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[Biomechanical aspects of load-bearing capacity after total endoprosthesis replacement of the hip joint. An evaluation of current knowledge and review of the literature].

PURPOSE: Purpose of the study was to summarize the current scientific knowledge of the interaction between rehabilitative procedures and the periprosthetic bone remodeling processes in the early postoperative phase of total hip arthroplasties. METHOD: In a comprehensive review of the international literature we analysed the interdependence between osseointegration, primary implant stability, relative micromotion of implant versus bone, and joint loading forces during mobilisation or physiotherapy. Accordingly, guidelines for the rehabilitation of cemented as well as cementless hip arthroplasties were established in order to eliminate factors disturbing prosthetic integration and hence provide for the best long-term stability of the implanted prosthesis possible. RESULTS: Osseointegration of cementless implants is impossible if relative micromotions exceed > 150 microns. Furthermore, torsional stresses (i.e. alternate climbing of stairs, rising from seated position without arm support) will destabilize uncemented femoral shaft implants. Cemented prostheses may be loaded with full body weight. Uncemented implants should be loaded only partially for at least 6 weeks. Loadings of the hip joint with more than twice the body-weight (i.e. walking without crutches, physical exercise against high resistances or long levers) are to be avoided for 3 months. The transition from the three-points walking to the two-points walking technique depends particularly on the conditions of the muscles stabilizing the hip joint. CONCLUSION: The rehabilitation of patients after total hip arthroplasty has to be brought into line with the changed biomechanical situation, the particulars of the implants and the individual requirements of the patients.

Arthroplasty, Replacement, Hip↗
PubMed1990

A model of semitendinosus muscle sarcomere length, knee and hip joint interaction in the frog hindlimb.

The interaction between the semitendinosus muscle and both hip and knee joint angles was examined in the frog (Rana pipiens) hindlimb. Sarcomere length was measured by laser diffraction in passive muscle during hip and knee rotation. A model was then developed to predict semitendinosus sarcomere length as a function of both hip and knee flexion angle. Based on published frog muscle fiber length-tension [Gordon, A. M. et al., J. Physiol. 184, 170-192 (1966)] and force-velocity [Edman, K. A. P., J. Physiol. 291, 143-159 (1979)] properties, and published joint angles during hopping [Calow, L. J. and Alexander, R. McN., J. Zool. (Lond.) 171, 293-321 (1973)], muscle sarcomere length, force and hip and knee torque during a hop were predicted. The semitendinosus muscle generally operated on the descending limb of the length-tension curve at normal joint angle combinations. The model predicted that, during a single coordinated movement, a period of sarcomere shortening (concentric) was followed by a period of sarcomere lengthening (eccentric). Based on calculated torque profiles at the hip and knee joints, this study suggested that the semitendinosus muscle probably functions more as a hip extensor than a knee flexor. In addition, based on the nature of the shortening-lengthening cycle, the semitendinosus may act to mechanically link the force of knee extension to hip extension.

Animals↗
PubMed2004

Injuries to the hip joint in frontal motor-vehicle crashes: biomechanical and real-world perspectives.

Hip fractures and dislocations in frontal crashes are of substantial concern to clinicians and automotive safety engineers because of the frequency at which hip injuries occur and the associated potential for long-term disability. Impacts to the flexed knees of unembalmed cadavers under loading conditions similar to those that occur in frontal crashes of newer-model vehicles indicate that the hip is the weakest part of the knee-thigh-hip complex and that hip injury tolerance is reduced by hip flexion and adduction from a typical driving posture. These results are being used to develop new knee-thigh-hip injury assessment criteria for use in anthropomorphic test devices (crash test dummies).

Accidents, Traffic↗
PubMed1987

Diagnostic arthroscopy of the hip joint in pigmented villonodular synovitis.

A case of pigmented villonodular synovitis of the hip is presented. The delay between the onset of symptoms and the histopathologic confirmation of this condition generally accounts for the massive local bone invasion, frequently necessitating a total hip arthroplasty. Earlier diagnosis through arthroscopy and subsequent chemical synoviorthesis might reduce the need for more aggressive surgery and improve the prognosis of this rare condition.

Adult↗