Abstract
Introduction
Biomechanical analysis is an important tool that could improve the treatment of a diseased hip. However, it is still unclear how the biomechanical status affects the clinical outcome of a certain disease. In this work we studied the long-term effect of contact hip stress on the clinical outcome of hips that were operated on by various intertrochanteric osteotomies due to avascular necrosis of the femoral head. The hypothesis being tested is that the hips with a more favourable postoperative distribution of contact hip stress have a better clinical outcome.
Materials and methods
The study was performed on a population of 30 hips. For each hip, we determined the peak contact hip stress before the operation and immediately after the operation by using a recently developed method based on a three-dimensional mathematical model and the data from standard anteroposterior roentgenographs of both hips and pelvis. The hips were evaluated clinically 9–26 years after the operation and divided into a successful and an unsuccessful group. The average change of the peak stress due to the operation was calculated for each group, and the values were compared by t-test.
Results
In the successful group the operation caused an average decrease of the peak hip stress of about 10%, while in the unsuccessful group the operation caused an average increase of the peak hip stress of about 4%, the difference between the respective changes of the peak stress due to the operation being statistically significant (p=0.001).
Conclusion
Our results support the hypothesis that the hips with a more favourable postoperative distribution of contact hip stress have a better clinical outcome.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Atsumi T, Yoshikatsu K (1992) Role of impairment of blood supply of the femoral head in the pathogenesis of idiopathic osteonecrosis. Clin Orthop 277:22–30
Baker KJ, Brown TD, Brand RA (1989) A finite element analysis of the effects of intertrochanteric osteotomy on stress in femoral head osteonecrosis. Clin Orthop 249:183–198
Brand RA, Iglič A, Kralj-Iglič V (2001) Contact stress in the human hip: implications for disease and treatment. Hip Int 11:117–126
Brown TD, Way ME, Ferguson AB (1980) Stress transmission anomalies in femoral heads altered by aseptic necrosis. J Biomech 13:687–699
Brown TD, Mutschler TA, Ferguson AB (1982) A non linear finite element analysis of some early collapse processes in femoral head osteonecrosis. J Biomech 15:705–715
Brown TD, Pedersen DR, Baker KJ, Brand RA (1993) Mechanical consequences of core drilling and bone grafting on osteonecrosis of the femoral head. J Bone Joint Surg Am 75:1358–1367
Daniel M, Antolič V, Iglič A, Kralj-Iglič V (2001) Determination of contact hip stress from nomograms based on a mathematical model. Med Eng Phys 23:347–357
Dolinar D, Herman S, Daniel M, Pavlovčič V, Iglič A, Kralj-Iglič V (2002) Distribution of contact hip joint stress in avascular necrosis of femoral head. In: Bedzinski R (ed) Proceedings of the 13th Conference of European Society of Biomechanics, Wroclav, pp 302–303
Dostal WF, Andrews JG (1981) A three dimensional biomechanical model of the hip musculature. J Biomech 14:803–812
Ficat RP, Arlet J (1980) Functional investigation of bone under normal conditions. In: Hungerford DS (ed) Ishemia and necrosis of bone. Wiliams and Wilkins, Baltimore, pp 29–52
Iglič A, Kralj-Iglič V (1999) Computer system for determination of hip joint contact stress distribution from standard AP pelvic radiographs. Radiol Oncol 33:263–266
Iglič A, Srakar F, Antolič V (1993) Influence of the pelvic shape on the biomechanical status of the hip. Clin Biomech 8:223–224
Iglič A, Kralj-Iglič V, Daniel M, Maček-Lebar A (2002) Computer determination of contact stress distribution and size of weight bearing area in the human hip joint. Comput Methods Biomech Biomed Eng 5:185–192
Ipavec M, Brand RA, Pedersen DR, Mavčič B, Kralj-Iglič V, Iglič A (1999) Mathematical modelling of stress in the hip during gait. J Biomech 32:1229–1235
Jaklič A, Pernuš F (1994) Morphometric analysis of AP pelvic and hip radiographs. In: Zajc B, Solina F (eds) Proceedings of the Third Slovenian Electrotechnical and Computer Science Conference, Ljubljana, pp 352–355
Kersnič B, Iglič A, Kralj-Iglič V, Srakar F, Antolič V (1997) Increased incidence of arthrosis in women could be related to femoral and pelvic shape. Arch Orthop Trauma Surg 116:345–347
Mavčič B, Pompe B, Antolič V, Daniel M, Iglič A, Kralj-Iglič V (2002) Mathematical estimation of stress distribution in normal and dysplastic human hips. J Orthop Res 20:1025–1030
Mont MA, Hungerford DS (1995) Non-traumatic avascular necrosis of the femoral head. J Bone Joint Surg Am 77:459–469
Pauwels F (1976) Biomechanics of the normal and diseased hip. Springer Verlag, Berlin Heidelberg New York
Pavlovčič V, Dolinar D, Arnež Z (1999) Femoral head necrosis treated with vascularised iliac crest graft. Int Orthop 23:150–153
Schmitt J, Meiforth J, Lengsfeld M (2001) Development of a hybrid finite element model for individual simulation of intertrochanteric osteotomies.Med Eng Phys 23:529–539
Ueo T, Tsutsumi S, Yamamuro T, Okumura H, Shimizu A, Nakamura T (1985) Biomechanical aspects of the development of aseptic necrosis of the femoral head. Arch Orthop Trauma Surg 104:145–149
Zupanc O, Antolič V, Iglič A, Jaklič A, Kralj-Iglič V, Stare J, Vengust R (2001) The assessment of contact stress in the hip joint after operative treatment for severe slipped capital femoral epiphysis. Int Orthop 25:9–12
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dolinar, D., Antolič, V., Herman, S. et al. Influence of contact hip stress on the outcome of surgical treatment of hips affected by avascular necrosis. Arch Orthop Trauma Surg 123, 509–513 (2003). https://doi.org/10.1007/s00402-003-0541-9
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-003-0541-9