Joint Reaction Forces Research Articles

Knee Load Distribution in Hip Osteoarthritis Patients After Total Hip Replacement.

Reduced external knee adduction moments in the second half of stance after total hip replacement have been reported in hip osteoarthritis patients. This reduction is thought to shift the load from the medial to the lateral knee compartment and as such increase the risk for knee osteoarthritis. The knee adduction moment is a surrogate for the load distribution between the medial and lateral compartments of the knee and not a valid measure for the tibiofemoral contact forces which are the result of externally applied forces and muscle forces. The purpose of this study was to investigate whether the distribution of the tibiofemoral contact forces over the knee compartments in unilateral hip osteoarthritis patients 1 year after receiving a primary total hip replacement differs from healthy controls. Musculoskeletal modeling on gait was performed in OpenSim using the detailed knee model of Lerner et al. (2015) for 19 patients as well as for 15 healthy controls of similar age. Knee adduction moments were calculated by the inverse dynamics analysis, medial and lateral tibiofemoral contact forces with the joint reaction force analysis. Moments and contact forces of patients and controls were compared using Statistical Parametric Mapping two-sample t-tests. Knee adduction moments and medial tibiofemoral contact forces of both the ipsi- and contralateral leg were not significantly different compared to healthy controls. The contralateral leg showed 14% higher medial tibiofemoral contact forces compared to the ipsilateral (operated) leg during the second half of stance. During the first half of stance, the lateral tibiofemoral contact force of the contralateral leg was 39% lower and the ratio 32% lower compared to healthy controls. In contrast, during the second half of stance the forces were significantly higher (39 and 26%, respectively) compared to healthy controls. The higher ratio indicates a changed distribution whereas the increased lateral tibiofemoral contact forces indicate a higher lateral knee joint loading in the contralateral leg in OA patients after total hip replacement (THR). Musculoskeletal modeling using a detailed knee model can be useful to detect differences in the load distribution between the medial and lateral knee compartment which cannot be verified with the knee adduction moment.

Ankle Joint Pressure in Supination–External Rotation Injuries: A Biomechanical Study in an Unrestrained Cadaver Model

Previous biomechanical studies simulating supination-external rotation (SER) IV injuries revealed different alterations in contact area and peak pressure. We investigated joint reaction forces and radiographic parameters in an unrestrained, more physiological setup. Twelve lower leg specimens were destabilized stepwise by osteotomy of the fibula (SER II) and transection of the superficial (SER IVa) and the deep deltoid ligament (SER IVb) according to the Lauge-Hansen classification. Sensors in the ankle joint recorded tibio-talar pressure changes with axial loading at 700 N in neutral position, 10° of dorsiflexion, and 20° of plantarflexion. Radiographs were taken for each step. Three of 12 specimen collapsed during SER IVb. In the neutral position, the peak pressure and contact area changed insignificantly from 2.6 ± 0.5 mPa (baseline) to 3.0 ± 1.4 mPa (SER IVb) (P = .35) and from 810 ± 42 mm2 to 735 ± 27 mm2 (P = .08), respectively. The corresponding medial clear space (MCS) increased significantly from 2.5 ± 0.4 mm (baseline) to 3.9 ± 1.1 mm (SER IVb) (P = .028).The position of the ankle joint had a decisive effect on contact area (P = .00), center of force (P = .00) and MCS (P = .01). Simulated SER IVb injuries demonstrated radiological, but no biomechanical changes. This should be considered for surgical decision making based on MCS width on weightbearing radiographs. Not applicable. Biomechanical study.

Three dimensional finite element modelling of metatarsal stresses during running

Second metatarsal stress fractures are a problematic injury for runners and are formed when the rate of repair of bone is outpaced by the damage accumulated during loading. Measuring the peak stresses on the bone during running gives an indication of damage accumulation but direct measurement is invasive. Finite element modelling is a viable alternative method of accurately estimating bone stresses but tends to be too computationally expensive for use in applied research. This study presents a novel and simple finite element model which can estimate bone stresses on the second metatarsal during the stance phase of walking and running, accounting for joint reaction forces and soft tissue effects. The influence of the forces and kinematic inputs to the model and the presence of the soft tissues was quantified using a sensitivity analysis. The magnitudes of maximum stress from the model are similar to existing finite element models and bone staple strain gauge values collected during walking and running. The model was found to be most sensitive to the pitch angle of the metatarsal and the joint reaction forces and was less sensitive to the ground reaction forces under the metatarsal head, suggesting that direct measurement of external forces should not be assumed to represent internal stresses.

Dysplastic hip anatomy alters muscle moment arm lengths, lines of action, and contributions to joint reaction forces during gait

Developmental dysplasia of the hip (DDH) is characterized by abnormal bony anatomy, which causes detrimental hip joint loading and leads to secondary osteoarthritis. Hip joint loading depends, in part, on muscle-induced joint reaction forces (JRFs), and therefore, is influenced by hip muscle moment arm lengths (MALs) and lines of action (LoAs). The current study used subject-specific musculoskeletal models and in-vivo motion analysis to quantify the effects of DDH bony anatomy on dynamic muscle MALs, LoAs, and their contributions to JRF peaks during early (~17%) and late-stance (~52%) of gait. Compared to healthy hips (N = 15, 16–39 y/o), the abductor muscles in patients with untreated DDH (N = 15, 16–39 y/o) had smaller abduction MALs (e.g. anterior gluteus medius, 35.3 vs. 41.6 mm in early stance, 45.4 vs. 52.6 mm late stance, p ≤ 0.01) and more medially-directed LoAs. Abduction-adduction and rotation MALs also differed for major hip flexors such as rectus femoris and iliacus. The altered MALs in DDH corresponded to higher hip abductor forces, medial JRFs (1.26 vs. 0.87 × BW early stance, p = 0.03), and resultant JRFs (5.71 vs. 4.97 × BW late stance, p = 0.05). DDH anatomy not only affected hip muscle force generation in the primary plane of function, but also their out-of-plane mechanics, which collectively elevated JRFs. Overall, hip muscle MALs and their contributions to JRFs were significantly altered by DDH bony anatomy. Therefore, to better understand the mechanisms of joint degeneration and improve the efficacy of treatments for DDH, the dynamic anatomy-force relationships and multi-planar functions of the whole hip musculature must be collectively considered.

A Finite Element Model for Estimation of Contact Dynamics During a Jumping Movement on a Trampoline

In order to fully understand contact dynamics on a trampoline, a simulation approach using a musculoskeletal model coupled with a dynamic model of the trampoline is essential. The purpose of the study was to examine dynamics and selected lower extremity muscle forces in a landing and jumping movement on a trampoline, using a combination of finite element modeling and musculoskeletal modeling. The rigid frame of the trampoline was modeled in ADAMS and coupled with a finite element model of the elastic trampoline net surface in ANSYS. A musculoskeletal model of an elite trampoline athlete was further developed in LifeMod and combined with the finite element model of the trampoline. The results showed that the peak trampoline reaction forces (TRF) were 3400 N (6.6 BW) and 2900 N (5.6 BW) for the left and right limb, respectively. The right hip, knee and ankle joint reaction forces reached the maximum between 3000-4000 N (5.8 – 7.7 BW). The gluteus maximum and quadriceps reached the maximum muscle force of 380 N (0.7 BW) and 780 N (1.5 BW), respectively. Asymmetric loading patterns between left and right TRFs and lower extremities joint reaction forces were observed due to the need to generate the rotational movement during the takeoff. The observed rigid and erect body posture suggested that the hip and knee extensors played important roles in minimizing energy absorption and maximizing energy generation during the trampoline takeoff.

Hip and ankle kinematics are the most important predictors of knee joint loading during bicycling

ObjectivesTo assess the effect of ankle, knee, and hip kinematics on patellofemoral and tibiofemoral joint reaction forces (JRF) during bicycling. Secondarily, to assess if sex, horizontal saddle position, or crank arm length were related to JRFs, after accounting for kinematics. DesignExperimental cross-sectional study. MethodsForty healthy adults (mean (SD); 28.6 (7.2) years, 24.2 (2.6)kg/m2, 17 women) bicycled under 18 bicycling positions. One position used commercial guidelines and 17 randomly deviated from commercial. Resultant patellofemoral as well as compressive and shear tibiofemoral JRFs were calculated. Linear mixed-effects models with a random intercept of leg-nested-in-participant were used. ResultsPatellofemoral resultant forces were most sensitive to all joint kinematics (i.e., sensitivity was defined as the slope of single predictor models); all JRFs were least sensitive to minimum knee flexion. Tibiofemoral compression was predicted by minimum hip flexion and maximum ankle dorsiflexion (R2=0.90). Tibiofemoral shear (R2=0.86) and the resultant patellofemoral JRF (R2=0.90) were predicted by minimum hip flexion, maximum ankle dorsiflexion, minimum knee flexion, and the interaction between minimum hip flexion and minimum knee flexion. Adding sex as a factor improved fit of all models. This sex-effect was driven by differences in cycling intensity, reflected by the tangential crank arm force. Horizontal saddle position and crank arm length were not related to JRFs. ConclusionsOptimizing joint kinematics should be the primary goal of bicycle-fit. JRFs were least sensitive to the current gold standard for assessing bicycle-fit, minimum knee flexion. Bicycle-fit is of particular importance for those working at high intensities.

Analysis of subject specific grasping patterns

Existing haptic feedback devices are limited in their capabilities and are often cumbersome and heavy. In addition, these devices are generic and do not adapt to the users’ grasping behavior. Potentially, a human-oriented design process could generate an improved design. While current research done on human grasping was aimed at finding common properties within the research population, we investigated the dynamic patterns that make human grasping behavior distinct rather than generalized, i.e. subject specific. Experiments were conducted on 31 subjects who performed grasping tasks on five different objects. The kinematics and kinetics parameters were measured using a motion capture system and force sensors. The collected data was processed through a pipeline of dimensionality reduction and clustering algorithms. Using finger joint angles and reaction forces as our features, we were able to classify these tasks with over 95% success. In addition, we examined the effects of the objects’ mechanical properties on those patterns and the significance of the different features for the differentiation. Our results suggest that grasping patterns are, indeed, subject-specific; this, in turn, could suggest that a device capable of providing personalized feedback can improve the user experience and, in turn, increase the usability in different applications. This paper explores an undiscussed aspect of human dynamic patterns. Furthermore, the collected data offer a valuable dataset of human grasping behavior, containing 1083 grasp instances with both kinetics and kinematics data.

Unilaterally Implemented Trunk Modification Associated With Asymmetrical Increase In Spinal Load

Trunk modification (TM) is associated with reduced knee adduction moment during gait in both healthy and symptomatic individuals. Reported reductions are dependent on the magnitude of modification implemented. Evidence however suggests that increased trunk motion augments structural loading at the spine. Despite the positive adaptations at the knee, potential unanticipated changes in spinal load are yet to be investigated. PURPOSE: To investigate changes in trunk joint reaction force (JRF) during ipsilateral (IP) and contralateral (CT) stance phases subsequent to implementing unilateral subject-specific TM. METHODS: 19 healthy participants (26.7±4.8 years; 1.69±0.17 m; 72.3±11.8 kg) were recruited. Trunk lean was implemented towards the side of the preferred kicking limb. Participants average trunk angle (TA) was assessed during 10 baseline trials using a motion capture system (200Hz) and force plates (1000Hz). Subject-specific TA range was determined by adding 1-3 standard deviations (small), and 3-5 standard deviations (large) to baseline value. Participants completed 5 trials using both small and large subject-specific TM angles. Real-time TA projected as a line graph which was visible to participants during TM trials reinforced performance. Visual 3D was used to deliver feedback and determine trunk JRF (N/kg). Changes to trunk JRF was assessed using a Friedman test with Wilcoxon signed-ranked test and Bonferroni-adjusted significance level. Analyses were conducted using a significance level of p<0.017. RESULTS: Peak lateral JRF during IP and CT stance were significantly greater during TM trials (χ2 (2) = 32.9, and 30.7, p<0.001 respectively). Participants experienced increased lateral JRF during both IP (d=1.5, and d=1.7, small and large TM respectively), and CT (d=1.6, and d=1.7, small and large TM respectively) compared to baseline. CONCLUSION: Changes in trunk JRFs are indicative of elevated spinal loads. During CT stance, lateral JRF in the direction of the modified side persisted which is indicative of continued asymmetric trunk load. Findings suggest TM could result in detrimental adaptations and may be contraindicated for certain individuals. Further research employing longitudinal design is needed to investigate if observed acute changes are transient in nature.

Muscular Not Skeletal Components Of Leg Stiffness Are Significantly Correlated With Associated Biomechanical Variables During Running

Muscular (kMusc) and skeletal (kSkel) components of leg stiffness have been previously related to injury patterns in runners [1]. Though these components mirror proposed injury mechanisms in runners, their relationship to underlying biomechanical variables remains unclear. PURPOSE: to evaluate the association between components of leg stiffness (kMusc & kSkel) with common biomechanical variables of muscular (joint work) and skeletal loading (joint reaction forces) during a running task. METHODS: Thirteen recreational runners (8 male, 5 female) performed ten over ground running trials at 3.35 m/s (±5%) in each of four conditions with varying shoe and strike patterns. Kinematics and ground reaction forces (GRFs) were recorded using an 8-camera motion capture system (240 Hz, Qualisys) and force platform (1200 Hz, OR-7, AMTI). Visual3D (C-Motion) was used to calculate joint powers and compressive joint reaction forces (JRFs). MATLAB was used to calculate negative joint work values and stiffness variables. kMusc and kSkel were calculated as previously reported [1]. Prism 8.0 (GraphPad) was used to perform correlation analyses between muscular and skeletal contributions to load attenuation. RESULTS: kMusc had moderate and weak relationships with lower extremity work (p < 0.01; r = 0.55) and knee joint work (p = 0.01; r = 0.32). Weak correlations existed between kSkel and ankle (p = 0.25; r = -0.10), knee (p = 0.17; r = 0.14) and hip joint reaction forces (p = 0.46; r = 0.01). CONCLUSIONS: These data revealed moderate associations between kMusc and negative work values suggesting that kMusc is proportional to muscular contributions to load attenuation. JRFs had weak associations with kSkel, suggesting kSkel may not represent skeletal loading. These findings suggest this simplistic model may be insufficient to describe muscular and skeletal contributions to load attenuation. [1] Powell, Paquette & Williams, 2017.

Stability Assessment of the Flexible System using Redundancy

In this study, dynamic behavior of a mooring line in a floating system is analyzed by probability approaches. In dynamics, most researches have shown the system model and environments by mathematical expression. We called this process as the forward dynamics. However, there is a limit to define the exact environments because of uncertainty. To consider uncertainty, we introduce the redundancy in flexible system, mooring line. For verifying the effectiveness and stability of the mooring line, criterion of axial breaking load of the mooring line is applied to joint reaction forces according to the various path of the mooring line. To cover the limits for defining the non-linearity of the environments, various responses of the mooring line along the redundancy that is used in Robotics, are derived by probability distribution. By using the Newton-Euler formulation, the inverse kinematics and the linear acceleration theorem to get joint displacements, velocities and accelerations, the joint reaction forces and moments are calculated and probability distribution of the mooring about stability and compatibility is investigated. Lastly, we simulate the flexible systems in various null motions, calculated each joint torque and force, and evaluated failure probabilities using the Monte-Carlo method.

Effects Of Foot Rotation On Knee Joint Reaction Forces During Running

PURPOSE: The purpose of this study was to examine the effects of internal and external foot rotation on knee joint reaction forces during running. METHODS: Motion capture and force data were recorded on nineteen healthy adult runners (22.3±4.0 years, 67.99±10.27 kg, and 1.77±0.10 m) running at 3.5 m/s with normal and maximal comfortable external (EXT) and internal (INT) foot rotation. Musculoskeletal simulations were performed using the Rajagopal 2015 model and OpenSim (SimTK). All data were low pass filtered at 10 Hz and normalized to a full stride (stance: 0-36% & swing: 37-100% stride). Models were scaled to each subject’s anthropometric parameters. Inverse dynamics were derived by combining inverse kinematics and force data. Muscle excitations were derived using Static Optimization, including muscle physiology parameters. Joint Reaction Forces were obtained by combining inverse kinematics, force data, and muscle excitations. Within-subjects ANOVAs via Statistical Parametric Mapping were used to determine differences in resultant knee joint reaction force waveforms. RESULTS: The EXT condition decreased early stance (0-2% stride) and late swing (92-100% stride) phase forces, but increased forces during early swing (44-46%) phase compared to normal. The INT condition reduced forces during very late swing phase (92-94% stride). The EXT reduced forces during early stance (0-1% stride) and late swing (97-100% stride) compared to INT. CONCLUSIONS: Despite the known success of altered foot rotation on reducing external knee abduction moments during walking and running, knee forces were only reduced during low-loading portions of running strides. Thus, it appears altered foot rotations does not improve knee loading during running.

Effects Of Weighted Baseball Throwing On Youth Glenohumeral Joint Reaction Force

Effects Of Weighted Baseball Throwing On Youth Glenohumeral Joint Reaction Force

A Pilot Study of Musculoskeletal Abnormalities in Patients in Recovery from a Unilateral Rupture-Repaired Achilles Tendon

The purpose of this study was to compare the inter-limb joint kinematics, joint moments, muscle forces, and joint reaction forces in patients after an Achilles tendon rupture (ATR) via subject-specific musculoskeletal modeling. Six patients recovering from a surgically repaired unilateral ATR were included in this study. The bilateral Achilles tendon (AT) lengths were evaluated using ultrasound imaging. The three-dimensional marker trajectories, ground reaction forces, and surface electromyography (sEMG) were collected on both sides during self-selected speed during walking, jogging and running. Subject-specific musculoskeletal models were developed to compute joint kinematics, joint moments, muscle forces and joint reaction forces. AT lengths were significantly longer in the involved side. The side-to-side triceps surae muscle strength deficits were combined with decreased plantarflexion angles and moments in the injured leg during walking, jogging and running. However, the increased knee extensor femur muscle forces were associated with greater knee extension degrees and moments in the involved limb during all tasks. Greater knee joint moments and joint reaction forces versus decreased ankle joint moments and joint reaction forces in the involved side indicate elevated knee joint loads compared with reduced ankle joint loads that are present during normal activities after an ATR. In the frontal plane, increased subtalar eversion angles and eversion moments in the involved side were demonstrated only during jogging and running, which were regarded as an indicator for greater medial knee joint loading. It seems after an ATR, the elongated AT accompanied by decreased plantarflexion degrees and calf muscle strength deficits indicates ankle joint function impairment in the injured leg. In addition, increased knee extensor muscle strength and knee joint loads may be a possible compensatory mechanism for decreased ankle function. These data suggest patients after an ATR may suffer from increased knee overuse injury risk.

Muscle contributions to tibiofemoral shear forces and valgus and rotational joint moments during single leg drop landing.

Anterior cruciate ligament (ACL) injuries commonly occur during single-leg landing tasks and are a burdensome condition. Previous studies indicate that muscle forces play an important role in controlling ligamentous loading, yet these studies have typically used cadaveric models considering only the knee-spanning quadriceps, hamstrings, and gastrocnemius muscle groups. Any muscles (including non-knee-spanning muscles) capable of opposing the anterior shear joint reaction force and the valgus joint reaction moment are thought to have the greatest potential for protecting the ACL from injury. Thus, the purpose of this study was to investigate how lower-limb muscles modulate knee joint loading during a single-leg drop landing task. An electromyography-informed neuromusculoskeletal modeling approach was used to compute lower-limb muscle force contributions to the anterior shear joint reaction force and the valgus joint reaction moment at the knee during a single-leg drop landing task. The average shear joint reaction force ranged from 153 N of anterior shear force to 744 N of posterior shear force. The muscles that generated the greatest posterior shear force were the soleus, medial hamstrings, and biceps femoris, contributing up to 393N, 359N, and 162N, respectively. The average frontal plane joint reaction moment ranged from a 19Nm varus moment to a 6Nm valgus moment. The valgus moment was primarily opposed by the gluteus medius, gluteus minimus, and soleus, with these muscles providing contributions of up to 38, 22, and 20Nm toward a varus moment, respectively. The findings identify key muscles that mitigate loads on the ACL.

Soft tissue artifact causes underestimation of hip joint kinematics and kinetics in a rigid-body musculoskeletal model

Rigid body musculoskeletal models have been applied to study kinematics, moments, muscle forces, and joint reaction forces in the hip. Most often, models are driven with segment motions calculated through optical tracking of markers adhered to the skin. One limitation of optical tracking is soft tissue artifact (STA), which occurs due to motion of the skin surface relative to the underlying skeleton. The purpose of this study was to quantify differences in musculoskeletal model outputs when tracking body segment positions with skin markers as compared to bony landmarks measured by direct imaging of bone motion with dual fluoroscopy (DF). Eleven asymptomatic participants with normally developed hip anatomy were imaged with DF during level treadmill walking at a self-selected speed. Hip joint kinematics and kinetics were generated using inverse kinematics, inverse dynamics, static optimization and joint reaction force analysis. The effect of STA was assessed by comparing the difference in estimates from simulations based on skin marker positions (SM) versus virtual markers on bony landmarks from DF. While patterns were similar, STA caused underestimation of kinematics, range of motion (ROM), moments, and reaction forces at the hip, including flexion-extension ROM, maximum internal rotation joint moment and peak joint reaction force magnitude. Still, kinetic differences were relatively small, and thus they may not be relevant nor clinically meaningful.

The influence of musculoskeletal forces on the growth of the prenatal cortex in the ilium: a finite element study

Remodelling and adaptation of bone within the pelvis is believed to be influenced by the mechanical strains generated during locomotion. Variation in the cortical bone thickness observed in the prenatal ilium has been linked to the musculoskeletal loading associated with in utero movements; for example the development of a thicker gluteal cortex is a possible response to contractions of the gluteal muscles. This study examines if the strains generated in the prenatal iliac cortex due to musculoskeletal loading in utero are capable of initiating bone remodelling to either maintain homeostasis or form new bone. Computational modelling techniques were used firstly to predict the muscle forces and resultant joint reaction force acting on the pelvis during a range of in utero movements. Finite element analyses were subsequently performed to calculate the von Mises strains induced in the prenatal ilium. The results demonstrated that strains generated in the iliac cortex were above the thresholds suggested to regulate bone remodelling to either maintain homeostasis or form new bone. Further simulations are required to investigate the extent to which the heterogeneous cortex forms in response to these strains (i.e., remodelling) or if developmental bone modelling plays a more pivotal role.

Hip Load Moments and Muscular Activity During Lifting

The load on the hip joint during lifting was studied. Healthy subjects lifted a 12.8 kg box from floor to table level with straight and flexed knees in four different ways. The loading moment of force about the bilateral hip axis was calculated by means of a computerized static sagittal plane model. The highest load moment, 124 Nm, occurred initially in the straight knee lift and the compressive joint reaction force was 2.7 times body-weight. The lowest load moment, 82 Nm, occurred in the flexed knee lift with the burden moved close to the trunk, the compressive force was 3.2 X bw. The load moment was also discussed in relation to the strength capability. The EMG levels of seven different hip muscles were normalized and expressed as a percentage of the recorded level of each muscle group during an isometric maximum voluntary contraction. The initial activity in the hamstrings was higher in the straight knee lift compared to flexed knees. The gluteus maximus was activated to a moderate level.

Torus obstacle method as a wrapping approach of the deltoid muscle group for humeral abduction in musculoskeletal simulation

Musculoskeletal models of the shoulder complex are valuable research aids to investigate tears of the supraspinatus and the resulting mechanical impact during abduction of the humerus. One of the major contributors to this motion is the deltoid muscle group and for this, an accurate modeling of the lines of action is indispensable. The aim of this work was to utilize a torus obstacle wrapping approach for the deltoids of an existing shoulder model and assess the feasibility of the approach during humeral abduction. The shoulder model from the AnyBody™ modeling system was used as a platform. The size of the tori is based on a magnetic resonance imaging (MRI) approach and several kinematic couplings are implemented to determine the trajectories of the tori during abduction. To assess the model behavior, the moment arms of the virtual muscle elements and the resultant glenohumeral joint reaction force (GHJF) were compared with reference data from the literature during abduction of the humerus in the range 20°–120°. The root mean square error for the anterior, lateral and posterior part between the simulated muscle elements and reference data from the literature was 3.9, 1.7 and 5.8 mm, respectively. The largest deviation occurred on the outer elements of the muscle groups, with 12.6, 10.4 and 20.5 mm, respectively. During abduction, there is no overlapping of the muscle elements and these are in continuous contact with the torus obstacles, thus enabling a continuous force transmission. This results in a rising trend of the resultant GHJF.The torus obstacle approach as a wrapping method for the deltoid muscles provides a guided muscle pathing by simultaneously approximating the curvature of the deltoid muscle. The results from the comparison of the simulated moment arms and the resultant GHJF are in accordance with those in the literature in the range 20°–120° of abduction.Although this study shows the strength of the torus obstacle as a wrapping approach, the method of fitting the tori according to MRI data was not suitable. A cadaver study is recommended to better validate and mathematically describe the torus approach.

Lower functioning patients demonstrate atypical hip joint loading before and following total hip arthroplasty for osteoarthritis.

Previous studies have established that up to 1 year post total hip arthroplasty (THA), patients do not recover normal function and the magnitude of hip joint loading remains reduced compared to healthy individuals. However, the temporal nature of the loading profile has not been considered to identify individuals who are at a greater risk of poor functional outcomes following THA. This study aimed to determine changes to the profile and magnitude of the resultant hip joint reaction force before and up to 6 months post-primary THA, and factors associated with atypical loading profiles. Hip joint loading was computed using a personalized lower-limb musculoskeletal model in 43 participants awaiting primary THA for osteoarthritis (mean age: SD = 65, 14 years; body mass index: SD = 30, 5 kg/m2 ) before and up to 6 months after THA. Atypical, single-peak loading profiles were observed for 11 patients before surgery, where four showed a single peak at 6 months. Patients displaying a single-peak profile walked slower (mean difference: -0.4 m/s) compared to individuals displaying double-peak profile (P = <.001) and had significantly reduced sagittal plane hip range of motion during gait (mean difference -9.6°, P = <.001). Self-reported pain, function, and stiffness did not differentiate between patients with a single or double-peak loading profile. Individuals with a single-peak force profile did not meet the minimal clinically important hip range of motion during gait and would be classified as low-functioning THA patients. Clinical Relevance: The temporal nature of the force profile may help to identify individuals who are at the greatest risk of poor functional outcomes after THA.

Blood-induced cartilage damage alters the ankle joint load during walking.

Ankle cartilage damage due to repeated joint bleeds often leads to altered gait in adult patients with hemophilia. It is therefore of clinical importance to develop an understanding of the biomechanical gait features in hemophilia patients with and without blood-induced cartilage damage and age-matched control subjects. We recruited a control group (n = 17), patients with hemophilia (PwH) without blood-induced ankle cartilage damage (PwH_NoCartDam , n = 5) and PwH with severe blood-induced ankle cartilage damage (PwH_CartDam , n = 19). We collected three-dimensional gait analysis data with following outcome variables in the ankle, Chopart and the first metatarsophalangeal (MTP 1) joints: range of motion (ROM) during stance phase, peak joint moment and powers. Biomechanical loading (BW) was quantified as the joint reaction forces using inverse dynamic analysis. Loading rate (BW/s) and impulse (BW*s) were calculated between 50% and 70% of stance phase. All biomechanical variables of the ankle joint were significantly lowered in the PwH_CartDam group compared with both the control subjects and the PwH_NoCartDam group. No compensatory biomechanical function was observed in other foot joints. An ankle loading rate of 2.64 ± 0.83 BW/s was observed in the control group, which was significantly higher than 1.75 ± 0.43 BW/s (P = .049) and 1.22 ± 0.59 BW/s (P < .001) in respectively the PwH_NoCartDam group and PwH_CartDam group. Patients with severe blood-induced cartilage damage demonstrated a (mal)adaptive gait strategy as they experience difficulties to properly unload the ankle cartilage during walking.