Developmental Dysplasia of the Hip (DDH) is an abnormal condition where hip joint dislocation, misalignment, or instability is present in infants. Rates of incidence of DDH in newborn infants have been reported to vary between 1 and 20 per 1000 births, making it the most common congenital malformation of the musculoskeletal system. DDH early detection and treatment is critical to avoid the use of surgical treatment in infants and to prevent future complications such as osteoarthritis in adult life. To this day several non-surgical treatments involving the use of harnesses and braces have been proposed to treat DDH in infants, with the Pavlik harness being the current non-surgical standard used to treat DDH at early stages. Although the Pavlik harness has been proven to be successful treating subtle dislocations, severe dislocations do not always reduce. Until now the use of the harness remains an empirical method, and its effectiveness often depends on physician expertise or trial-error procedures; thus a clear guideline has not been established to determine the best optimal harness configuration to treat both subtle and severe dislocations. The goal of this dissertation is to understand the connection between reductions for subtle and severe dislocations and passive muscle forces and moments generated while the harness is used during treatment. While the understanding of DDH biomechanics will provide a valuable clinically applicable approach to optimize and increase harness success rate, it is not without its difficulties. This research has created and developed a three-dimensional based on patient-specific geometry of an infant lower limb. The kinematics and dynamics of the lower limb were defined by modeling the hip, femur, tibia, fibula, ankle, foot, and toe bones. The lines of action of five (5) adductor muscles, namely, the Adductor Brevis, Adductor Longus, Adductor Magnus, Pectineus, and Gracilis were identified as mediators of reduction and its mechanical behavior was characterized using a passive response. Four grades (1-4) of dislocation as specified by the International Hip Dysplasia Institute (IHDI) were considered, and the computer model was computationally manipulated to represent physiological dislocations. To account for proper harness modeling, the femur was restrained to move in an envelope consistent with its constraints. The model of the infant lower limb has been used to analyze subtle and severe dislocations. Results are consistent with previous studies based on a simplified anatomically-consistent synthetic model and clinical reports of very low success of the Pavlik harness for severe dislocations. Furthermore the findings on this work suggest that for severe dislocations, the use of the harness could be optimized to achieve hyperflexion of the lower limb leading to successful reduction for cases where the harness fails. This approach provides three main advantages and innovations: 1) the used of patient-specific geometry to elucidate the biomechanics of DDH; 2) the ability to computationally dislocate the model to represent dislocation severity; and 3) the quantification of external forces needed to accomplish reduction for severe dislocations. This study aims to offer a practical solution to effective treatment that draws from engineering expertise and modeling capabilities and also draws upon medical input. The findings of this work will lay the foundation for future optimization of non-surgical methods critical for the treatment of DDH.

Biomechanical factors influencing the reduction of dislocated hips with the Pavlik harness in patients of Developmental Dysplasia of the Hip (DDH) were studied using a simplified three-dimensional computer model simulating hip reduction dynamics in (1) subluxated, and (2) fully dislocated hip joints. The CT-scans of a 6 month-old female infant were used to measure the geometrical features of the hip joint including acetabular and femoral head diameter, acetabular depth, and geometry of the acetabular labrum, using the medical segmentation software Mimics. The lower extremity was modeled by three segments: thigh, leg, and foot. The mass and the location of the center of gravity of each segment were calculated using anthropometry, based on the total body mass of a 6-month old female infant at the 50th length-for-age percentile. A calibrated nonlinear stress-strain model was used to simulate muscle responses. The simplified 3D model consists of the pubis, ischium, acetabulum with labrum, and femoral head, neck, and shaft. It is capable of simulating dislocated as well as reduced hips in abduction and flexion. Five hip adductor muscles were identified as key mediators of DDH prognosis, and the non-dimensional force contribution of each in the direction necessary to achieve concentric hip reductions was determined. Results point to the adductor muscles as mediators of subluxated hip reductions, as their mechanical action is a function of the degree of hip dislocation. For subluxated hips in abduction and flexion, the Pectineus, Adductor Brevis, Adductor Longus, and proximal Adductor Magnus muscles contribute positively to reduction, while the rest of the Adductor Magnus contributes negatively. In full dislocations all muscles contribute detrimentally to reduction, elucidating the need for traction to reduce Graf IV type dislocations. Reduction of iv dysplastic hips was found to occur in two distinct phases: (a) release phase and (b) reduction phase. To expand the range of DDH-related problems that can be studied, an improved threedimensional anatomical computer model was generated by combining CT-scan and muscle positional data belonging to four human subjects. This model consists of the hip bone and femora of a 10-week old female infant. It was segmented to encompass the distinct cartilaginous regions of infant anatomy, as well as the different regions of cortical and cancellous bone; these properties were retrieved from the literature. This engineering computer model of an infant anatomy is being employed for (1) the development of a complete finite element and dynamics computer model for simulations of hip dysplasia reductions using novel treatment approaches, (2) the determination of a path of least resistance in reductions of hip dysplasia based on a minimum potential energy approach, (3) the study of the mechanics of hyperflexion of the hip as alternative treatment for late-presenting cases of hip dysplasia, and (4) a comprehensive investigation of the effects of femoral anteversion angle (AV) variations in reductions of hip dysplasia. This thesis thus reports on an interdisciplinary effort between orthopedic surgeons and mechanical engineers to apply engineering fundamentals to solve medical problems. The results of this research are clinically relevant in pediatric orthopaedics.