Polkowski 2010
Polkowski 2010
Polkowski 2010
Hip Biomechanics
Gregory G. Polkowski, MD and John C. Clohisy, MD
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
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
hip), the maximum pressure is found at the lateral rim, and Adult Hip. 2nd ed. Philadelphia: Lippincott Williams &
its magnitude is much greater than with 130 degrees of Wilkins; 2007:81–90.
coverage.32,45 The clinical implications of these calculations 10. Kapandji IA. The Physiology of the Joints, v 2. Edinburgh:
correlate well with observed patterns of accelerated Churchill Livingstone; 1970.
cartilage wear in patients with acetabular dysplasia, in 11. Robbins CE. Anatomy and biomechanics. In: Fagerson TL,
ed. The Hip Handbook. Boston, MA: Butterworth-Heinemann;
which there is excessive edge loading of the socket and
1998:1–37.
subsequent premature arthrosis. 12. Hamill J, Knutzen K. Biomechanical Basis of Human Move-
Direct measurements of joint pressure at the articular ment. 3rd ed. Baltimore: Lippincott Williams & Wilkins;
surface have been done, but are fraught with inherent 2009:187–254.
difficulties. Ruschfelt et al measured articular pressure 13. Radin EL. Biomechanics of the human hip. Clin Orthop. 1980;
using an ultrasound probe at the implant-cartilage interface 152:28–34.
after hemiarthroplasty in hip specimens. On account of 14. Sim FH, Rock MG, Scott SG. Pelvis and hip injuries in
subtle differences between the socket and prosthesis athletes: Anatomy and function. In: Nicholas JA, Hershman
diameter, they were unable to make any generalizations EB, eds. The Lower Extremity & Spine in Sports Med. 2nd ed.
regarding pressure measurements in the natural joint.47 Saint Louis, MO: Mosby; 1995:1025–1065.
Brown and Shaw used the pressure transducers mounted 15. Trueta J, Harrison MHM. The normal vascular anatomy of
in cadaveric femoral heads to measure articular contact the femoral head in adult man. J Bone Joint Surg Br. 1953;
pressures, but found a random distribution of the maximal 35:442–461.
16. Hansen A. Anatomy and surgical approaches. In: Morrey B,
point of pressures.48 Brinckmann describes a few of
ed. Reconstructive Surgery of the Joints. 2nd ed. New York:
the pitfalls in their experimental design, namely that the Churchill Livingsone; 1996:889–890.
femoral head was only loaded in the orientation of the load 17. Seldes RM, Tan V, Hunt J, et al. Anatomy, histologic features,
vector and was not allowed to move freely and the fact that and vascularity of the adult acetabular labrum. Clin Orthop.
there is a mismatch between the stiffness of the transducer 2001;382:232–240.
material and the articular cartilage and subchondral bone, 18. Dewberry MJ, Bohannon RW, Tiberio D, et al. Pelvic and
which might affect the measurements when the system was femoral contributions to bilateral hip flexion by subjects
loaded.32 suspended from a bar. Clin Biomech. 2003;18:494–499.
19. Nordin M, Frankel VH. Basic Biomechanics of the Musculo-
skeletal System. 3rd ed. Baltimore: Lippincott Williams &
CONCLUSIONS Wilkins; 2001:203–221.
This concludes a general overview of basic hip 20. Murry R, Bohannon R, Tiberio D, et al. Pelvifemoral rhythm
biomechanics. The demands of sport often exceed the during unilateral hip flexion in standing. Clin Biomech.
relative basic description of mechanics and involve complex 2002;17:147–151.
interaction of osseus structure, muscles, capsule, and 21. Johnston RC, Smidt GL. Hip motion measurements for
ligaments of this joint. In assessing and treating athletic selected activities of daily living. Clin Orthop. 1970;72:205.
abnormalities in the soft tissues about the hip, the osseus 22. Johnston RC, Smidt GL. Measurement of hip-joint motion
during walking. Evaluation of an electogoniometric method.
abnormalities should be taken into account, as they are
J Bone Joint Surg. 1969;51A:1083.
becoming increasingly recognized as contributing factors 23. Craib MW, Mitchell VA, Fields KB, et al. The association
and bear consideration in the diagnosis and treatment of between flexibility and running economy and sub-elite male
hip disorders. These points are further expanded in distance runners. Med Sci Sports Exerc. 1996;28:737–743.
subsequent contributions. 24. Gleim GW, Stachenfeld NS, Nicholas JA. The influence of
flexibility on the economy of walking and jogging. J Orthop
REFERENCES Res. 1990;8:814–823.
25. Tyler T, Zook L, Brittis D, et al. a new pelvic tilt detection
1. Rao J, Zhou XY, Villar RN. Injury to the ligamentum teres: device: roentgenographic validation and application to assess-
mechanism, findings, and results of treatment. Clin Sports ment of hip motion in professional ice hockey players. J Orthop
Med. 2001;20:791–799. Sports Phys Ther. 1996;24:303–308.
2. Watanabe RS. Embryology of the human hip. Clin Orthop. 26. Offierski CM, Macnab MB. Hip-spine syndrome. Spine.
1974;98:8. 1983;8:316–321.
3. Ponseti IV. Growth and development of the acetabulum in the 27. Ingber RS. Iliopsoas myofascial dysfunction: a treatable cause
normal child. J Bone Joint Surg Am. 1978;60:575–585.
of ‘‘failed’’ low back syndrome. Arch Phys Med Rehabil. 1989;
4. Weinstein SL. Developmental hip dysplasia and dislocation.
70:382–386.
In: Morrissy RT, Weinstein SL, eds. Lovell & Winters’
28. Kabada MP, Ramakaishnan HK, Wooten ME, et al.
Pediatric Orthopaedics. 6th ed. Philadelphia: Lippincott
Repeatablilty of kinematic, kinetic and electomygraphic data
Williams & Wilkins; 2006:987–1033.
5. Clohisy JC, Carlisle JC, Beaule PE, et al. A systematic in normal adult gait. J Orthop Res. 1989;7:849–860.
approach to the plain radiographic evaluation of the young 29. Murray MP, Kory RC, Clarkson BH. Walking patterns in
adult hip. JBJS Am. 2008;90:47–66. healthy old men. J Gerontol. 1969;24:169–178.
6. Ganz R, Parvizi J, Beck M, et al. Femoroacetabular 30. Hughes PE, Hsu JC, Matava MJ. Hip anatomy and
impingement. A cause for osteoarthritis of the hip. Clin biomechanics in the athlete. Sports Med Arthrosc Rev. 2002;10:
Orthoped. 2003;417:112–120. 103–114.
7. Ferguson SJ, Bryant JT, Ganz R, et al. The influence of the 31. Mann RA. Biomechanics of running. In: Mack RP, ed. American
acetabular labrum on hip joint cartilage consolidation: a Academy of Orthopedic Surgeons Symposium on the Foot and Leg
poroelastic finite element model. J Biomech. 2000;33:953–960. in Running Sports. St Louis, MO: Mosby; 1982:1–29.
8. Takechi H, Nagashima H, Ito S. Intra-articular pressure of the 32. Brinckmann P, Frobin W, Leivseth G. Musculoskeletal
hip joint outside and inside the limbus. Nippon Seikeigeka Biomechanics. New York: Thieme New York; 2002:69–84.
Gakkai Zasshi. 1982;56:529–536. 33. Pauwels F. Biomechanics of the Locomotor Apparatus: Con-
9. Johnson JD, Noble PC, Hurwitz DE, et al. Biomechanics of tributions on the Functional Anatomy of the Locomotor
the hip. In: Callaghan J, Rosenberg A, Rubash H, eds. The Apparatus. Bewrlin: Springer-Verlag; 1980.
34. Neumann DA. Hip abductor muscle activity as subjects with 42. Morrison JB. Bioengineering analysis of force actions trans-
hip prostheses walk with different methods of using a cane. mitted by the knee joint. Biomed Engng. 1968;3:164–170.
Phys Ther. 1998;78:490–501. 43. Van den Bogert AJ, Read L, Nigg BM. An analysis of hip joint
35. Delp SL, Maloney W. Effects of hip center location on the loading during walking, running and skiing. Med Sci Sports
moment-generating capacity of the muscles. J Biomech. 1993; Exerc. 1999;31:131–142.
26:485–499. 44. McNitt-Gray JI. Kinetics of the lower extremities during
36. Free SA, Delp SL. Trochanteric transfer in total hip drop landings from three heights. J Biomech. 1993;26:
replacement: effects on the moment arms and force-generating 1037–1046.
capacities of the hip abductors. J Orthop Res. 1996;14:245–250. 45. Brinckmann P, Frobin W, Hierholzer E. Stress on the articular
37. Bergmann G, Deuretzbacher G, Heller M, et al. Hip contact surface of the hip joint in healthy adults and persons with
forces and gait patterns from routine activites. J Biomech. idiopathic osteoarthrosis of the hip joint. J Biomech. 1981;
2001;34:859–871. 14:159–156.
38. Novacheck TF. The biomechanics of running. Gait Posture. 46. Greenwald AS, O’Connor JJ. The transmission of load
1998;7:77–95. through the human hip joint. J Biomech. 1971;4:507–528.
39. Winter DA. Biomechanics and Motor Control of Human 47. Rushfeldt PD, Mann RW, Harris WH. Improved techniques
Movement. 2nd ed. New York: Wiley; 1990. for measuring in vitro the geometry and pressure distribution
40. Paul JP. Forces transmitted by joints in the human body. Proc in the human acetabulum. Parts I and II. J Biomech. 1981;
Inst Mech Eng. 1967;181:8–15. 14:253–260, 315–323.
41. Paul JP. Forces transmitted by joints in the human body. Proc 48. Brown TD, Shaw DT. In vitro contract stress distributions in
R Soc Lond B. 1976;192:163–172. the natural human hip. J Biomech. 1983;16:373–384.