With a prevalence of 17% in men and 4% in women, Femoroacetabular Impingement (FAI) of type cam is characterized by a decreased femoral head-neck offset and/or asphericity of the lateral femoral head, associated with groin pain and reduced hip range of motion. Since the aetiology is still unclear, the mechanisms of development, progression and degeneration of FAI are largely investigated. Musculoskeletal modeling can support the development of a biomechanical framework to advance the research on FAI pathomechanisms, expand the knowledge about hip contact load distribution in FAI population, and relate the muscle and hip contact forces to the alterations observed during functional tasks. Therefore, this thesis is composed of two parts: the development of a methodological framework, and its application to the investigation of FAI pathomechanisms. The variability of the modelling outcomes (i.e.., body kinematics, torques, contact and muscle forces) to different marker sets, pelvic marker misplacements, and hip joint center (HJC) location was investigated within an inverse kinematic framework. The findings from such studies supported the modelling choices for the clinical investigation of FAI pathomechanisms. In particular, the performance of three different marker sets (Plug-in-Gait, University of Ottawa Motion Analysis Model and a 3-marker-cluster marker set) was compared, and absolute and relative reliability indices were calculated with the purpose of finding a simple yet reliable marker set to be used within an inverse kinematic framework in a clinical study. Thereafter, the sensitivity of joint angles, moments and hip contact forces to simulated inaccurate pelvic tilt was analyzed. The resulting variability indices were high with variations up to 1.3 times the body weight in hip contact forces. The kinematic variations propagated non-linearly to all planes and joints, showing the importance of adjusting possible pelvic misalignments. A methodology was presented to correct the pelvic alignment when the relative position of surface pelvic markers with respect to bony landmarks is known from medical images. The HJC location is a crucial modelling parameter in the analysis of hip kinematics and forces. A certain degree of customization could be introduced in the model by using HJC measured from medical images. Therefore, the performance of a generic musculoskeletal model with customized or non-customized HJC was compared during walking. Hip contact forces were highly sensitive to HJC location, especially because of the dependency of muscle moment arms to HJC changes. However, the variation of HJC without consistent muscle anatomy customization introduced artifacts that could potentially produce inaccurate muscle and joint contact forces estimation. When HJC cannot be measured from medical images, regression equations can be used instead. Therefore, the validity of two popular HJC regression equations (Harrington and Davis) was tested on FAI participants using non-parametric statistical and Bland-Altman tests. The results indicated that the equations were valid for FAI population. In addition, skin thickness measurements were provided for pelvic bony landmarks, and their correlation with body mass index was proposed for systematic error reduction. New adult-specific regression equations were developed from medical images. The described methodological framework was then applied to investigate the functional alterations observed in FAI population. The differences in muscle and hip contact forces were compared between FAI and healthy control groups during level walking. The FAI group showed reduced muscle and hip contact forces, which were linked to the lower normalized walking speed and shorter step length. These results can be interpreted as a protective mechanism developed by FAI patients to prevent high compression at the site of impingement, given that the compressing hip contact force was directed towards the anterior-superior quadrant of the acetabulum, consistent with the localization of the cam-type deformity and the cartilage and labrum damages. Based on these findings, a possible FAI pathomechanism was proposed, which could be used to support the development of preventive treatment and intervention for symptomatic FAI patients.

Femoroacetabular impingement (FAI) is a hip joint deformity that causes joint pain, decreases joint range of motion and results in abnormal kinematic and kinetic characteristics. It is not known whether these biomechanical variations are caused by the actual mechanical impingement aspect of hip deformity or neuromuscular adaptations and soft tissue damage associated with pain. The purpose of this study was to investigate the effects of femoroacetabular cam deformity (FAD) during daily functional tasks. This was accomplished by measuring and comparing the hip joint biomechanics of symptomatic FAI (sFAI), asymptomatic FAD, and control (CON) subjects. Fifty one subjects volunteered to the study (n = 51; CON = 17, FAD = 18, sFAI = 16) and they performed 6 simulated activities of daily living: stair ascent and descent, sit-to-stand and stand-to-sit, dynamic range of motion, maximum depth squats and level walking tasks while motion ground reaction force and muscle activity were recorded. However, only the squat and level walking tasks were analyzed for this thesis. For each task, three-dimensional kinematics and kinetics were recorded and analyzed. Qualitative questionnaires (HOOS and WOMAC) and physical exams were also part of the testing protocol, and maximum voluntary isometric contractions (MVIC) were collected as part of a separate EMG protocol. The EMG results were not analyzed but the MVIC results were and the moments of force were determined. The sFAI group had significantly reduced scores for all HOOS and WOMAC metrics compared to FAD and CON. The sFAI group had significantly reduced external rotation, internal rotation, and a trend indicating reduced hip flexion compared to FAD and CON groups. The FAD group had a trend indicating reduced internal rotation compared to CON. There were no differences in the moments of force between groups for the MVICs. No statistically significant differences were observed between groups for the squat trials, however, the sFAI group showed biomechanical variations. Both the CON and FAD groups were able to squat deeper, had greater pelvic range of motion and a larger maximum hip and knee flexion angle compared to sFAI. Similarly, the walking tasks did not elucidate any between group differences in biomechanical characteristics. Yet, there was a noticeable trend of decreased peak hip abduction angle in the sFAI group compared to CON. This result may be indicative of a gait adaptation based on the pain that sFAI subjects endure over a long period of time. Interestingly, the FAD group did not have obvious gait patterns similar to either the CON or sFAI, making it unclear if the asymptomatic cam deformity has any gait adaptation effects. Since no differences were observed between FAD and CON in squatting and walking, the actual bone deformity may not be the cause of restricted motion during daily activities as previously thought. Internal rotation physical examination appears to indicate potential restrictions in the FAD compared to CON, and may be the best parameter to assess differences between groups and predict the presence of cam deformity. It is suggested that the presence of pain, caused by soft tissue damage over time, may be confounding factors leading to the biomechanical and neuromuscular discrepancies observed in sFAI, and should be the next avenue of study.

Introdução: As alterações anatômicas do fêmur proximal ou do acetábulo, como as decorrentes das sequelas da epifisiólise do fêmur proximal, da displasia do quadril da doença de Legg-Perthes-Calvé, podem levar ao desenvolvimento da artrose do quadril. No entanto, em torno de 80% dos indivíduos que desenvolvem essa doença têm uma anatomia óssea considerada normal. Ainda assim, surgiu a hipótese que alterações sutis do fêmur proximal ou do acetábulo, denominadas, respectivamente, cam e pincer, poderiam gerar um contato anormal entre essas estruturas ósseas, desencadear lesão condral e, como consequência, a artrose do quadril. Esse mecanismo foi denominado impacto fêmoro-acetabular. No entanto, a comprovação da relação entre o impacto e a artrose do quadril depende da uniformização dos critérios diagnósticos do cam e do pincer, ainda escassa e variável na literatura. Dessa forma, será possível a definição da prevalência e história natura do impacto fêmoro-acetabular e da sua relação com a artrose do quadril. Objetivo: Avaliar a prevalência do impacto fêmoro-acetabular tipo cam e tipo pincer em uma amostra de indivíduos assintomáticos. Pacientes e Métodos: Foram estudados 106 indivíduos assintomáticos (65 homens e 41 mulheres), com idade entre 20 e 40 anos. A condição determinante para a inclusão no estudo foi à ausência de história de dor no quadril ao longo da vida. Foram obtidas radiografias em ântero-posterior e Dünn 45°. A presença de cam foi determinada por um ângulo alfa, arbitrado, de 55° e a presença de pincer, quando observado o sinal da parede posterior e/ou o sinal de crossover. Resultados: Foi observada prevalência de cam de 29%; o sinal do crossover e da parede posterior ocorreram, respectivamente, em 20% e 29% dos indivíduos estudados. Pelo menos uma das imagens de impacto fêmoro-acetabular estava presente em 65% dos indivíduos da amostra. Conclusão: A prevalência encontrada das imagens de impacto fêmoro-acetabular (65%) está acima daquelas relatadas na literatura. É necessária a ampliação do estudo para confirmar os resultados encontrados e a realização de estudos prospectivos bem controlados para avaliar o papel do cam e do pincer no desenvolvimento da artrose do quadril. / Background: Anatomical abnormalities of the proximal femur or the acetabulum, such as those resulting from the consequences of slipped epiphyses of the proximal femur, the hip dysplasia of Legg-Calve-Perthes disease, could lead to the development of hip osteoarthrosis. Nevertheless, around 80% of individuals who develop this condition have a bone anatomy considered normal. Still, the hypothesis arose that subtle alterations of the proximal femur or the acetabulum, called, respectively, cam and pincer, could generate an abnormal contact between these bony structures, triggering chondral lesion and as a consequence, arthritis of the hip. This mechanism has been named femoroacetabular impingement. Nevertheless, evidence of the relationship between the impact and osteoarthritis of the hip depends on the standardization of diagnostic criteria of cam and pincer, still scarce and variable in the literature. Thus it will be possible to define the prevalence and natural history of femoroacetabular impingement and its relationship with hip osteoarthrosis. Aim: To determine the prevalence of cam-type and pincer-type femoroacetabular impingements in asymptomatic subjects. Patients and Methods: Were studied 106 asymptomatic subjects (65 males and 41 females) aged between 20 and 40 years. The determining condition for inclusion in the study was the absence of history of hip pain throughout life. Radiographs were obtained in anteroposterior pelvic view and Dunn 45° view. The presence of cam was determined by an angle alpha, arbitrated, 55 ° and the presence of pincer when the observed the posterior wall and / or crossover signs. Results: A prevalence of 29% of cam, and 20% and 29% of crossover sign and posterior wall sign respectively was found. At least, one of those radiographic signs of femoroacetabular impingement was found in 65% (68) of the cases. Conclusion: In conclusion, the prevalence of images of femoroacetabular impingement (65%) is above those reported in the literature. Increase of the study is necessary to verify the results found, and the performance of well-controlled prospective studies to evaluate the role of the cam and pincer in the development of osteoarthritis of the hip.

Surgical interventions on the hip joint have greatly increased over the past decade, with the cumulative cost total hip arthroplasties (THA) alone exceeding $400B/year by 2020. Although positive patient-reported outcomes and satisfaction after THA and hip preservation for cam femoroacetabular impingement (FAI) are among the highest in orthopaedics, a limited number of research has investigated the biomechanics of dynamic activities following-up the surgery. This doctoral thesis examined the kinematics, muscle force component, and hip contact loading in pre- and postoperative patients during the deep squat motion. Specifically, this research: 1) examined muscle strength and pelvic kinematics in asymptomatic FAI, 2) examined lower-limb kinematics and muscle activity in postoperative patients who underwent either THA or FAI correction during a deep squat task, and 3) examined muscle force contributions and hip contact forces (HCF) during dynamic motion in postoperative FAI patients. First, clinical and medical imaging evaluations classified the participants into three groups: symptomatic FAI, asymptomatic FAI (FAD – participants had the cam deformity, but no pain), and healthy controls. The FAD participants had significantly greater hip extensor strength compared to the FAI and CTRL groups, which allowed them to achieve greater pelvic mobility and squat as deep as the CTRL group. Second, at the follow-up for the FAI surgery the patients showed increased pelvic ROM during the squat, and weakness associated with hip flexion and hip flexion-with-abduction were associated with postoperative alterations. For the THA follow-up analyses, the patients using a dual- mobility (DM) prosthesis reached an anterior pelvic tilt similarly to the CTRL during the dynamic parts of the squat; however, without returning its neutral tilt at the bottom of the squat, while the single- bearing (SB) prosthesis was associated with excessive hip abduction during the squat. Third, a generic full-body musculoskeletal model (MSKM) was optimized to allow for the analysis of tasks with a high range of motion (ROM; e.g. deep squat task), which controlled muscle moment arms during the high joint flexions to avoid the model’s motor tendon units (MTU) to penetrate the bony structures and respect the anatomical via points. Simulation performed during gait demonstrated that FAI patients enhance medial-lateral hip stability postoperatively, allowing reduced dynamic forces of the muscles associated with the sagittal aspect of the gait due to a less compensatory strategy to stabilize the hip joint. Furthermore, simulations performed during deep squat showed a higher anterior pelvic tilt in postoperative FAI patients as a ‘restore to native’ mechanism once the cam-deformity was no longer present. Increased semimembranosus force was linked to higher vertical HCF and total magnitude. The outcomes of this research include findings for gait and squat analyses that provide a better understanding of the pelvic mobility and hip muscle forces in hip diseases. In silico models can improve biomechanical assessment of postoperative patients in order to quantify surgical effectiveness and support clinicians in making subject-specific case decisions. The contributions also lay on the assertion of helping us to formulate future research directions in biomechanics applied to the orthopaedics field.

No description available.

Aim of this thesis is to evaluate distribution of plantar pressure and the movement of spine and pelvis in patients diagnosed with femoroacetabular impingement syndrome. The results were obtained using Diers pedoscan system which can record the pressure distribution of feet during stance and motion. Also Diers formetric III 4D system was used to obtain photogrammetic records of spine and pelvis movement. We use rasterstereography based on Moiré topografy. Measured data represent three dimensional model of back surface during static or dynamic analysis. In addition we evaluated the effect of treatment using Dynamic neuromuscular stabilization. Obtained results were statistically processed. Powered by TCPDF (www.tcpdf.org)

Computational modeling in the field of biomechanics is becoming increasingly popular and successful in practice for its ability to predict function and provide information that would otherwise be unobtainable. Through the application of these new and constantly improving methods, kinematics and joint contact characteristics in pathological conditions of femoroacetabular impingement (FAI) and total hip arthroplasty (THA) were studied using a lower extremity computational model. Patients presenting with FAI exhibit abnormal contact between the femoral neck and acetabular rim leading to surrounding tissue damage in daily use. THA is the replacement of both the proximal femur and acetabular region of the pelvis and is the most common surgical intervention for degenerative hip disorders. A combination of rigid osteoarticular anatomy and force vectors representing soft tissue structures were used in developing this model. Kinematics produced by healthy models were formally validated with experimental data from Burnfield et al. This healthy model was then modified to emulate the desired morphology of FAI and a THA procedure with a range of combined version (CV) angles. All soft tissue structures were maintained constant for each subsequent model. Data gathered from these models did not provide any significant differences between the kinematics of healthy and FAI but did show a large amount of variation in all THA kinematics including incidents of dislocation with cases of lower CV angles. With the results of these computational studies performed with this model, an increased understanding of hip morphology with regards to STS has been achieved.

Femoroacetabular impingement (FAI) is recognized as a pathomechanical process that leads to hip osteoarthritis (OA). It is hypothesized that mechanical stimuli are prominent at higher range of motions in hips with cam FAI (aspherical femoral head-neck deformity). Adverse loading conditions can impose elevated mechanical stimuli levels at the articulating surfaces and underlying subchondral bone, which plays a predominant mechanical role in early OA. The aim of this research was to determine the levels of mechanical stimuli within the hip, examining the effects of severe cam impingement on the onset of OA, using patient-specific biomechanics data, CT data, and finite element analysis (FEA). Patient-specific hip joint reaction forces were applied to two symptomatic patient models and two control-matched models, segmented from patient-specific CT data. The finite element models were simulated to compare the locations and magnitudes of mechanical stimuli during two quasi-static positions from standing to squatting. Maximum-shear stress (MSS) was analyzed to determine the adverse loading conditions within the joint and strain energy density (SED) was determined to examine its effect on the initiation of bone remodelling. The results revealed that peak mechanical stimuli concentrations were found on the antero-superior acetabulum during the squatting position, underlying to the cartilage. The MSS magnitudes were significantly higher and concentrated for the FAI patients (15.145 ± 1.715 MPa) in comparison with the MSS magnitudes for the control subjects (4.445 ± 0.085 MPa). The FAI group demonstrated a slight increase in peak SED values on the acetabulum from standing (1.005 ± 0.076 kPa) to squatting (1.018 ± 0.082 kPa). Insignificant changes in SED values were noticed for the control subjects. Squatting orients the femoral head into the antero-superior acetabulum, increasing the contact area with the cartilage and labral regions, thus resulting in higher peaks behind the cartilage on the acetabulum. The resultant location of the peak MSS and SED concentrations correspond well with the region of initial cartilage degradation and early OA observed during open surgical dislocation. Due to the relatively low elastic modulus of the articular cartilage, loads are transferred and amplified to the subchondral bone. This further suggests that elevated stimuli levels can provoke stiffening of the underlying subchondral plate, through bone remodelling, and consequently accelerating the onset of cartilage degradation. Since mechanical stimuli results are unique to their patient-specific loading parameters and conditions, it would be difficult to determine a patient-specific threshold to provoke bone remodeling at this stage.

Femoroacetabular impingement (FAI) is recognized as a pathomechanical process that leads to hip osteoarthritis (OA). It is hypothesized that mechanical stimuli are prominent at higher range of motions in hips with cam FAI (aspherical femoral head-neck deformity). Adverse loading conditions can impose elevated mechanical stimuli levels at the articulating surfaces and underlying subchondral bone, which plays a predominant mechanical role in early OA. The aim of this research was to determine the levels of mechanical stimuli within the hip, examining the effects of severe cam impingement on the onset of OA, using patient-specific biomechanics data, CT data, and finite element analysis (FEA). Patient-specific hip joint reaction forces were applied to two symptomatic patient models and two control-matched models, segmented from patient-specific CT data. The finite element models were simulated to compare the locations and magnitudes of mechanical stimuli during two quasi-static positions from standing to squatting. Maximum-shear stress (MSS) was analyzed to determine the adverse loading conditions within the joint and strain energy density (SED) was determined to examine its effect on the initiation of bone remodelling. The results revealed that peak mechanical stimuli concentrations were found on the antero-superior acetabulum during the squatting position, underlying to the cartilage. The MSS magnitudes were significantly higher and concentrated for the FAI patients (15.145 ± 1.715 MPa) in comparison with the MSS magnitudes for the control subjects (4.445 ± 0.085 MPa). The FAI group demonstrated a slight increase in peak SED values on the acetabulum from standing (1.005 ± 0.076 kPa) to squatting (1.018 ± 0.082 kPa). Insignificant changes in SED values were noticed for the control subjects. Squatting orients the femoral head into the antero-superior acetabulum, increasing the contact area with the cartilage and labral regions, thus resulting in higher peaks behind the cartilage on the acetabulum. The resultant location of the peak MSS and SED concentrations correspond well with the region of initial cartilage degradation and early OA observed during open surgical dislocation. Due to the relatively low elastic modulus of the articular cartilage, loads are transferred and amplified to the subchondral bone. This further suggests that elevated stimuli levels can provoke stiffening of the underlying subchondral plate, through bone remodelling, and consequently accelerating the onset of cartilage degradation. Since mechanical stimuli results are unique to their patient-specific loading parameters and conditions, it would be difficult to determine a patient-specific threshold to provoke bone remodeling at this stage.

No description available.