A Clinically Relevant Review of Hip Biomechanics

doi:10.1016/j.arthro.2010.01.027

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 26, Issue 8, August 2010, Pages 1118-1129

https://doi.org/10.1016/j.arthro.2010.01.027 Get rights and content

Abstract

The hip is a complex anatomic structure composed of osseous, ligamentous, and muscular structures responsible for transferring the weight of the body from the axial skeleton into the lower extremities. This must be accomplished while allowing for dynamic loading during activities such as gait and balance. The evaluation of hip pain and periarticular pathology can be challenging because of the complex local anatomy and broad differential diagnosis. Recent advancements in the evaluation and surgical treatment of hip pathology have led to a renewed interest in the management of these disorders. An understanding of the basic biomechanical and kinematic function of the hip and the consequences of associated pathology can greatly assist the orthopaedic surgeon in appropriately diagnosing and treating these problems. In this review we discuss the basic biomechanical concepts of the native hip and surrounding structures and the changes experienced as a result of various pathologies including dysplasia, femoroacetabular impingement, labral injury, capsular laxity, hip instability, and articular cartilage injury. We will also discuss the clinical implications and surgical management of these pathologies and their role in restoring or preserving the native function of the hip joint.

Section snippets

Functional Anatomy and Kinematics

The hip effectively acts as a multi-axial ball-and-socket joint upon which the upper body is balanced during stance and gait. Stability of this joint is critical to allow motion while supporting the forces encountered during daily activity. Nearly all motion between the femoral head and acetabulum is rotational, with no detectable translation because of the congruency of the articulating surfaces.3, 4 The range of motion required in the hip during everyday tasks, such as rising from a chair,

General Biomechanics

The femoroacetabular joint is unique in the fact that it is never fully unloaded during daily activities. Although the duration of maximum loads experienced by the articular surfaces of the hip may be short, there is a residual compressive force acting across the joint at all times, with an average magnitude approximately equal to the body weight.²⁷ Pauwels²⁸ defined the forces acting around the hip and the moments required to balance the pelvis. The joint reactive force is the compressive

Pathologic Biomechanics and Surgical Intervention

Biomechanics in the development or as a result of pathologic conditions in the hip may result from anatomic alteration, congenital deficiency, injury, or degeneration. Familiarity with the biomechanical causes of various pathologies of the hip and the consequences of anatomic variations of the structures comprising the joint allows the orthopaedist to recommend appropriate treatment.

Conclusions

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Cited by (107)

Investigating pelvic drop gait abnormality in adolescent hip pathology patients
2024, Gait and Posture
Trendelenburg gait describes contralateral pelvic drop during single leg stance (SLS) with occasional lateral trunk lean compensation over the stance limb. However, quantitative research on ‘uncompensated Trendelenburg’ gait (pelvic drop independent of lateral trunk lean) remains sparse among populations that commonly utilize this gait pattern, such as adolescent hip pathology patients.
How prevalent is uncompensated Trendelenburg among various adolescent hip pathologies and how is it related to hip load, hip abduction strength, and self-reported hip pain?
Gait, strength, and pain data were collected among 152 pre-operative patients clinically diagnosed with acetabular hip dysplasia, femoroacetabular impingement, Legg-Calvé-Perthes, or slipped capital femoral epiphysis (SCFE). Patients with ≥ 5.4° of dynamic pelvic drop in SLS were divided into a ‘pelvic drop’ group and screened to exclude those with excessive ipsilateral trunk lean. They were then compared to the ‘stable pelvis’ patients using a Mann-Whitney test.
Dysplasia patients represented the highest proportion of the pelvic drop group (46%). The pelvic drop group showed a significant increase in self-reported hip pain (p = 0.011), maximum hip abductor moment (p = 0.002), and peak coronal power absorption at the affected hip during SLS loading response, (p < 0.001) while showing no difference in abduction strength (p = 0.381).
Uncompensated Trendelenburg gait may lead to increased loading of the affected hip in adolescent hip pathology patients. Disadvantageous hip biomechanics can create increased abductor muscle demand among these pathological populations, with dysplasia patients showing the highest prevalence. Maximal abduction strength did not correlate with pelvic drop. Future work should aim to identify and quantify causal factors. Increased coronal hip power absorption during weight acceptance warrants clinical attention, as there may be a detrimental, over-reliance on passive hip structures to support load among a population that that is already predisposed to hip osteoarthritis.
Hip Manipulation Under Anesthesia for Post-Hip Arthroscopy Pericapsular Scarring: Indications and Techniques
2023, Arthroscopy Techniques
Hip arthroscopy has become an increasingly common procedure with expanding indications over the last several decades. With the increase in number of procedures performed a complication profile has emerged, although there is yet to be a formal classification system for complications. The most cited complications include lateral femoral cutaneous nerve neuropraxia, other sensory deficits, chondral or labral iatrogenic damage, superficial infection and deep vein thrombosis. One complication that has not yet been well documented in the literature is pericapsular scarring/adhesions resulting in decreased hip range of motion and function. If this complication is noted to persist after adequate impingement resection and a rigorous post-operative physical therapy regimen, the senior author has addressed this with a hip manipulation under anesthesia. Therefore, this techniques paper aims to describe pericapsular scarring as a post hip-arthroscopy condition which may cause pain and demonstrate our technique to address this diagnosis through hip manipulation under anesthesia.
Changes in Hip Labral Size Two Years After Arthroscopic Repair Are Correlated With Preoperative Measurements on Magnetic Resonance Imaging
2023, Arthroscopy - Journal of Arthroscopic and Related Surgery
The purposes of our study were 1) to investigate the potential change of labral size after arthroscopic repair and 2) to analyze the relationship between acetabular labral size and functional outcomes.
In this retrospective study, patients diagnosed with labral tear and undergoing hip arthroscopic repair in our institution between September 2016 and December 2018 were included. Magnetic resonance imaging was obtained preoperatively and postoperatively, and the labral length and labral height were measured in three anatomic sites: 11:30, 1:30, and 3:00 positions. All patients completed at least 2-year follow-up. Patients whose preoperative labral size in any position wider than 2 standard deviation away from the mean were identified as the hypertrophic labrum group and were compared with the control in radiographic variables and patient-reported outcomes (PROs), including the visual analog scale (VAS), modified Harris Hip Score (mHHS), the International Hip Outcome Tool-12 (iHOT-12) and the Hip Outcome Score-Activities of Daily Living (HOS-ADL).
A total of 82 patients (82 hips) were included, and the mean follow-up period was 39.54 ± 8.48 months. Significant improvement in PROs was determined before and after surgeries. Twelve patients were identified with labral hypertrophy and had higher postoperative mHHS scores, higher postoperative iHOT-12 scores, and greater improvement in HOS-ADL compared with the control group. Patients with larger preoperative anterosuperior labral height exhibited more favorable clinical outcomes. Meanwhile, no significantly morphologic change in labral size was determined.
There is no significantly morphologic change in labral size of superior, anterosuperior, and anterior labrum after arthroscopic repair. Patients with hypertrophic labrum achieved more favorable clinical outcomes compared with those with normal-sized labrum.
Level III, retrospective comparative prognostic trial.
Peripheral Joint Radiofrequency Ablation
2022, Physical Medicine and Rehabilitation Clinics of North America
Blood Flow Restriction Enhances Rehabilitation and Return to Sport: The Paradox of Proximal Performance
2022, Arthroscopy, Sports Medicine, and Rehabilitation
The use of blood flow restriction (BFR) within rehabilitation is rapidly increasing as further research is performed elucidating purported benefits such as improved muscular strength and size, neuromuscular control, decreased pain, and increased bone mineral density. Interestingly, these benefits are not isolated to structures distal to the occlusive stimulus. Proximal gains are of high interest to rehabilitation professionals, especially those working with patients who are limited due to pain or postsurgical precautions. The review to follow will focus on current evidence and ongoing hypotheses regarding physiologic responses to BFR, current clinical applications, proximal responses to BFR training, potential practical applications for rehabilitation and injury prevention, and directions for future research. Interestingly, benefits have been found in musculature proximal to the occlusive stimulus, which may lend promise to a greater variety of patient populations and conditions. Furthermore, an increasing demand for BFR use in the sports world warrants further research for performance research and recovery.
Level V, expert opinion.
Arthroscopic Treatment of Femoroacetabular Impingement Using Labral Reconstruction with Capsular Autograft
2021, Arthroscopy Techniques
The acetabular labrum is essential for stability during physiologic motion of the hip. Labral repairs frequently are attempted in cases of primary tears, although labral reconstruction is an important alternative in the revision setting or in the primary setting when the tissue is unsalvageable. Labral reconstruction has been shown to restore the hip’s suction-seal and fluid pressurization to that of the premorbid state, and cohort studies have demonstrated significantly improved patient-reported outcomes at midterm follow-up. Notably, the cost is of consideration during any reconstruction, and techniques have been described using both allograft and autograft sources. Autograft sources include the iliotibial band, ligamentum teres, gracilis tendon, and hip capsule. A previously described technique using the capsule was noted to hinder routine capsular closure. We present an alternative method for labral reconstruction using hip capsular tissue that is easily performed and allows for routine capsular closure.

View all citing articles on Scopus

: J.K.S. has received support from OrthoDynamix, Jacksonville, FL, exceeding $500 related to this research.

Note: To access the videos accompanying this report, visit the August issue of Arthroscopy at www.arthroscopyjournal.org.

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Current Concepts With Video IllustrationA Clinically Relevant Review of Hip Biomechanics

Abstract

Section snippets

Functional Anatomy and Kinematics

General Biomechanics

Pathologic Biomechanics and Surgical Intervention

Conclusions

Arthroscopy

Rev Chir Orthop Reparatrice Appar Mot

J Biomech

J Arthroplasty

Arthroscopy

Arthroscopy

J Biomech

J Biomech

Clin Sports Med

Clin Biomech (Bristol, Avon)

J Biomech

Arthroscopy

Arthroscopy

Arthroscopy

Clin Sports Med

Clin Sports Med

Oper Tech Sports Med

Differences in physician and patient ratings of items used to assess hip disorders

Am J Sports Med

Posterior-anterior glide of the femoral head in the acetabulum: A cadaver study

J Orthop Sports Phys Ther

Kinesiology

Incongruent surfaces in the human hip joint

Nature

Biomechanics of the human hip

Clin Orthop Relat Res

Biomechanics of the hip-joint

Clin Orthop Relat Res

Mechanical behaviour of articular cartilage under tensile cyclic load

Rheumatology (Oxford)

Structure of the most superficial layer of articular cartilage

J Bone Joint Surg Br

The thickness of the cartilage in the hip joint

J Anat

Comparative study of the intrinsic mechanical properties of the human acetabular and femoral head cartilage

J Orthop Res

The shape of acetabular cartilage optimizes hip contact stress distribution

J Anat

Stress-lowering function of articular cartilage

Med Biol Eng

The role of the acetabular labrum and the transverse acetabular ligament in load transmission in the hip

J Bone Joint Surg Am

Structure, strain and function of the transverse acetabular ligament

Acta Anat (Basel)

Anatomy, histologic features, and vascularity of the adult acetabular labrum

Clin Orthop Relat Res

Current Concepts With Video Illustration
A Clinically Relevant Review of Hip Biomechanics