Biomechanical analysis

of Hip Joint.

Prepared by:
Dr. Tumaini Matandala
 Contents:

 Introduction
 Anatomy
 Kinematics
 Carrying Angle
 Elbow Stability
 Kinetics
 Elbow Joint Forces
 Articular Surface Forces
 Calculation of Joint Reaction Forces at the Elbow
Introduction
• The hip joint, or coxofemoral joint, is the articulation of
the acetabulum of the pelvis and the head of the femur.
• Diarthrodial ball-and-socket joint

Three degrees of freedom:

1. Flexion/extension in the sagittal plane
2. Abduction/adduction in the frontal plane
3. Medial/lateral rotation in the transverse plane
 Introduction.

• The primary function of the hip joint is to support

the weight of the head, arms, and trunk (HAT)
both in static erect posture and in dynamic
postures such as ambulation, running, and stair
climbing.
 Anatomy of the Hip Joint.
Acetabulum
The opening of the acetabulum is approximately laterally
inclined 50°; anteriorly rotated (anteversion) 20°; and
anteriorly tilted 20° in the frontal, transverse, and sagittal
planes, respectively
Proximal Articular Surface.

• Acetabular depth can be measured as the center edge angle

of Wiberg
 Anatomy of the Elbow Joint.

The center edge angle (the angle of Wiberg) (A) and the angle of acetabular anteversion (B) are the angles that describe how much coverage the
acetabulum provides the femoral head. The center edge angle denotes the extent to which the acetabulum covers the femoral head in the frontal
plane; it is highly variable but measures 35° to 40° on average in radiographs of adults. The acetabular anteversion angle relates to how much the
acetabulum surrounds the femoral head within the horizontal plane. The average value is approximate 20°.
 Anatomy of the Hip Joint.
Center edge angles are classified as follows:
• Definite dysplasia less than 16°
• Possible dysplasia 16° to 25° and
• Normal greater than 25°

In addition, abnormalities in acetabular depth,

inclination, and version (abnormal positioning in
the transverse plane) can also affect femoral head
coverage
 Anatomy of the Hip Joint
• Anteversion of the acetabulum exists when the acetabulum
is positioned too far anteriorly in the transverse plane.

• Retroversion exists when the acetabulum is positioned too

far posteriorly in the transverse plane.
Anatomy of the Hip Joint
Acetabular labrum
• The entire periphery of the acetabulum is
rimmed by a ring of wedge-shaped
fibrocartilage called the acetabular labrum
• Deepens the socket, increases the concavity of
the acetabulum, grasping the head of the
femur to maintain contact with the acetabulum
• It enhances joint stability by acting as a seal to
maintain negative intra-articular pressure
• Also provide proprioceptive feedback
 Anatomy of the Hip joint
THE FEMORAL HEAD
• The femoral head is the convex component of the ball-and-
socket hip joint.
• It forms two-thirds of a sphere
Articular Cartilage:
• Thickest on the medial-central surface surrounding the fovea.
• Thinnest toward the periphery.
• Variations in thickness affect strength and stiffness in
different regions
 Anatomy of the Hip Joint-FH
Viscoelasticity:
1. Cartilage in the hip joint is viscoelastic.
2. Influences loading patterns on the femoral head based on applied
load magnitude.
Load Distribution:
3. Load-bearing area shifts:
1. Concentrated at the periphery of the lunate surface at smaller
loads.
2. Shifts to the center of the lunate surface and anterior/posterior
horns with increasing loads.
4. Studies indicate anterior and medial lunate surfaces transmit most
load during daily activity.
5. Improper formation can lead to osteoarthritis, altering load
distribution during activity.
Anatomy Cont…
THE FEMORAL NECK
• The femoral neck is a critical component of the hip
joint, contributing to its stability and mobility.
Angular Relationships: Highlight the importance of two
key angles:
• Angle of Inclination: This refers to the angle between
the femoral neck and shaft. It affects weight distribution
and load-bearing capabilities.
• Torsion Angle: This is the angle between the axis
through the femoral head and neck and the axis through
the femoral condyles. It influences the range of motion
and stability of the hip joint.
 Anatomy Cont…..
Inclination Angle:
• Starts around 140° to 150° at birth.
• Gradually decreases to about 125° in adulthood.
• Range in adulthood is typically 90°–135°.
• Coxa valga: Angle greater than 125°.
• Coxa vara: Angle less than 125°.
• Both coxa valga and coxa vara alter hip moments,
potentially leading to negative effects.
• Median angle of inclination (125°) is considered important
due to its balance.
Anatomy Cont…..
 Anatomy cont….
Torsion Angle:
• Reflects medial rotary migration of the lower limb bud during
fetal development.
• Approximately 40° in newborns.
• Decreases substantially in the first two years of life.
• Normal range: 10° to 20°.
• Anteversion: Angles greater than 12°, leading to internal
rotation of the leg during gait.
• Retroversion: Angles less than 12°, leading to external
rotation of the leg during gait.
• Both are common during childhood and typically outgrown
1. FAI and Osteoarthritis: Abnormal inclination and torsion angles,
along with structural deformities, can lead to femoroacetabular
impingement. This impingement, caused by structural deformities, is
considered the single most common cause of osteoarthritis.
2. Bone Composition and Mechanics: The femoral head and neck are
composed of cancellous bone with trabeculae organized into medial
and lateral systems. The forces and stresses, especially the joint
reaction force, parallel the trabeculae of the medial system,
highlighting their importance in supporting this force. The lateral
trabecular system likely resists compressive force produced by
contraction of abductor muscles.
3. Age-Related Changes: With aging, the femoral neck undergoes
degenerative changes, including thinning and resorption of cortical
bone, which may predispose it to fracture. This is particularly
relevant for the elderly population.
THE HIP CAPSULE AND MUSCLES SURROUNDING THE HIP
JOINT

Hip Capsule Structure and Function:

• Composed of three capsular ligaments, stabilizes the hip
joint.
• Prevents dislocation, especially in extreme motions.
• Capsular ligaments are thickened anterosuperiorly and
relatively thin posteroinferiorly.
• Rotation in fetal development coils the ligaments,
affecting stability in different positions
 THE HIP CAPSULE AND MUSCLES SURROUNDING THE HIP
JOINT

Musculotendinous Units:
• Over 27 units cross the hip joint, crucial for proper
function.
• Biomechanical modeling should include agonist-antagonist
muscle forces.
• Simplification of forces can be achieved through vector
combination.
Influence of Lower Limb Musculature:
• Musculature from knee through ankle affects hip function.
• Chronic hyperextension of the knee and weak lateral hip
rotators can cause issues.
Ligaments around the hip joint
• Both joint capsule and ligamentum teres provide stability of the hip joint
during distractive forces
 STRUCTURAL ADAPTATIONS TO WEIGHT BEARING

In standing or upright weightbearing activities, at least half the weight of the HAT (the
gravitational force) passes down through the pelvis to the femoral head, whereas the
ground reaction force (GRF) travels up the shaft.
 Trabecular system

• The medial (or principal compressive) trabecular system

• The lateral (or principal tensile) trabecular system
• Accessory (or secondary) trabecular systems
• zone of weakness
Kinematics
1. Hip Motion in Three Planes:
1. Sagittal (flexion-extension)
2. Frontal (abduction-adduction)
3. Transverse (internal-external rotation)
2. Ranges of Motion:
1. Sagittal Plane: Flexion (0° to approximately 140°), Extension
(0° to 15°)
2. Frontal Plane: Abduction (0° to 30°), Adduction (0° to 25°)
3. Transverse Plane: External Rotation (0° to 90°), Internal
Rotation (0° to 70° when hip flexed)
Kinematics
Measurement Techniques: The range of motion of the hip
joint during walking has been measured using
electrogoniometry in all three planes: sagittal, frontal, and
transverse.

Sagittal Plane Motion: During level walking, the hip joint

is maximally flexed during the late swing phase as the limb
moves forward for heel-strike. It extends as the body moves
forward at the beginning of the stance phase, reaching
maximum extension at heel-off. During the swing phase,
the joint reverses into flexion, reaching maximal flexion
(35° to 40°) prior to heel-strike.
Kinematics
Frontal Plane Motion: Abduction of the hip joint occurs
during the swing phase, reaching its maximum just after
toe-off. At heel-strike, the hip joint reverses into adduction,
continuing until late stance phase.

Transverse Plane Motion: The hip joint is externally

rotated throughout the swing phase, rotating internally just
before heel-strike. It remains internally rotated until late
stance phase, at which point it again rotates externally.
 Kinetics
Kinetics studies reveal significant forces acting on the hip joint
during various activities. Understand forces on the joint :
• Statically (standing) or
• Dynamically (e.g., climbing stairs, walking, running).
Biomechanical Analyses:
• Understanding total forces and their magnitude on the joint.
• Identifying activities potentially harmful to joints and soft
tissues.
• Differentiating between healthy and diseased joint function.
• Designing treatment and evaluation plans for hip problems or
joint replacements.
• Optimizing hip joint structure for performance.
 Kinetics - Hip Joint Musculature
Movements
• Flexion : chiefly by psoas major, iliacus assisted by rectus
femoris and sartorius
• Adductor longus assists in early flexion following full
extension

• Extension : gluteus maximus and the hamstrings.

• Abduction : gluteus medius and minimus

assisted by sartorius,tensor fasciae latae and piriformis.
Action is limited by adductor longus,pubofemoral ligament
and medial band of ilio femoral ligament
 Kinetics - Hip Joint Musculature
• Adduction : by adductor longus, adductor brevis and
adductor fibers of adductor magnus
• Lateral rotation : piriformis, obturator internus and
externus, superior and inferior gemelli and quadratus
femoris assisted by the gluteus maximus

• Medial rotation : the anterior fibers of the gluteus medius

and gluteus minimus, tensor fasciae latae

• Piriformis muscle was a lateral rotator at 0° of hip flexion

but a medial rotator at 90° of hip flexion.
HIP FREE BODY ANALYSIS
HIP FREE BODY ANALYSIS
• W = gravitational force
weight of the body minus weight of ipsilateral
extremity (or 5/6 body weight)
• M = abductor muscle force
• R = joint reaction force
can reach 3 to 6 times body weight
 kinetics-Hip joint forces and muscle function in
stance
Bilateral Stance.
• The line of gravity falls just posterior to the axis for
flexion/extension of the hip joint
• In the frontal plane during bilateral stance, the
superincumbent body weight is transmitted through the
sacroiliac joints and pelvis to the right and left femoral heads
• joint axis of each hip lies at an equal distance from the line of
gravity of HAT.
• The gravitational moment arms for the right hip(DR) and the
left hip (DL) are equal
 kinetics-Hip joint forces and muscle function in
stance
• Because the body weight (W) on each femoral head is the
same (WR = WL), the magnitude of the gravitational
torques around each hip must be identical.
• WR X DR =WL X DL
• The gravitational torques on the right and left hips occur in
opposite directions.
• The weight of the body acting around the right hip tends to
drop the pelvis down on the left (right adduction moment),
whereas the weight acting around the left hip tends to drop
the pelvis down on the right (left adduction moment)
 Kinetics-Hip joint forces and muscle function
in stance

• These two opposing gravitational moments of equal

magnitude balance each other, and the pelvis is maintained
in equilibrium in the frontal plane without the assistance of
active muscles.
 Kinetics-Hip joint forces and muscle function in
stance
• Assuming that muscular forces are not required to
maintain either sagittal or frontal plane stability at
the hip joint in bilateral stance, the compression
across each hip joint in bilateral stance should
simply be half the superimposed body weight (or
one third of HAT to each hip)
• In bilateral stance when both lower limbs bear at
least some of the superimposed weight, the
contralateral abductors and adductors may function
as synergists to control the frontal plane motion of
the pelvis.
Kinetics-Hip joint forces and muscle function in
stance
Unilateral stance
• The left leg has been lifted from the ground and the full
superimposed body weight (HAT) is being supported by
the right hip joint.
• The weight of the non-weightbearing left limb that is
hanging on the left side of the pelvis must be supported
along with the weight of HAT by right hip joint.

• Of the one-third of the portion of body weight found in

the lower extremities, the non-weightbearing limb must
account for half of that, or one sixth of the full body
weight
 Kinetics-Hip joint forces and muscle function in
stance

The magnitude of body weight (W) compressing the right hip

joint in right unilateral stance, therefore
Kinetics-Hip joint forces and muscle function in
stance
• The force of gravity acting on HAT and the
nonweightbearing left lower limb (HATLL) will create an
adduction torque around the weight-bearing hip joint
• Gravity will attempt to drop the pelvis around the right
weight-bearing hip joint axis.

• The abduction countertorque will have to be supplied

by
the hip abductor musculature
• The result will be joint compression or a joint reaction
force that is a combination of both body weight and
abductor muscular compression
 Kinetics-Hip joint forces and muscle function in
stance

Compensatory Lateral Lean of the Trunk

• The compensatory lateral lean of the trunk toward the painful stance limb will swing the line
of gravity closer to the hip joint, thereby reducing the gravitational moment arm
• It does reduce the gravitational torque.
 Kinetics-Hip joint forces and muscle function in
stance

• Use of a Cane Ipsilaterall -Body wt passes mainly through cane

• Use of a Cane Contralaterally-Cane assists the abductor muscles in providing
counter torque
 Kinetics-Hip joint forces and muscle function in
stance
Reducing joint reaction force.
Reduced by:
1.Reducing the body weight- generated momentum.

By reducing body weight or reducing the body weight

lever arm
Seen in Trelendenburg gait(leaning towards the
diseased hip)
 Kinetics-Hip joint forces and muscle function in
stance

2. Reducing the required hip abductor force.

• Altering the neck-shaft angle through varus

osteotomy/varus placement of the femoral stem.
• Increasing offset or medialization of the socket
• Use of cane in contralateral hand
EFFECT OF EXTERNAL SUPPORT ON HIP JOINT
REACTION FORCE.

• Static analysis reveals that during walking, a cane

should be utilized on the side opposite the painful or
operated hip.
• Using a cane on the contralateral side of the affected hip
joint, with careful instructions for near maximal effort,
resulted in a significant reduction in muscle activity by
42%..
• This reduction equates to approximately one times body
weight, transitioning from 2.2 times body weight with a
cane to 3.4 times body weight without.
IMPACT OF GENDER ON HIP KINETICS
Joint Reaction Forces:

• During the gait cycle, joint reaction forces vary

significantly.
• Peaks occur just after heel-strike and just before toe-off.
• During foot flat, forces decrease due to rapid
deceleration of the body’s center of gravity.
• Forces during the swing phase remain relatively low.
 IMPACT OF GENDER ON HIP KINETICS
Gender Differences:

• Force patterns are similar between genders but magnitude

differs.
• Women exhibit lower magnitudes of joint reaction forces,
reaching a maximum of approximately four times body
weight during late stance phase.
• Possible reasons for lower magnitude in women include
wider pelvis, differences in femoral angle, footwear, and gait
patterns.
 IMPACT OF GENDER ON HIP KINETICS
• Gait Differences:
• A recent study found significant differences in gait between
genders, particularly in extension and adduction joint
moments.

• Females tend to have greater adduction angles at the hip,

contributing to higher adduction moments and suggesting a
narrower step width relative to pelvic width.

• This implies higher hip joint stress in dynamic activities for

females compared to males.
 IMPACT OF GENDER ON HIP KINETICS
Implications:

• Understanding gender-specific differences in hip kinetics is

crucial for assessing joint stress and injury risk.

• These differences may have implications for designing

interventions and treatments tailored to each gender.eg
prosthetic hip

• Further research is needed to fully understand the impact of

gender on hip kinetics and to develop targeted strategies for
injury prevention and rehabilitation.
Biomechanics of total hip arthroplasty
Biomechanics of total hip arthroplasty
 Biomechanics of total hip arthroplasty
Four important variables that help determine the
stability of THA .
• Component design.
• Component position
• Soft-tissue tensioning
• Soft tissue function.
The factors affecting stability from a component position and design perspective are
dictated by two key con cepts, ‘Primary arc’ and the ‘Jump distance.

‘Primary arc’- The total movement of a prosthetic head inside a Polyethylene liner until
the point of impingement.
Jump distance.-The further movement from that point until the point of dislocation.
 Biomechanics of total hip arthroplasty
A. COMPONENT DESIGN.
• Femoral component design
• Acetabular component design

Femoral component design

• Head size (Diameter)
• Head-neck ratio

Head –Neck Ratio: Diameter of femoral head/diameter of femoral neck

Head-neck ratio < 2:1
 Femoral component design

• Large femoral heads decreased dislocation

rates due to head-neck ratio increased.

• Larger head-neck ratios allow greater Primary arc

range of motion prior to impingement

• Large femoral heads are seated deeper within the

acetabulum, increasing jump-distance
• increase in jump-distance increases joint stability
Acetabular component design

Elevated rim liner

• A posteriorly placed elevated rim liner may
increase joint stability.(increase jump distance)
Acetabular component design
Lateralized liner
• increases soft-tissue tension by increasing offset.
 Biomechanics of total hip arthroplasty
• B. COMPONENT POSITION
• Acetabular position
• Femoral stem position
• Combined version
COMPONENT POSITION

Acetabular position
Recommendations
• Anteversion :5° - 25°
• abduction :30° - 50°
• Medialization of the cup increases moment arm
of the abductors (gluteus medius & gluteus
minimus)
• Increased moment arm leads to decreased joint
reactive forces
 Acetabular position

Anteversion :5° - 25° Abduction :30° - 50°

 Acetabular position
complications
• Excessive retroversion -posterior dislocation
• Excessive anteversion -anterior dislocation
• Excessive abduction (high theta angle, vertical
cup) -posterior superior dislocation
• Eccentric polyethylene wear and late instability
 Acetabular position-Complications

Posterior dislocation Posterior superior dislocation

Femoral stem position
• Recommendations,
10°- 15° of anteversion

Combined version
Definition-femoral component anteversion plus
acetabular component anteversion
• Recommendations
• 37 degrees
 Biomechanics of total hip arthroplasty
C+D SOFT-TISSUE TENSIONING SOFT TISSUE
FUNCTION.
Importance of Abductor Muscle Force Lever Arm
Ratio:
• Influences joint reaction force on the femoral head.

Ways to Decrease Joint Reaction Forces:

• Altering center of motion in prosthetic design.
• Slight changes in abductor muscle lever arm through
surgery.
• Restoration of offset
• Definition-perpendicular distance from femoral
head center of rotation to the axis of the femur
Increased offset leads to :
• Decreased impingement
• Decreased joint reaction force
• Increases soft tissue tension without increasing leg
length
Decreased offset may lead to:
• Instability
• Abductor weakness
• Gluteus medius lurch
Increasing offset improves hip stability