation, and artifacts interfering with the diagnosis.Results. Tomosynthesis was superior to radiography with sharper delineation of demineralization and osteolysis in the AP projection. A limitation was the inability to generate lateral tomosynthesis images, with inferior assessment of the area anterior and posterior to the acetabular cup compared to cross-table radiographs. Artifacts interfering with diagnosis were found in one hip.Conclusion. Tomosynthesis improved evaluation of total hip arthroplasty in the AP projection but was limited by the lack of lateral projections.

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The influence of shape and sliding distance of femoral head movement loci on the wear of acetabular cups in total hip arthroplasty

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1243/095441102321032184 ◽

2002 ◽

Vol 216 (6) ◽

pp. 393-402 ◽

Cited By ~ 14

Author(s):

D Bennett ◽

J F Orr ◽

D E Beverland ◽

R Baker

Keyword(s):

Femoral Head ◽

Aspect Ratio ◽

Hip Joint ◽

Wear Rates ◽

Total Hip ◽

Aspect Ratios ◽

Average Aspect Ratio ◽

Sliding Distance

Wear of the polyethylene acetabular component is the most serious threat to the long-term success of total hip replacements (THRs). Greatly reduced wear rates have been reported for unidirectional, compared to multidirectional, articulation in vitro. This study considers the multidirectional motions experienced at the hip joint as described by movement loci of points on the femoral head for individual THR patients. A three-dimensional computer program determined the movement loci of selected points on the femoral head for THR patients and normal subjects using kinematic data obtained from gait analysis. The sizes and shapes of these loci were quantified by their sliding distances and aspect ratios with substantial differences exhibited between individual THR patients. The average sliding distances ranged from 10.0 to 18.1 mm and the average aspect ratios of the loci ranged from 2.5 to 9.2 for the THR patients. Positive correlations were found between wear rate and average sliding distance, the inverse of the average aspect ratio of the loci and the product of the average sliding distance and the inverse of the average aspect ratio of the loci. Patients with a normal hip joint range of motion produce multidirectional motion loci and tend to experience more wear than patients with more unidirectional motion loci. Differing patterns of multidirectional motion at the hip joint for individual THR patients may explain widely differing wear rates in vivo.

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Total hip joint prosthesis for in vivo measurement of forces and moments

Medical Engineering & Physics ◽

10.1016/j.medengphy.2009.10.003 ◽

2010 ◽

Vol 32 (1) ◽

pp. 95-100 ◽

Cited By ~ 47

Author(s):

Philipp Damm ◽

Friedmar Graichen ◽

Antonius Rohlmann ◽

Alwina Bender ◽

Georg Bergmann

Keyword(s):

Hip Joint ◽

Joint Prosthesis ◽

Total Hip ◽

In Vivo Measurement

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Space Orientation of Total Hip Prosthesis

Acta Radiologica Diagnosis ◽

10.1177/028418518602700602 ◽

1986 ◽

Vol 27 (6) ◽

pp. 619-627 ◽

Cited By ~ 20

Author(s):

K. Herrlin ◽

G. Selvik ◽

H. Pettersson

Keyword(s):

Present Method ◽

Hip Prosthesis ◽

The Body ◽

Neutral Position ◽

Total Hip Prosthesis ◽

Total Hip ◽

Prosthetic Loosening

A method for in vivo determination of orientation and relation in space of components of total hip prosthesis is described. The method allows for determination of the orientation of the prosthetic components in well defined anatomic planes of the body. Furthermore the range of free motion from neutral position to the point of contact between the edge of the acetabular opening and the neck of the femoral component can be determined in various directions. To assess the accuracy of the calculations a phantom prosthesis was studied in nine different positions and the measurements of the space oriented parameters according to the present method correlated to measurements of the same parameters according to Selvik's stereophotogrammetric method. Good correlation was found. The role of prosthetic malpositioning and component interaction evaluated with the present method in the development of prosthetic loosening and displacement is discussed.

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