Capsular ligaments provide a passive stabilizing force to protect the hip against edge loading

Aims In the native hip, the hip capsular ligaments tighten at the limits of range of hip motion and may provide a passive stabilizing force to protect the hip against edge loading. In this study we quantified the stabilizing force vectors generated by capsular ligaments at extreme range of motion (ROM), and examined their ability to prevent edge loading. Methods Torque-rotation curves were obtained from nine cadaveric hips to define the rotational restraint contributions of the capsular ligaments in 36 positions. A ligament model was developed to determine the line-of-action and effective moment arms of the medial/lateral iliofemoral, ischiofemoral, and pubofemoral ligaments in all positions. The functioning ligament forces and stiffness were determined at 5 Nm rotational restraint. In each position, the contribution of engaged capsular ligaments to the joint reaction force was used to evaluate the net force vector generated by the capsule. Results The medial and lateral arms of the iliofemoral ligament generated the highest inbound force vector in positions combining extension and adduction providing anterior stability. The ischiofemoral ligament generated the highest inbound force in flexion with adduction and internal rotation (FADIR), reducing the risk of posterior dislocation. In this position the hip joint reaction force moved 0.8° inbound per Nm of internal capsular restraint, preventing edge loading. Conclusion The capsular ligaments contribute to keep the joint force vector inbound from the edge of the acetabulum at extreme ROM. Preservation and appropriate tensioning of these structures following any type of hip surgery may be crucial to minimizing complications related to joint instability. Cite this article: Bone Joint Res 2021;10(9):594–601.

Acetabular Edge Loading During Gait Is Elevated by the Anatomical Deformities of Hip Dysplasia

Developmental dysplasia of the hip (DDH) is a known risk factor for articular tissue damage and secondary hip osteoarthritis. Acetabular labral tears are prevalent in hips with DDH and may result from excessive loading at the edge of the shallow acetabulum. Location-specific risks for labral tears may also depend on neuromuscular factors such as movement patterns and muscle-induced hip joint reaction forces (JRFs). To evaluate such mechanically-induced risks, we used subject-specific musculoskeletal models to compare acetabular edge loading (AEL) during gait between individuals with DDH (N = 15) and healthy controls (N = 15), and determined the associations between AEL and radiographic measures of DDH acetabular anatomy. The three-dimensional pelvis and femur anatomy of each DDH and control subject were reconstructed from magnetic resonance images and used to personalize hip joint center locations and muscle paths in each model. Model-estimated hip JRFs were projected onto the three-dimensional acetabular rim to predict instantaneous AEL forces and their accumulative impulses throughout a gait cycle. Compared to controls, subjects with DDH demonstrated significantly higher AEL in the antero-superior acetabulum during early stance (3.6 vs. 2.8 × BW, p ≤ 0.01), late stance (4.3 vs. 3.3 × BW, p ≤ 0.05), and throughout the gait cycle (1.8 vs. 1.4 × BW*s, p ≤ 0.02), despite having similar hip movement patterns. Elevated AEL primarily occurred in regions where the shallow acetabular edge was in close proximity to the hip JRF direction, and was strongly correlated with the radiographic severity of acetabular deformities. The results suggest AEL is highly dependent on movement and muscle-induced joint loading, and significantly elevated by the DDH acetabular deformities.

Computer Navigation for Revision Total Hip Arthroplasty Reduces Dislocation Rates

INTRODUCTION: Computer-assisted hip navigation offers more accurate placement of hip components, potentially avoiding impingement, edge-loading, and dislocation; major causes of failure leading to revision THA. As such, the use of computer navigation may be particularly beneficial in the revision THA population. The purpose of this study was to determine if the use of computer-assisted hip navigation reduced the rate of dislocation in patients undergoing revision THA.METHODS: A retrospective review of 72 patients undergoing computer-navigated revision THA between February 2016 and May 2017 was performed. Demographics, indications for revision, type of procedure performed, and postoperative complications were collected for all patients. Clinical follow-up was recorded at 3-months, 1-year and 2-years.RESULTS: All 72 patients (48% female; 52% male) were included in the final analysis. Mean age of patients was 70.4 ± 11.2 years. Mean BMI was 26.4 ± 5.2 kg/m2. The most common indications for revision THA were instability (31%), aseptic loosening (29%), osteolysis/eccentric wear (18%), infection (11%), and miscellaneous (11%). At 3-months, 1-year, and 2-years there were no dislocations in any patients (0%). Compared to preoperative dislocation values, there was a significant reduction in the rate of dislocation with the use of computer-assisted hip navigation (31% vs. 0%; p<0.05).DISCUSSION: Our study demonstrates a significant reduction in the rate of dislocation following revision THA with the use of computer navigation. Although the cause of postoperative dislocation is often multifactorial, the use of computer-assisted surgery may help to curtail femoral and acetabular malalignment in revision THA.

The Influence of Kinematic Conditions and Variations in Component Positioning on the Severity of Edge Loading and Wear of Ceramic-on-Ceramic Hip Bearings

Dynamic separation and direct edge loading of hip replacement bearings can be caused by many factors, including implant positioning, implant design, changes in device over time, surgical variations and patient variations. Such dynamic separation and direct edge loading can lead to increased wear. Different input kinematic conditions have been used for experimental hip simulator studies to produce clinically relevant elliptical contact wear paths between the bearings during gait. The aim of this study was to investigate the influence of input kinematics (two axes of rotation simulation conditions (without abduction/adduction) and three axes of rotation simulation conditions (with abduction/adduction and different loading profiles) and variations in component positioning (different levels of medial-lateral translational mismatch at standard and steep cup inclination angles) on the occurrence, severity of edge loading, dynamic separation and wear of size 36 mm ceramic-on-ceramic hip bearings on an electromechanical hip joint simulator. The results showed that, overall, either of the two axes or three axes input profiles were equally valid in providing a suitable preclinical testing method for assessing the occurrence and severity of edge loading and wear under edge loading conditions. In terms of component positioning, as cup inclination and medial-lateral translational mismatch increased, so did dynamic separation, axial load at the rim, severity of edge loading and wear.