Polkowski 2010

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REVIEW ARTICLE

Hip Biomechanics
Gregory G. Polkowski, MD and John C. Clohisy, MD

values of these angles relate to the depth of the acetabulum,


Abstract: As the primary link between the trunk and the lower the inclination of its weight-bearing surface, and the corres-
limb, the hip joint plays an important role in the generation and ponding amount of coverage of the femoral head. Acetabular
transmission of forces during routine activities of daily living and development continues until the fusion of the triradiate
athletic activities alike. This joint is characterized by an extra-
cartilage, usually from 16 to 18 years of age.3
ordinary amount of inherent bony stability, with differences in
osseous anatomy significantly impacting the biomechanical proper- Although the classical description of the hip joint
ties of the human hip. These biomechanical principles have as a ball and socket with a single center of rotation
important implications relative to the diagnosis and surgical allows for conceptual simplicity and thus the ability to
treatment of structural hip abnormalities, and the physical generate biomechanical assumptions that allow for work-
demands placed on the hip joint during athletic activities may able calculations, the shape of the femoral head is slightly
predispose to injury or other chronic pathologic processes. out-of-round. As such, the center of rotation of this joint
is not uniform throughout its range of motion. Further-
Key Words: hip biomechanics, hip anatomy, pathomechanics, hip
more, individual differences in proximal femoral morphol-
impingement, hip forces, hip mechanics
ogy affect the extent to which this phenomenon is observed,
(Sports Med Arthrosc Rev 2010;18:56–62) and have important implications in the potential develop-
ment for future coxarthrosis.6 On account of the
difficulties associated with quantifying the effects of subtle
differences in proximal femoral and acetabular morphology
on hip biomechanics—especially as these differences
ANATOMY have are yet to be well described—the assumption will be
To address the biomechanical principles involved in made for the remainder of this text that the hip represents a
the function of the human hip, it is essential to consider the uniform ball-and-socket joint with a single center of
normal anatomy of the proximal femur and pelvis, as the rotation, with a spherical femoral head unless otherwise
muscles, ligaments, and bony structures all contribute to specified.
the equilibrium of forces that allow for controlled motion The functional depth of the acetabulum is increased by
at the femoral–acetabular articulation. Although the local the fibrocartilaginous acetabular labrum, which lines the
anatomy surrounding the hip is important, it should also be acetabular rim and is found just deep to the joint capsule.
emphasized that the hip serves as a link between the trunk This structure serves to increase the functional stablity of
and the lower limb, with these more remote structures the joint by acting as a seal between the socket and the
contributing greatly to hip biomechanics. For the purpose femoral head, preventing displacement of fluid from the
of simplification, however, the anatomy of the trunk and intraarticular space.7,8 This seal must be overcome to
lower limb will not be addressed specifically. dissociate the femoral head from the acetabulum, which
The hip joint has classically been described as a adds to the hip joint stablilty,9 and this phenomenon
constrained articulation between the spherical head of the produces an effect in cadaveric specimens strong enough,
proximal femur and the concave socket of the pelvis called so that if the ligaments and musculature of the hip are
the acetabulum. Together, the femoral head and the removed, the femur may remain in the socket because of
acetabulum form a ball-and-socket joint. The acetabulum this suction effect alone.10 Furthermore, weight bearing
is located at the confluence of the ilium, ischium, and pubis activities in the presence of a functioning labral seal cause
bones of the pelvis—the triradiate cartilage—and begins an increase in intraarticular pressure—a process that
developing as early as 8 weeks of gestation,1 with a fully reduces intraarticular friction by improving joint lubri-
formed hip joint by 11 weeks gestation.2 Physeal growth cation.7,9
occurs through the triradiate cartilage, with the normal The spherical femoral head develops simultaneously
acetabular opening developing in response to the presence with the acetabulum,3 and is connected to the shaft of the
of the femoral head3,4 in an orientation that faces inferior, femur through its intracaspular neck and extracapsular
lateral, and anterior sides. The dimensions and orientation intertrochanteric regions. The normal inclination between
of the acetabular opening can be described radiographically the femoral neck and shaft gradually decreases from
by the lateral center edge angle, anterior center edge infancy to skeletal maturity, and has been found to be as
angle, and Tonnis angle or acetabular inclinication5; the high as 150 degrees in the newborn, with normal values at
skeletal maturity in the adult hip of 125±5 degrees.11 In the
From the Department of Orthopedic Surgery, Washington University axial plane the proximal femur has an anterior torsional
School of Medicine, St. Louis, MO. relationship with respect to its distal femoral epicondylar
Reprints: John C. Clohisy, Washington University School of Medicine, axis, or anteversion, with the normal amount of anteversion
Department of Orthopedic Surgery, 660 South Euclid Avenue, being 12 to 14 degrees.12 As the amount of anteversion
Campus Box 8233, St. Louis, MO 63110 (e-mail: clohisyj@
wudosis.wustl.edu). in the proximal femur increases, the mechanical advan-
Copyright r 2010 by Lippincott Williams & Wilkins tage of the gluteus maximus muscle increases,13 whereas

56 | www.sportsmedarthro.com Sports Med Arthrosc Rev  Volume 18, Number 2, June 2010
Sports Med Arthrosc Rev  Volume 18, Number 2, June 2010 Hip Biomechanics

the mechanical advantage of the abductors decreases.14 HIP MOTION


The greater and lesser trochanters are the bony promi- In the sagittal plane the normal hip can move to 120 to
nences found on the superior-lateral and posterior-medial 125 degrees of flexion and 10 to 15 degrees of extension.12,18
aspects of the proximal femur, respectively, and are the The overall limitations of this motion include constraints
insertion sites for a variety of the muscles that effect hip from the capsuloligamentous structures and musculotendi-
motion. nous units and the bony architecture of the hip. Hip flexion
The hip joint is surrounded by a thick fibrous capsule is significantly limited by the position of the knee joint, with
that extends from the acetabular rim to the anterior knee extension significantly reducing hip flexion because of
intertrochanteric line on the proximal femur anteriorly, the associated increased tension on the hamstring muscu-
and onto the posterior intertrochanteric line posteriorly.11 lature that crosses both of these joints.12 The iliofemoral
Confluent with the hip capsule are 3 reinforcing ligaments ligament, anterior capsule, and hip flexors limit hip
that help to stabilize it at the extremes of range of motion. extension.12 With the hip joint flexed, internal rotation
These ligaments include: the iliofemoral ligament (ligament ranges from 0 to 70 degrees, and external rotation ranges
of Bigelow), which extends from the anterior inferior iliac from 0 to 90 degrees.19 There is considerably less internal
spine to the anterior intertrochanteric line; the pubofemoral and external rotation with the hip extended, as the soft
ligament which attaches to the superior pubic ramus and tissue structures about the hip are under greater tension in
inferior femoral neck; and the ischiofemoral ligament, extension, thus limiting the extent of rotation.
which extends from the ischium around to the posterior The combined motion of the hip joint and pelvis
inferior femoral neck. These 3 ligaments stabilize the head together contribute to the overall motion of the hip, and the
in hyperextension, hyperabduction, and extension, respec- ranges of motion listed above include contributions from
tively.14 Whereas the iliofemoral ligament is the strongest pelvic motion. Dewberry et al described differences in the
of these structures, the posterior ischiofemoral ligament is extent of the posterior rotation of the pelvis with 26% of
the thinnest and weakest.14 These ligaments are tighter in hip flexion coming from lumbopelvic rotation with the
a position of hip extension, which accounts for increases knees in a flexed position and 39% of the hip flexion
in ranges of rotatory motion seen in positions of flexion coming from lumbopelvic rotation with the knee held in a
compared with extension. position of extension.18 During weight-bearing activities
The majority of the blood supply to the proximal pelvic rotation has been described to contribute approxi-
femur comes in the terminal branches of the medial cir- mately 18% to hip flexion.20
cumflex femoral arteries, with lesser contributions from the Although the main limitations of the hip joint have
lateral circumflex artery anteriorly.15 The acetabulum and classically been attributed to the soft tissue structures about
acetabular labrum are supplied by branches of the superior the hip, the importance of the bony architecture has become
gluteal, and inferior gluteal, and obturator arteries.11,14,16,17 of greater interest lately. In conditions that predispose to
The muscles that contribute to the motion of the hip abnormalities in proximal femoral or acetabular morpho-
joint are numerous, and together help position the trunk logy, such as femoroacetabular impingement, range of
and lower limb in relation to each other. The type of motion is often limited because of abnormal bony contact
motion affected by these muscles depends on their origin between portions of the proximal femur and acetabular rim
and insertion and the position of the hip in relation to the at the extremes of range of motion.6 In such clinical
pelvis and knee. Individual descriptions of these muscles’ situations, the motion that occurs between the femur and
origins and insertions will not be entertained here, but a acetabulum is less, with the contribution from pelvic motion
brief summary of the major muscle groups, their actions, occurring earlier in the overall range of motion.
and innervations follows. The iliopsoas, rectus femoris, The required amount of hip range of motion necessary
sartorius, and tensor fascia lata muscles are responsible to accomplish standard activities of daily living have been
for hip flexion. The first 3 of these are innervated by the described,21 and are listed in Table 1. Johnston and Smidt
femoral nerve, whereas the tensor fascia lata muscle is took electrogoniometric measurements of 33 individuals,
innervated by the superior gluteal nerve.11 Extension of the and found that abduction and external rotation of 20
hip joint is accomplished with contraction of the gluteus degrees and hip flexion of 120 degrees were required for
maximus and hamstring groups of muscles (biceps femoris, conducting activities of daily living such shoe tying.21,22
semimembranosus, and semitendinosus).11 The gluteus Furthermore, as individuals age, there is an overall loss in
maximus is innervated by the inferior gluteal nerve, whereas hip range of motion, with older individuals having
the hamstrings are innervated by the tibial branch of the decreased hip flexion and extension, and an overall
sciatic nerve.11 Contractions of the gluteus medius, gluteus decreased stride length.20
minimus, and tensor fascia lata muscles cause both There are certain members of the athletic population
abduction and internal rotation of the hip joint and are that have been found to have reduced amounts of hip range
all innervated by branches of the superior gluteal nerve.11 of motion. For example, some nonelite long-distance runners
Adduction of the hip joint is achieved by contraction of the with less flexibility than their more flexible counterparts have
adductor magnus, adductor longus, and adductor brevis been shown to have increased running efficiency. The gain in
muscles that are innervated by the obturator nerve.11 There running economy in these athletes is thought to arise from a
are 5 muscles that contribute to external rotation motion relative lack of energy expenditure necessary to stabilize the
of the hip joint, and these muscles with their respective hip and pelvis during the act of running by the musculo-
innervations are: obturator internus (nerve to obturator tendinous units about the hip compared with the more
internus), obturator externus (obturator nerve), superior flexible runner.23,24 Similarly, hip extension has been found to
gemellus (nerve to obturator internus), inferior gemellus be 10 degrees less in professional ice hockey players than age-
(nerve to quadratus femoris), piriformis (ventral rami of S1 matched controls,25 and some researchers cite hip flexion
and S2), and quadratus femoris (nerve to quadratus contractures as a potential cause of chronic low back pain in
femoris).11 some athletes.26,27

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Polkowski and Clohisy Sports Med Arthrosc Rev  Volume 18, Number 2, June 2010

forward.22 Table 2 summarizes changes in hip position,


TABLE 1. Mean Values for Maximum Hip Motion in 3 Planes functioning muscles, and percent occurrence during the gait
During Common Activities21
cycle during the different phases of gait.30
Plane of Recorded Value The presence of the double-support phase defines
Activity Motion (Degrees) the activity of walking. As the rate of gait increases, the
Tying shoe with foot Sagittal 124 duration of the double-support phase decreases, and
on floor running occurs when this phase is eliminated from the gait
Frontal 19 cycle and replaced with a float phase, when both feet are
Transverse 15 off the ground simultaneously.31 As the speed of running
Tying shoe with foot across Sagittal 110 increases, the duration of the float phase increases. The
opposite thigh extent to which the hip flexes and extends changes as the
Frontal 23 rate of ambulation increases from walking to jogging to
Transverse 33
running, with increases in maximal hip flexion to greater
Sitting down on chair Sagittal 104
rising from sitting than 55 degrees during the midswing phase of gait
Frontal 20 compared with less than 50 degrees of hip joint flexion
Transverse 17 during walking and jogging.30 During walking and jogging
Stooping to obtain object Sagittal 117 hip extension is less than during running, and toe-off occurs
from floor before maximum hip extension during running and jogging,
Frontal 21 although this event occurs after maximum hip extension
Transverse 18 during walking.30 The amount of hip joint abduction and
Squatting Sagittal 122 adduction also varies as an individual accelerates from
Frontal 28
walking to jogging to running, with the maximal values to
Transverse 26
Ascending stairs Sagittal 67 both of these motions occurring during running.30 Adduc-
Frontal 16 tion during running peaks to 15 to 20 degrees during
Transverse 18 running and occurs just before heel strike, whereas
Descending stairs Sagittal 36 maximum abduction occurs during the swing phase of
running after toe-off.30

GAIT CYCLE FORCES ACTING ON THE HIP


The hip joint serves as a link between the lower limbs Considerable effort has been made over the years to
and the trunk, and the motion between these body parts describe the variety of forces that contribute to the joint
allows for bipedal ambulation. The motion that occurs at reaction force of the human hip. Estimates have been made
the hip joint during the gait cycle has been characterized based on calculations and free body diagrams, but these
according to the different phases of the cycle during both methods require several assumptions and simplifications
running and walking, with averages in hip flexion and regarding antagonistic muscles and the extensive variety
extension to about 35 and 10 degrees, respectively.22,28 of soft tissues that contribute to the distribution of hip joint
During walking the hip is maximally extended at heel-off forces. Direct measurement of such forces is even more
and maximally flexed during the late swing phase.29 During cumbersome, and to date is not possible in individuals.
the stance phase of gait, the hip is adducted and internally However, direct measurements have been done after
rotated, bringing the center of gravity closer in line with the endoprosthetic instrumentation of the hip joint, and
hip joint, whereas during the swing phase, the hip abducts extrapolations from these data can be applied to the native
and externally rotates as the lower limb is brought joint.

TABLE 2. Eight Phases of the Gait Cycle30


Occurrence During
Phase of Gait Hip Position Active Muscles Cycle (%)
Stance
Initial contact 30 degrees of flexion Hamstrings and gluteus maximus 0-2
Loading response 30 degrees of flexion Hamstrings and gluteus maximus 0-10
5 to 10 degrees of adduction
5 to 10 degrees internal rotation
Mid-stance 0 degrees of flexion-extension Gluteus medius, gluteus minimus, and 10-30
tensor fascia lata
Neutral abduction-adduction
Terminal stance 10 degrees of extension Iliacus 30-50
Pre-swing 0 degrees of flexion-extension Iliacus and adductor longus 50-60
Swing
Initial swing 20 degrees of flexion iliopsoas, rectus femoris, gracilis, 60-73
and sartorius
5 degrees of abduction
Midswing 20 to 30 degrees of flexion iliopsoas, gracilis, and sartorius 73-87
Terminal swing 30 degrees of flexion Hamstrings and gluteus maximus 87-100

58 | www.sportsmedarthro.com r 2010 Lippincott Williams & Wilkins


Sports Med Arthrosc Rev  Volume 18, Number 2, June 2010 Hip Biomechanics

In Vitro Calculations A trendelenburg gait is observed when a patient bends in


Calculations of the forces that occur at the hip joint the coronal plane during the stance phase of walking, such
are commonplace in the biomechanical and orthopedic that a greater proportion of his weight is centered
literature, with the most common diagrams and descrip- over the standing leg. This is frequently seen in patients
tions seen being the free body diagram of the forces across with hip pain, and is often thought to be representative of
the hip joint that occur during single limb stance19,32,33 underlying hip pathology or abductor muscle weakness.
(Fig. 1). These calculations are simplifications that rely only Although pure abductor weakness may be a rare clinical
on frontal plane forces that occur at the hip joint under finding (in the absence of underlying hip pathology), an
static conditions, but are useful to consider because it understanding of basic hip biomechanics helps explain why
allows an easy-to-understand basis for demonstration of such a gait technique is advantageous in the setting of a
the importance that subtle changes in body position or hip painful hip. As the individual’s weight is shifted over the
anatomy can have on changes in forces that can occur standing leg and closer to the hip center of rotation,
about the hip joint. Under static conditions the following the moment arm of the gravitational force is reduced, thus
forces are seen to act on the pelvis and hip joint to keep the decreasing the force that must be generated by the abductor
pelvis level (Fig. 1): gravitational force, W, which is the musculature to counteract the force of gravity on the pelvis.
weight of the body minus the weight of the contralateral This results in an overall decrease in force/load generated at
lower limb; A, which is the force of the abductor muscles the hip joint,32 with this reduction being proportional to the
acting to keep the pelvis level; and F, which is the force extent of reduction in the moment arm of the gravitational
exerted by the femoral head on the acetabulum, or the joint force. In other words, the worse the trendelenburg ‘‘lurch,’’
reaction force.32 It is possible to determine the hip joint the greater reduction in load across the hip joint.
reaction force, F, once the abductor force is calculated. As changes in magnitude of the moment arm of the
With knowledge of the individual’s weight, moment arm of force of gravity are related to the trendelenburg pattern of
the gravitational force, d, and moment arm of the abductor gait, they can also be altered by the use of a cane to help
musculature, l, the abductor force, A, can be calculated reduce the load across the hip joint. When a cane is used in
according to the following equation:19 the contralateral hand during walking, an upward directed
5=6 W  d force is generated that helps offset the force of gravity on
A¼ : the patient’s weight, such that there is a reduction in the
l amount of necessary abductor force to keep the pelvis
In equilibrium, the sum of the force vectors, A, F, and level, and a corresponding reduction in load across the
W equal zero, thus with the addition of vectors A and W, hip joint.32 The amount of cane ground reaction force
the magnitude and direction of the joint reaction force, F, is necessary to affect a reduction in contralateral hip joint
calculated to be 2.7 times the body weight with a direction reaction force is proportionally much less because the
of 69 degrees from the horizontal during single leg stance moment arm of the cane’s force is considerably longer than
with the pelvis being kept parallel to the floor.19 the moment arm of the contralateral abductor musculature.
This reduction in force can be calculated, and has been
found to approximate 20% by some researchers.32 Others
have found that by maximizing effort with cane use,
as much as a 42% reduction in muscle activity can be
achieved, which correlates with a reduction of hip joint
reaction force from 3.4 times body weight to 2.2 times body
weight.34
Although the presence and treatment of overt hip
osteoarthritis is not usually a primary concern in the
management of athletes, it bears mentioning that weight
reduction can significantly reduce hip joint reaction forces,
and thus potentially reduce symptoms in a patient with an
arthritic hip. Figure 1 shows the hip joint reaction force is
ultimately affected by the patient’s body mass, and as such,
any reduction in body mass would help reduce this force.
The use of a cane can be used as an example to a patient
to show the advantage of weight loss, with body mass
reduction of approximately 20% being equivalent to the
amount of relief experience by use of a cane.32
As the hip joint reaction force is proportional to the
force exerted on the proximal femur by the abductors, if
Equation (1) above is revisited it follows that the ‘‘key
factor influencing the magnitude of the joint reaction force
on the femoral head is the ratio of the abductor muscle
force lever arm to the gravitational force lever arm,’’ or the
ratio of l to d in the equation above.19 As this ratio
decreases, the joint reaction force increases. The moment
FIGURE 1. Forces acting on the hip joint during single leg stance arms of gravitational force and the abductor muscles can be
under conditions of equilibrium. Gravitational force W, abductor manipulated during reconstructive hip surgery. For exam-
muscle force A, hip joint reaction force F, abductor muscle ple, by medializing the acetabular component during total
moment arm l, and force of gravity moment arm d. hip arthroplasty, the moment arm of the gravitational force

r 2010 Lippincott Williams & Wilkins www.sportsmedarthro.com | 59


Polkowski and Clohisy Sports Med Arthrosc Rev  Volume 18, Number 2, June 2010

can reduce the abductor force by 40% and abductor of measurements obtained during different activities after
moment by 50%.35 Similarly, increasing femoral offset or total hip arthroplasty. This group of researchers was able
lateralizing the greater trochanter during total hip arthro- to implant pressure transducers into total hip arthroplasty
plasty increases the mechanical advantage of the abductor components to make these measurements. The results of
musculature by increasing the abductor moment arm, these measurements confirm earlier ex vivo calculations,
which correlates with a decrease in joint reaction force.36 and a few bear mentioning. As expected, the hip joint force
A varus-producing osteotomy would have the same effect, increases with increasing gait, to 300% body weight during
reducing the joint reaction force by increasing the moment slow walking, 350% to 400% with quick walking, and up
arm of the abductor musculature. to 500% during jogging, to a maximum of 800% during
Although static considerations regarding forces acting stumbling. Interestingly, the amount of force on the hip
on the hip joint are useful and relatively straightforward, during 2-legged stance measured approximately 80% to
the effects of motion and varying loads are likely of more 100% of body weight. The fact that these forces are not one
interest and of greater relevance in the care of athletes. The half this value are attributed to the persistent muscle
forces exhibited on the hip joint can be calculated during tension acting on the hips during this type of stance.32
both running and walking, but these calculations require The advantage of this type of in vivo measurement is that
consideration of kinetic and kinematic data of the entire all of the forces acting on the hip are included in such
lower limb, are quite complex, and are far beyond the scope measurements, whereas the in vitro calculations require
of this article. Brinckmann et al32 summarizes the work dismissal of minor contributions from antagonistic muscle
of Bergmann et al,37 Novacheck,38 Winter,39 Paul,40,41 and activity and the elastic tension of muscles, tendons, or joint
Morrison42 with respect to such calculations.28 These capsules.32
researchers showed that during slow walking the hip was
loaded with approximately 3 times body weight just after JOINT SURFACE PRESSURE
heel strike, with forces increasing to 4 times body weight
Because focal changes in articular cartilage pressure at
just before toe-off.28 As the speed of walking increases, the
the hip joint have been implicated as contributing factors in
initial peak in joint load increased to approximately 4 times
the development of hip osteoarthritis, it is useful to consider
body weight, with less of an increase in load before toe-off.
the anatomic elements and forces that determine these
During running, forces equivalent to 7 to 8 times body
potential pressure changes. The most basic estimation of
weight are transmitted across the hip joint during heel
joint pressure can be determined by dividing the joint
strike, and increase to a value slightly higher than that
reaction force by the area over which this force is
during toe-off.28 It should be noted that these calculations
distributed in the femoral head:
are based on an individual moving forward in a straight
line, and these do not take into consideration activities that Pmean ¼ F=A
are seen in athletes of other sports such as basketball, with A being the ‘‘projected area’’ of the joint.32 Although
tennis, and football, which require a great deal of cutting, this does not take into account the curved surface of the
twisting, and pivoting. femoral head and is an oversimplification, assuming a body
The complexities of motion associated with cutting mass of 60 kg and a femoral head diameter of 5 cm, using
and pivoting sports make force calculations difficult, but the information from the free body diagrams above, with a
Van den Bogert et al have employed a mathematical model joint reaction force of 1500 N, the average pressure seen at
to approximate the forces across the hip joint during the hip joint in this case is calculated to be 75 N/cm2.32
downhill skiing. They found loads as high as 8.3 to 12.4 The actual bearing surface of the hip joint is not a
times body weight across the hip joint during Mogul skiing, perfect sphere, however, and the actual distribution of
with lower loads (from 4.1 to 7.8 times body weight) pressure across the articular cartilage is not uniform. This is
approximated during non-Mogul downhill skiing.43 As related to the fact that the acetabular socket opens laterally,
expected, cross-country skiing had much lower calculated and does not form a uniform hemisphere. In the situation
loads across the hip joint, and ranged from 4.0 to 4.6 times of a uniform hemisphere, the maximum amount of pressure
body weight.43 across the articulation would occur at a point that is
Ground reaction forces during landing have been colinear with the joint reaction force. From this point the
shown to be lower in trained gymnasts compared with pressure decreases as the periphery of the hemisphere is
recreational athletes. McNitt-Gray and colleagues found approached, and reaches zero at the rim of the hemi-
this to be the case when ground reaction forces were spherical socket, assuming there was no friction in the
measured during landing from 3 different heights.44 They system (which is a reasonable assumption given the
also found that the peak ground reaction force was reached exceedingly small coefficient of friction of articular carti-
on average 6.3 ms faster in the trained gymnasts, and that lage). In the situation of an incompletely covered ball and
the recreational athletes adjusted to the higher landing socket joint, although, to satisfy equilibrium conditions,
heights by increasing the amount of hip flexion and the a greater amount of pressure is seen by the cartilage near
overall length of their landing phase, whereas the trained the uncovered rim, with pressures near zero at the more
gymnasts were found to have larger ankle and hip extensor constrained side.32 Greenwald and Brinckmann have
moments during landing.44 further described this pressure distribution after a cosine
distribution, and were able to calculate the magnitude of
In Vivo Measurements the pressure distribution in hemispheres of varying amounts
Direct measurements of hip joint forces in the athlete of coverage.45,46 For example, in the case of a sphere with
would require surgical insertion of a force transducer, 130 degrees of coverage, the point of maximum pressure is
which would be impractical. Fortunately, in an effort to found to occur more laterally to satisfy equilibrium
characterize the forces acting on prosthetic joints after total conditions, whereas decreasing the amount of coverage
hip arthroplasty, Bergmann et al37 have conducted a series to 110 degrees (simulating the morphology of a dysplastic

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Sports Med Arthrosc Rev  Volume 18, Number 2, June 2010 Hip Biomechanics

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