De Pieri Enrico, Friesenbichler Bernd, List Renate, Monn Samara, Casartelli Nicola C, Leunig Michael, Ferguson Stephen J
Laboratory for Movement Analysis, University of Basel Children's Hospital, Basel, Switzerland.
Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
Front Bioeng Biotechnol. 2021 Jul 21;9:679360. doi: 10.3389/fbioe.2021.679360. eCollection 2021.
Hip osteoarthritis may be caused by increased or abnormal intra-articular forces, which are known to be related to structural articular cartilage damage. Femoral torsional deformities have previously been correlated with hip pain and labral damage, and they may contribute to the onset of hip osteoarthritis by exacerbating the effects of existing pathoanatomies, such as cam and pincer morphologies. A comprehensive understanding of the influence of femoral morphotypes on hip joint loading requires subject-specific morphometric and biomechanical data on the movement characteristics of individuals exhibiting varying degrees of femoral torsion. The aim of this study was to evaluate hip kinematics and kinetics as well as muscle and joint loads during gait in a group of adult subjects presenting a heterogeneous range of femoral torsion by means of personalized musculoskeletal models. Thirty-seven healthy volunteers underwent a 3D gait analysis at a self-selected walking speed. Femoral torsion was evaluated with low-dosage biplanar radiography. The collected motion capture data were used as input for an inverse dynamics analysis. Personalized musculoskeletal models were created by including femoral geometries that matched each subject's radiographically measured femoral torsion. Correlations between femoral torsion and hip kinematics and kinetics, hip contact forces (HCFs), and muscle forces were analyzed. Within the investigated cohort, higher femoral antetorsion led to significantly higher anteromedial HCFs during gait (medial during loaded stance phase and anterior during swing phase). Most of the loads during gait are transmitted through the anterior/superolateral quadrant of the acetabulum. Correlations with hip kinematics and muscle forces were also observed. Femoral antetorsion, through altered kinematic strategies and different muscle activations and forces, may therefore lead to altered joint mechanics and pose a risk for articular damage. The method proposed in this study, which accounts for both morphological and kinematic characteristics, might help in identifying in a clinical setting patients who, as a consequence of altered femoral torsional alignment, present more severe functional impairments and altered joint mechanics and are therefore at a higher risk for cartilage damage and early onset of hip osteoarthritis.
髋关节骨关节炎可能由关节内压力增加或异常引起，已知这与关节软骨结构损伤有关。股骨扭转畸形此前已被证实与髋关节疼痛和盂唇损伤相关，并且它们可能通过加剧现有病理解剖结构（如凸轮和夹钳形态）的影响而促使髋关节骨关节炎的发病。要全面了解股骨形态类型对髋关节负荷的影响，需要针对个体运动特征的特定形态测量和生物力学数据，这些个体表现出不同程度的股骨扭转。本研究的目的是通过个性化肌肉骨骼模型，评估一组具有不同股骨扭转范围的成年受试者在步态过程中的髋关节运动学和动力学以及肌肉和关节负荷。37名健康志愿者以自我选择的步行速度接受了三维步态分析。采用低剂量双平面X线摄影评估股骨扭转。收集的运动捕捉数据用作逆动力学分析的输入。通过纳入与每个受试者X线测量的股骨扭转相匹配的股骨几何形状，创建个性化肌肉骨骼模型。分析股骨扭转与髋关节运动学和动力学、髋关节接触力（HCF）以及肌肉力量之间的相关性。在研究队列中，较高的股骨前倾角导致步态期间显著更高的前内侧HCF（负重站立期为内侧，摆动期为前方）。步态期间的大部分负荷通过髋臼的前/后上象限传递。还观察到与髋关节运动学和肌肉力量的相关性。因此，股骨前倾角可能通过改变运动学策略以及不同的肌肉激活和力量，导致关节力学改变并带来关节损伤风险。本研究中提出的方法，既考虑了形态学特征又考虑了运动学特征，可能有助于在临床环境中识别那些由于股骨扭转对线改变而出现更严重功能障碍和关节力学改变、因此软骨损伤风险更高且髋关节骨关节炎发病更早的患者。
