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Yu CY, Mannen EM, Lujan TJ, Uzer G, Upasani V, Edmonds EW, Fitzpatrick CK. Porcine computational modeling to investigate developmental dysplasia of the hip. J Orthop Res 2024. [PMID: 38650103 DOI: 10.1002/jor.25858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
While it is well-established that early detection and initiation of treatment of developmental dysplasia of the hip (DDH) is crucial to successful clinical outcomes, research on the mechanics of the hip joint during healthy and pathological hip development in infants is limited. Quantification of mechanical behavior in both the healthy and dysplastic developing joints may provide insight into the causes of DDH and facilitate innovation in treatment options. In this study, subject-specific three-dimensional finite element models of two pigs were developed: one healthy pig and one pig with induced dysplasia in the right hindlimb. The objectives of this study were: (1) to characterize mechanical behavior in the acetabular articular cartilage during a normal walking cycle by analyzing six metrics: contact pressure, contact area, strain energy density, von Mises stress, principal stress, and principal strain; and (2) to quantify the effect on joint mechanics of three anatomic abnormalities previously identified as related to DDH: variation in acetabular coverage, morphological changes in the femoral head, and changes in the articular cartilage. All metrics, except the contact area, were elevated in the dysplastic joint. Morphological changes in the femoral head were determined to be the most significant factors in elevating contact pressure in the articular cartilage, while the effects of acetabular coverage and changes in the articular cartilage were less significant. The quantification of the pathomechanics of DDH in this study can help identify key mechanical factors that restore normal hip development and can lead to mechanics-driven treatment options.
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Affiliation(s)
- Chia-Yu Yu
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, Idaho, USA
| | - Erin M Mannen
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, Idaho, USA
| | - Trevor J Lujan
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, Idaho, USA
| | - Gunes Uzer
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, Idaho, USA
| | | | | | - Clare K Fitzpatrick
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, Idaho, USA
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Sun J, Zhang R, Liu S, Zhao Y, Mao G, Bian W. Biomechanical Characteristics of the Femoral Isthmus during Total Hip Arthroplasty in Patients with Adult Osteoporosis and Developmental Dysplasia of the Hip: A Finite Element Analysis. Orthop Surg 2022; 14:3019-3027. [PMID: 36125198 PMCID: PMC9627064 DOI: 10.1111/os.13474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/05/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This study investigated the underlying mechanisms of high fracture incidence in the femoral isthmus from a biomechanical perspective. Methods We retrospectively analyzed a total of 923 primary total hip arthroplasty (THA) patients and 355 osteoporosis (OP) patients admitted from January 2010 to January 2018. Through a series of screening conditions, 47 patients from each group were selected for inclusion in the study. The datasets on the unaffected side and affected side of the patients with unilateral developmental dysplasia of the hip (uDDH) were respectively classified as the normal group (Group I) and he tDDH group (Group II), and that of patients with osteoporosis were classified as the OP group (Group III). In this study, first, we collected computed tomography (CT) images and measured geometric parameters (inner and outer diameters) of the isthmus. Thereafter, to study biomechanical properties, we established six finite element models and calculated values of von Mises stress for each group with the methods of data conversion and grid processing. Results Compared with those of patients in the normal group, the values of the inner and outer diameters of femoral isthmus of patients in the DDH group were significantly lower (P < 0.001), while the inner diameters of patients in the OP group were significantly higher (P < 0.001) and the outer diameters of patients in the OP group showed no significant difference (P> 0.05). The cortical rates of patients in the normal group and the DDH group appeared insignificant (P > 0.05), and those of patients in normal group were significantly higher than those of patients in the OP group (P < 0.001). Moreover, patients in the DDH group showed a higher von Mises stress value than patients in the normal group (P < 0.001), but statistically speaking the values between patients in the OP and normal groups were insignificant (P > 0.05). Conclusions The relatively shorter inner and outer diameters of the isthmus in DDH resulted in intensive von Mises stress under the torque of the hip location, and induced a high fracture incidence. However, in patients in the OP group, the geometric morphology exhibited no anatomical variation, and the fracture was not due to the intensity of von Mises stress.
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Affiliation(s)
- Jianzhong Sun
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Rupeng Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shenghang Liu
- Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yuqi Zhao
- Xi'an Jiaotong University Health Science Center, Xi'an, China.,Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Genwen Mao
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Weiguo Bian
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Challenges in Kinetic-Kinematic Driven Musculoskeletal Subject-Specific Infant Modeling. MATHEMATICAL AND COMPUTATIONAL APPLICATIONS 2022. [DOI: 10.3390/mca27030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Musculoskeletal computational models provide a non-invasive approach to investigate human movement biomechanics. These models could be particularly useful for pediatric applications where in vivo and in vitro biomechanical parameters are difficult or impossible to examine using physical experiments alone. The objective was to develop a novel musculoskeletal subject-specific infant model to investigate hip joint biomechanics during cyclic leg movements. Experimental motion-capture marker data of a supine-lying 2-month-old infant were placed on a generic GAIT 2392 OpenSim model. After scaling the model using body segment anthropometric measurements and joint center locations, inverse kinematics and dynamics were used to estimate hip ranges of motion and moments. For the left hip, a maximum moment of 0.975 Nm and a minimum joint moment of 0.031 Nm were estimated at 34.6° and 65.5° of flexion, respectively. For the right hip, a maximum moment of 0.906 Nm and a minimum joint moment of 0.265 Nm were estimated at 23.4° and 66.5° of flexion, respectively. Results showed agreement with reported values from the literature. Further model refinements and validations are needed to develop and establish a normative infant dataset, which will be particularly important when investigating the movement of infants with pathologies such as developmental dysplasia of the hip. This research represents the first step in the longitudinal development of a model that will critically contribute to our understanding of infant growth and development during the first year of life.
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Lyu X, Chen T, Yang Z, Fu G, Feng C, Zhang T, Lu M. Tübingen hip flexion splint more successful than Pavlik harness for decentred hips after the age of three months. Bone Joint J 2021; 103-B:991-998. [PMID: 33934653 DOI: 10.1302/0301-620x.103b5.bjj-2020-1946.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The objective of this study was to evaluate the clinical and radiological outcomes of patients younger than six months of age with developmental dysplasia of the hip (DDH) managed by either a Pavlik harness or Tübingen hip flexion splint. METHODS Records of 251 consecutive infants with a mean age of 89 days (SD 47), diagnosed with DDH between January 2015 and December 2018, were retrospectively reviewed. Inclusion criteria for patients with DDH were: younger than 180 days at the time of diagnosis; ultrasound Graf classification of IIc or greater; treatment by Pavlik harness or Tübingen splint; and no prior treatment history. All patients underwent hip ultrasound every seven days during the first three weeks of treatment and subsequently every three to four weeks until completion of treatment. If no signs of improvement were found after three weeks, the Pavlik harness or Tübingen splint was discontinued. Statistical analysis was performed. RESULTS The study included 251 patients with Graf grades IIc to IV in 18 males and 233 females with DDH. Mean follow-up time was 22 months (SD 10). A total of 116 hips were graded as Graf IIc (39.1%), nine as grade D (3.0%), 100 as grade III (33.7%), and 72 as grade IV (24.2%). There were 109 patients (128 hips) in the Pavlik group and 142 patients (169 hips) in the Tübingen group (p = 0.227). The Tübingen group showed a 69.8% success rate in Graf III and Graf IV hips while the success rate was significantly lower in the Pavlik group, 53.9% (p = 0.033). For infants older than three months of age, the Tübingen group showed a 71.4% success rate, and the Pavlik group a 54.4% success rate (p = 0.047). CONCLUSION The Tübingen splint should be the preferred treatment option for children older than three months, and for those with severe forms of DDH such as Graf grade III and IV, who are younger than six months at time of diagnosis. The Tübingen hip flexion splint is a valid alternative to the Pavlik harness for older infants and those with more severe DDH. Cite this article: Bone Joint J 2021;103-B(5):991-998.
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Affiliation(s)
- XueMin Lyu
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Tao Chen
- Ultrasound Department, Beijing Jishuitan Hospital, Beijing, China
| | - Zheng Yang
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Gang Fu
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Chao Feng
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Tao Zhang
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Ming Lu
- Department of Pediatric Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
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Siddicky SF, Wang J, Rabenhorst B, Buchele L, Mannen EM. Exploring infant hip position and muscle activity in common baby gear and orthopedic devices. J Orthop Res 2021; 39:941-949. [PMID: 34566253 PMCID: PMC8462515 DOI: 10.1002/jor.24818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Infant positioning in daily life may affect hip development. While neonatal animal studies indicate detrimental relationships between inactive lower extremities and hip development and dysplasia, no research has explored infant hip biomechanics experimentally. This study evaluated hip joint position and lower extremity muscle activity of healthy infants in common body positions, baby gear, and orthopedic devices used to treat hip dysplasia (the Pavlik harness and the Rhino cruiserabduction brace). Surface electromyography(EMG) and marker-based motion capture recorded lower extremity muscle activity and kinematics of 22 healthy full-term infants (4.2±1.6 months, 13M/9F) during five conditions: Pavlik harness, Rhino brace, inward-facing soft-structured baby carrier, held in arms facing inwards, and a standard car seat. Mean filtered EMG signal, time when muscles were active, and hip position (angles) were calculated. Compared to the Pavlik harness, infants exhibited similar adductor activity (but lower hamstring and gluteus maximus activity) in the Rhino abduction brace, similar adductor and gluteus maximus activity (but lower quadriceps and hamstring activity) in the baby carrier, similar but highly variable muscle activity in-arms, and significantly lower muscle activity in the car seat. Hip position was similar between the baby carrier and the Pavlik harness. This novel infant biomechanics study illustrates the potential benefits of using inward-facing soft-structured baby carriers for healthy hip development and highlights the potential negative impact of using supine-lying container-type devices such as car seats for prolonged periods of time. Further study is needed to understand the full picture of how body position impacts infant musculoskeletal development.
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Affiliation(s)
- Safeer F. Siddicky
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
- Mechanical and Biomedical Engineering Department, College of Engineering, Boise State University, Boise, ID
| | - Junsig Wang
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Brien Rabenhorst
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Lauren Buchele
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Erin M. Mannen
- Department of Orthopaedic Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
- Mechanical and Biomedical Engineering Department, College of Engineering, Boise State University, Boise, ID
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Zhang Z, Sui D, Qin H, Li H, Zhang Z. Contact pressure distribution of the hip joint during closed reduction of developmental dysplasia of the hip: a patient-specific finite element analysis. BMC Musculoskelet Disord 2020; 21:600. [PMID: 32900362 PMCID: PMC7487652 DOI: 10.1186/s12891-020-03602-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Developmental dysplasia of the hip (DDH) is the most common deformity of the lower extremity in children. The biomechanical change during closed reduction (CR) focused on cartilage contact pressure (CCP) has not been studied. Thereby, we try to provide insight into biomechanical factors potentially responsible for the success of CR treatment sand complications by using finite element analysis (FEA) for the first time. Methods Finite element models of one patient with DDH were established based on the data of MRI scan on which cartilage contact pressure was measured. During CR, CCP between the femoral head and acetabulum in different abduction and flexion angles were tested to estimate the efficacy and potential risk factors of avascular necrosis (AVN) following CR. Results A 3D reconstruction by the FEA method was performed on a 16 months of age girl with DDH on the right side. The acetabulum of the involved side showed a long, narrow, and “flat-shaped” deformity, whereas the femoral head was smaller and irregular compared with the contralateral side. With increased abduction angle, the stress of the posterior acetabulum increased significantly, and the stress on the lateral part of the femoral head increased as well. The changes of CCP in the superior acetabulum were not apparent during CR. There were no detectable differences in terms of pressure on the femoral head. Conclusions Severe dislocation (IHDI grade III and IV) in children showed a high mismatch between the femoral head and acetabulum. Increased abduction angle corresponded with high contact pressure, which might relate to AVN, whereas increased flexion angle was not. Enhanced pressure on the lateral part of the femoral head might increase the risk of AVN.
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Affiliation(s)
- Zhiqiang Zhang
- Department of Orthopedics, National Children's Medical Center & Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Dashan Sui
- School of Materials Science and Engineering, Shanghai Jiao Tong University, 1954 Huashan Rd, Shanghai, 200030, China
| | - Haiyi Qin
- School of Materials Science and Engineering, Shanghai Jiao Tong University, 1954 Huashan Rd, Shanghai, 200030, China
| | - Hai Li
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Ziming Zhang
- Department of Pediatric Orthopedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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Wang CL, Zuo B, Li D, Zhu JF, Xiao F, Zhang XL, Chen XD. The long noncoding RNA H19 attenuates force-driven cartilage degeneration via miR-483-5p/Dusp5. Biochem Biophys Res Commun 2020; 529:210-217. [PMID: 32703413 DOI: 10.1016/j.bbrc.2020.05.180] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/25/2020] [Indexed: 02/04/2023]
Abstract
Developmental dysplasia of the hip (DDH) is a common hip disease characterized by abnormal development of the acetabulum and femoral head. In most cases, DDH ultimately leads to osteoarthritis. Anomalous biomechanical force plays an important role in cartilage degeneration in DDH. However, in addition to mechanical wear, the underlying molecular mechanisms in cartilage degeneration in DDH remain unclear. This study analyzed the effect of long noncoding RNA (lncRNA)-H19 on DDH cartilage degradation. To elucidate the specific role of lncRNA H19, we established an intermittent cyclic mechanical stress (ICMS) cell force model to simulate abnormal biomechanical environment in vitro. Then, the roles of lncRNA-H19 were also determined in vivo by establishing a model of swaddling DDH. We observed that patients with DDH possessed low levels of lncRNA-H19, COL2A1, and Aggrecan but high levels of MMP3 and Adamts5. The same results were also obtained in a DDH rat model. Furthermore, the data suggested that ICMS promoted cartilage degeneration and caused reorientation of the cytoskeleton, and lncRNA H19 helped inhibit cartilage degeneration. Bioinformatics analysis and lncRNA sequencing were performed, and luciferase assays showed that lncRNA H19 and Dusp5 are both direct targets of miR-483-5p. Moreover, Dups5 plays a negative role in ICMS-induced cartilage degradation by activating the Erk and p38 pathways. In vivo, lncRNA H19 had protective effects on the swaddling DDH model. These findings indicate that lncRNA-H19 played a positive role in cartilage degradation in DDH through the lncRNA H19/miR-483-5p/Dusp5 axis.
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Affiliation(s)
- Cheng-Long Wang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China
| | - Bin Zuo
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China
| | - De Li
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China
| | - Jun-Feng Zhu
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China
| | - Fei Xiao
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China
| | - Xiao-Ling Zhang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China.
| | - Xiao-Dong Chen
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine (SJTUSM), China.
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Biomechanical evaluation of femoral anteversion in developmental dysplasia of the hip and potential implications for closed reduction. Clin Biomech (Bristol, Avon) 2020; 72:179-185. [PMID: 31895995 DOI: 10.1016/j.clinbiomech.2019.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 10/30/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Earlier clinical reports have identified femoral anteversion as a factor associated with developmental dysplasia of the hip. This study investigates the biomechanical influence of femoral anteversion on severe dislocations and its effect on hip reduction using the Pavlik harness. METHODS A computational model of an infant lower-extremity, representing a ten-week old female was used to analyze the biomechanics of anteversion angles ranging from 30° to 70° when severe dislocation was being treated with the Pavlik harness. Specifically, the effects and relationships between muscle passive response and femoral anteversion angle were investigated over a range of hip abduction and external rotation. FINDINGS Results of this study suggest that increased femoral anteversion may decrease the success rate for treatment of high-grade developmental dysplasia of the hip when using the Pavlik harness. However, hip external rotation and decreased abduction in the harness may facilitate initial reduction in these cases. INTERPRETATION This biomechanical study may help explain why dissections of newborn specimen with developmental dysplasia of the hip have shown normal distribution of femoral anteversion in contrast to studies of patients requiring surgery where greater frequency of increased femoral anteversion has been reported. This study also suggests that adjusting the Pavlik harness to increase external hip rotation and decrease hip abduction may facilitate initial reduction for severe dislocations with increased femoral anteversion.
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Vafaeian B, Adeeb S, El-Rich M, Zonoobi D, Hareendranathan AR, Jaremko JL. Hip Joint Contact Pressure Distribution During Pavlik Harness Treatment of an Infant Hip: A Patient-Specific Finite Element Model. J Biomech Eng 2018; 140:2677753. [PMID: 29715363 DOI: 10.1115/1.4039827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Indexed: 11/08/2022]
Abstract
Developmental dysplasia of the hip (DDH) in infants under 6 months of age is typically treated by the Pavlik harness (PH). During successful PH treatment, a subluxed/dislocated hip is spontaneously reduced into the acetabulum, and DDH undergoes self-correction. PH treatment may fail due to avascular necrosis (AVN) of the femoral head. An improved understanding of mechanical factors accounting for the success/failure of PH treatment may arise from investigating articular cartilage contact pressure (CCP) within a hip during treatment. In this study, CCP in a cartilaginous infant hip was investigated through patient-specific finite element (FE) modeling. We simulated CCP of the hip equilibrated at 90 deg flexion at abduction angles of 40 deg, 60 deg, and 80 deg. We found that CCP was predominantly distributed on the anterior and posterior acetabulum, leaving the superior acetabulum (mainly superolateral) unloaded. From a mechanobiological perspective, hypothesizing that excessive pressure inhibits growth, our results qualitatively predicted increased obliquity and deepening of the acetabulum under such CCP distribution. This is the desired and observed therapeutic effect in successful PH treatment. The results also demonstrated increase in CCP as abduction increased. In particular, the simulation predicted large magnitude and concentrated CCP on the posterior wall of the acetabulum and the adjacent lateral femoral head at extreme abduction (80 deg). This CCP on lateral femoral head may reduce blood flow in femoral head vessels and contribute to AVN. Hence, this study provides insight into biomechanical factors potentially responsible for PH treatment success and complications.
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Affiliation(s)
- Behzad Vafaeian
- Department of Civil and Environmental Engineering, University of Alberta, 7-203 Donadeo Innovation Centre for Engineering, 9211-116 Street, Edmonton, AB T6G 1H9, Canada e-mail:
| | - Samer Adeeb
- Associate Professor Department of Civil and Environmental Engineering, University of Alberta, 7-203 Donadeo Innovation Centre for Engineering, , Edmonton, AB T6G 1H9, Canada e-mail:
| | - Marwan El-Rich
- Associate Professor Department of Mechanical Engineering, Khalifa University, Abu Dhabi, UAE e-mail:
| | - Dornoosh Zonoobi
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada e-mail:
| | - Abhilash R Hareendranathan
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada e-mail:
| | - Jacob L Jaremko
- Assistant Professor Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada e-mail:
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Zwawi MA, Moslehy FA, Rose C, Huayamave V, Kassab AJ, Divo E, Jones BJ, Price CT. Developmental dysplasia of the hip: A computational biomechanical model of the path of least energy for closed reduction. J Orthop Res 2017; 35:1799-1805. [PMID: 27764890 PMCID: PMC5573980 DOI: 10.1002/jor.23461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 10/14/2016] [Indexed: 02/04/2023]
Abstract
This study utilized a computational biomechanical model and applied the least energy path principle to investigate two pathways for closed reduction of high grade infantile hip dislocation. The principle of least energy when applied to moving the femoral head from an initial to a final position considers all possible paths that connect them and identifies the path of least resistance. Clinical reports of severe hip dysplasia have concluded that reduction of the femoral head into the acetabulum may occur by a direct pathway over the posterior rim of the acetabulum when using the Pavlik harness, or by an indirect pathway with reduction through the acetabular notch when using the modified Hoffman-Daimler method. This computational study also compared the energy requirements for both pathways. The anatomical and muscular aspects of the model were derived using a combination of MRI and OpenSim data. Results of this study indicate that the path of least energy closely approximates the indirect pathway of the modified Hoffman-Daimler method. The direct pathway over the posterior rim of the acetabulum required more energy for reduction. This biomechanical analysis confirms the clinical observations of the two pathways for closed reduction of severe hip dysplasia. The path of least energy closely approximated the modified Hoffman-Daimler method. Further study of the modified Hoffman-Daimler method for reduction of severe hip dysplasia may be warranted based on this computational biomechanical analysis. © 2016 The Authors. Journal of Orthopaedic Research Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 35:1799-1805, 2017.
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Affiliation(s)
- Mohammed A. Zwawi
- Department of Mechanical and Aerospace EngineeringUniversity of Central FloridaOrlandoFlorida32816
| | - Faissal A. Moslehy
- Department of Mechanical and Aerospace EngineeringUniversity of Central FloridaOrlandoFlorida32816
| | - Christopher Rose
- Department of Mechanical and Aerospace EngineeringUniversity of Central FloridaOrlandoFlorida32816
| | - Victor Huayamave
- Department of Mechanical EngineeringEmbry‐Riddle Aeronautical UniversityDaytona BeachFlorida32114
| | - Alain J. Kassab
- Department of Mechanical and Aerospace EngineeringUniversity of Central FloridaOrlandoFlorida32816
| | - Eduardo Divo
- Department of Mechanical EngineeringEmbry‐Riddle Aeronautical UniversityDaytona BeachFlorida32114
| | - Brendan J. Jones
- Department of Mechanical and Aerospace EngineeringUniversity of Central FloridaOrlandoFlorida32816
| | - Charles T. Price
- Pediatric Orthopedic SurgeryArnold Palmer Hospital, 1222 S. Orange Ave., OrlandoFlorida32806
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Vafaeian B, Zonoobi D, Mabee M, Hareendranathan AR, El-Rich M, Adeeb S, Jaremko JL. Finite element analysis of mechanical behavior of human dysplastic hip joints: a systematic review. Osteoarthritis Cartilage 2017; 25:438-447. [PMID: 27836678 DOI: 10.1016/j.joca.2016.10.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 10/20/2016] [Accepted: 10/28/2016] [Indexed: 02/02/2023]
Abstract
Developmental dysplasia of the hip (DDH) is a common condition predisposing to osteoarthritis (OA). Especially since DDH is best identified and treated in infancy before bones ossify, there is surprisingly a near-complete absence of literature examining mechanical behavior of infant dysplastic hips. We sought to identify current practice in finite element modeling (FEM) of DDH, to inform future modeling of infant dysplastic hips. We performed multi-database systematic review using PRISMA criteria. Abstracts (n = 126) fulfilling inclusion criteria were screened for methodological quality, and results were analyzed and summarized for eligible articles (n = 12). The majority of the studies modeled human adult dysplastic hips. Two studies focused on etiology of DDH through simulating mechanobiological growth of prenatal hips; we found no FEM-based studies in infants or children. Finite element models used either patient-specific geometry or idealized average geometry. Diversities in choice of material properties, boundary conditions, and loading scenarios were found in the finite-element models. FEM of adult dysplastic hips demonstrated generally smaller cartilage contact area in dysplastic hips than in normal joints. Contact pressure (CP) may be higher or lower in dysplastic hips depending on joint geometry and mechanical contribution of labrum (Lb). FEM of mechanobiological growth of prenatal hip joints revealed evidence for effects of the joint mechanical environment on formation of coxa valga, asymmetrically shallow acetabulum and malformed femoral head associated with DDH. Future modeling informed by the results of this review may yield valuable insights into optimal treatment of DDH, and into how and why OA develops early in DDH.
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Affiliation(s)
- B Vafaeian
- Department of Civil and Environmental Engineering, University of Alberta, 7-203 Donadeo Innovation Centre for Engineering, 9211-116 Street, Edmonton, Alberta, T6G 1H9, Canada.
| | - D Zonoobi
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
| | - M Mabee
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
| | - A R Hareendranathan
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
| | - M El-Rich
- Department of Civil and Environmental Engineering, University of Alberta, 7-203 Donadeo Innovation Centre for Engineering, 9211-116 Street, Edmonton, Alberta, T6G 1H9, Canada; Department of Mechanical Engineering at Khalifa University (UAE), United Arab Emirates.
| | - S Adeeb
- Department of Civil and Environmental Engineering, University of Alberta, 7-203 Donadeo Innovation Centre for Engineering, 9211-116 Street, Edmonton, Alberta, T6G 1H9, Canada.
| | - J L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 WMC, 8440-112 Street, Edmonton, Alberta, T6G 2B7, Canada.
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Wang CL, Wang H, Xiao F, Wang CD, Hu GL, Zhu JF, Shen C, Zuo B, Cui YM, Li D, Yuan-Gao, Zhang XL, Chen XD. Cyclic compressive stress-induced scinderin regulates progress of developmental dysplasia of the hip. Biochem Biophys Res Commun 2017; 485:400-408. [DOI: 10.1016/j.bbrc.2017.02.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/12/2017] [Indexed: 02/07/2023]
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Qiu A, Yang Z, Wang J, Wang T. Clinical evaluation of ultrasound screening in follow-up visits of infants with cerebral palsy at high risk for developmental dysplasia of the hip. Exp Ther Med 2016; 12:2431-2434. [PMID: 27698744 PMCID: PMC5038176 DOI: 10.3892/etm.2016.3653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/11/2016] [Indexed: 11/20/2022] Open
Abstract
The aim of the study was to assess the clinical value of ultrasound screenings for the developmental dysplasia of the hip (DDH) and explore its etiology in high-risk infants with cerebral palsy in follow-up visits. A group of 98 cases of infants at high-risk of cerebral palsy who received rehabilitation treatment between July, 2009 and July, 2010 were selected. Infants included 58 men and 40 women, aged <6 months and not lost to follow-up visits. Ultrasound (using Graf static inspection) screening of hips was performed and the infants with abnormalities were given clinical intervention, and 1- to 2-year-old infants were given outpatient follow-ups. The results were analyzed and there were 40 abnormal cases among the 98 cases of infants at high risk of cerebral palsy, including 18 cases of unstable hip joint, and 22 cases of DDH (12 cases of hip dysplasia, 3 cases of hip subluxation and 7 cases of hip dislocation). Early clinical intervention for infants with hip dysplasia and outpatient follow up for infants aged 1–2 years was carried out and had ischemic necrosis of femoral head, with the exception of 1 case of femoral detorsion that was poorly restored. In conclusion, the probability of DDH was higher in infants at high-risk of cerebral palsy compared to the normal infants. Hip ultrasound is a safe, simple, and effective screening method for these infants, which is of great clinical significance for an earlier diagnosis and treatment of DDH in infants with cerebral palsy.
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Márquez-Flórez KM, Silva O, Narváez-Tovar CA, Garzón-Alvarado DA. A Comparison of the Contact Force Distributions on the Acetabular Surface Due to Orthopedic Treatments for Developmental Hip Dysplasia. J Biomech Eng 2016; 138:2521878. [PMID: 27150210 DOI: 10.1115/1.4033547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Indexed: 11/08/2022]
Abstract
We used a three-dimensional rigid body spring model (RBSM) to compare the contact force distributions on the acetabular surface of the infant hip joint that are produced by three orthopedic treatments for developmental dysplasia of the hip (DDH). We analyzed treatments using a Pavlik harness, a generic rigid splint, and a spica cast. The joint geometry was modeled from tomography images of a 1-year-old female. The articular cartilage was modeled as linear springs connecting the surfaces of the acetabulum and the femoral head, whereas the femur and the hip bone were considered as rigid bodies. The hip muscles were modeled as tensile-only preloaded springs. The treatments with the Pavlik harness and the generic rigid splint were modeled for an infant in supine position with a hip flexion angle of 90 deg. Also, since rigid splints are often recommended when children are initiating their gait phase, we modeled the treatment with the infant in standing position. For the spica cast, we only considered the infant in standing position with a flexion angle of 0 deg, and the fixation bar at two heights: at the ankle and at the knee. In order to analyze the effect of the hip abduction angle over the contact force distribution, different abduction angles were used for all the treatments modeled. We have found that the treatments with the infant in supine position, with a flexion angle of 90 deg and abduction angles between 60 deg and 80 deg, produce a more homogenous contact force distribution compared to those obtained for the treatments with the infant in standing position.
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