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Test systems for the biomechanical evaluation of hip protectors: a systematic review

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Abstract

Various mechanical and biomechanical test systems to evaluate the effectiveness of hip protectors designed to prevent hip fracture as a result of falls were examined in this review. The articles considered were selected systematically. The effect of differences in design criteria was demonstrated, and it was observed that the impact energy employed during testing dramatically affects the performance of the hip protector. Over the past three decades, researchers have continuously experimented with various systems to determine the efficacy of various hip protectors. The primary aim has been to make informed decisions in optimizing hip protector design. This article provides a systematic review of various test systems employed in the determination of the biomechanical efficacy of hip protectors. A systematic literature search was carried out, and 28 relevant articles were included to demonstrate the effect of test systems in the evaluation of the biomechanical effectiveness of hip protectors. Methodological studies illustrated the appropriate use of impact testing systems for the simulation of hip anatomy and fall dynamics in evaluating the effectiveness of hip protectors in preventing a hip fracture. This systematic review has demonstrated the effect of the variability of test systems on the evaluation of impact attenuation by various hip protectors. The lack of standardized test systems accounts for the inconsistencies in the test results of the efficacy of hip protectors. This has been a major challenge in the efforts of researchers to optimize the interventions. The standardization of test systems may require needed improvements immediately as opposed to the development of new interventions in order to ensure that only hip protectors with adequately proven efficacies are deployed for clinical trials or for the protection of the hips of vulnerable individuals from sideways impact.

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References

  1. Holzer G, Holzer LA (2007) Hip protectors and prevention of hip fractures in older persons. Geriatrics 62:15–20

    PubMed  Google Scholar 

  2. Lauritzen JB (1996) Hip fractures: incidence, risk factors, energy absorption, and prevention. Bone 18:S65–S75. https://doi.org/10.1016/8756-3282(95)00382-7

    Article  Google Scholar 

  3. Kumar BA, Parker MJ (2000) Are hip protectors cost effective? Injury 31:693–695. https://doi.org/10.1016/S0020-1383(00)00078-4

    Article  CAS  PubMed  Google Scholar 

  4. Grisso JA, Kelsey JL, Strom BL, Ghiu GY, Maislin G, O'Brien LA, Hoffman S, Kaplan F (1991) Risk factors for falls as a cause of hip fracture in women. N Engl J Med 324:1326–1331. https://doi.org/10.1056/NEJM199105093241905

    Article  CAS  PubMed  Google Scholar 

  5. Empana JP, Dargent-Molina P, Bréart G (2004) Effect of hip fracture on mortality in elderly women: the EPIDOS prospective study. J Am Geriatr Soc 52:685–690. https://doi.org/10.1111/j.1532-5415.2004.52203.x

    Article  PubMed  Google Scholar 

  6. Melton LJ, Gabriel SE, Crowson CS, Tosteson ANA, Johnell O, Kanis JA (2003) Cost-equivalence of different osteoporotic fractures. Osteoporos Int 14:383–388. https://doi.org/10.1007/s00198-003-1385-4

    Article  PubMed  Google Scholar 

  7. Melton LJ (1993) Hip fractures: a worldwide problem today and tomorrow. Bone 14:1–8. https://doi.org/10.1016/8756-3282(93)90341-7

    Article  Google Scholar 

  8. Stollenwerk B, Waldeyer R, Klein-Meding C, Müller D, Stock S (2014) Cost effectiveness of external hip protectors in the hospital setting: a modeling study. Nurs Econ 32:89–98

    PubMed  Google Scholar 

  9. Gandjour A, Weyler EJ (2008) Cost-effectiveness of preventing hip fractures by hip protectors in elderly institutionalized residents in Germany. Value Heal 11:1088–1095. https://doi.org/10.1111/j.1524-4733.2008.00393.x

    Article  Google Scholar 

  10. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22:465–475. https://doi.org/10.1359/jbmr.061113

    Article  PubMed  Google Scholar 

  11. Lam S-L, Yip K-M, Wang J-L et al (2004) The force attenuation effect of foam mattress in simulated sideways fall of hip on level surface. Biomed Eng Appl Basis Commun 16:265–271. https://doi.org/10.4015/S1016237204000372

    Article  Google Scholar 

  12. Iaboni A, Van Ooteghem K, Marcil MN et al (2018) A palliative approach to falls in advanced dementia. Am J Geriatr Psychiatry 26:407–415. https://doi.org/10.1016/J.JAGP.2017.11.014

    Article  PubMed  Google Scholar 

  13. Courtney AC, Wachtel EF, Myers ER, Hayes WC (1994) Effects of loading rate on strength of the proximal femur. Calcif Tissue Int 55:53–58

    Article  CAS  Google Scholar 

  14. Nabhani F, Bamford JS (2004) Impact properties of floor coverings and their role during simulated hip fractures. J Mater Process Technol 153–154:139–144. https://doi.org/10.1016/j.jmatprotec.2004.04.211

    Article  Google Scholar 

  15. Li N, Tsushima E, Tsushima H (2013) Comparison of impact force attenuation by various combinations of hip protector and flooring material using a simplified fall-impact simulation device. J Biomech 46:1140–1146. https://doi.org/10.1016/j.jbiomech.2013.01.007

    Article  PubMed  Google Scholar 

  16. Laing AC, Robinovitch SN (2009) Low stiffness floors can attenuate fall-related femoral impact forces by up to 50% without substantially impairing balance in older women. Accid Anal Prev 41:642–650. https://doi.org/10.1016/j.aap.2009.03.001

    Article  PubMed  Google Scholar 

  17. Minns RJ, Marsh AM, Chuck A, Todd J (2007) Are hip protectors correctly positioned in use? Age Ageing 36:140–144. https://doi.org/10.1093/ageing/afl186

    Article  CAS  PubMed  Google Scholar 

  18. Cameron ID, Kurrle SE (2002) Hip protector prevents fractures but adherence is a problem. Br Med J 324:375–376

    Article  Google Scholar 

  19. Cameron ID, Kurrle SE (2003) Hip protectors. Lancet 362:1940–1941

    Article  Google Scholar 

  20. Haris A, Goh BWY, Tay TE, Lee HP, Rammohan AV, Tan VBC (2018) On the effectiveness of incorporating shear thickening fluid with fumed silica particles in hip protectors. Smart Mater Struct 27:01–12. https://doi.org/10.1088/1361-665X/aa9e60

    Article  Google Scholar 

  21. Holzer LA, Holzer G (2007) Design: a neglected factor in medicine. McGill J Med 10(3)

  22. Lauritzen JB, Petersen MM, Lund B (1993) Effect of external hip protectors on hip fractures. Lancet 341:11–13. https://doi.org/10.1016/0140-6736(93)92480-H

    Article  CAS  PubMed  Google Scholar 

  23. Lee T, Hwang DG, Ogihara N, Ito K (2017) The use of shear thickening polymer as a hip protector. In: Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS IEEE, pp 1633–1635

  24. Kiel DP, Magaziner J, Zimmerman S, Ball L, Barton BA, Brown KM, Stone JP, Dewkett D, Birge SJ (2007) Efficacy of a hip protector to prevent hip fracture in nursing home residents: the HIP PRO randomized controlled trial. J Am Med Assoc 298:413–422. https://doi.org/10.1001/jama.298.4.413

    Article  CAS  Google Scholar 

  25. Sawka AM, Boulos P, Beattie K, Papaioannou A, Gafni A, Cranney A, Hanley DA, Adachi JD, Papadimitropoulos EA, Thabane L (2007) Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis. J Clin Epidemiol 60:336–344

    Article  Google Scholar 

  26. Parker MJ, Gillespie WJ, Gillespie LD (2006) Effectiveness of hip protectors for preventing hip fractures in elderly people: systematic review. Br Med J 332:571–573. https://doi.org/10.1136/bmj.38753.375324.7C

    Article  Google Scholar 

  27. Santesso N, Carrasco-Labra A, Brignardello-Petersen R (2014) Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev:1–82. https://doi.org/10.1002/14651858.CD001255.pub5

  28. Holzer LA, von Skrbensky G, Holzer G (2009) Mechanical testing of different hip protectors according to a European Standard. Injury 40:1172–1175. https://doi.org/10.1016/j.injury.2009.02.005

    Article  PubMed  Google Scholar 

  29. Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M (1999) Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int 65:183–187. https://doi.org/10.1007/s002239900679

    Article  CAS  PubMed  Google Scholar 

  30. Wiener SL, Andersson GBJ, Nyhus LM, Czech J (2002) Force reduction by an external hip protector on the human hip after falls. Clin Orthop Relat Res 398:157–168. https://doi.org/10.1097/00003086-200205000-00023

    Article  Google Scholar 

  31. Lauritzen JB, Askegaard V (1992) Protection against hip fractures by energy absorption. Dan Med Bull 39:91–93

    CAS  PubMed  Google Scholar 

  32. Minns J, Dodd C, Gardner R, Bamford J, Nabhani F (2004) Assessing the safety and effectiveness of hip protectors. Nurs Stand 18:33–38. https://doi.org/10.7748/ns2004.06.18.39.33.c3625

    Article  PubMed  Google Scholar 

  33. Robinovitch SN, Evans SL, Minns J, Laing AC, Kannus P, Cripton PA, Derler S, Birge SJ, Plant D, Cameron ID, Kiel DP, Howland J, Khan K, Lauritzen JB (2009) Hip protectors: recommendations for biomechanical testing-an international consensus statement (part I). Osteoporos Int 20:1977–1988. https://doi.org/10.1007/s00198-009-1045-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Bulat T, Applegarth S, Wilkinson S et al (2008) Effect of multiple impacts on protective properties of external hip protectors. Clin Interv Aging 3:567–571

    Article  Google Scholar 

  35. Parkkari J, Kannus P, Poutala J, Vuori I (1994) Force attenuation properties of various trochanteric padding materials under typical falling conditions of the elderly. J Bone Miner Res 9:1391–1396. https://doi.org/10.1002/jbmr.5650090910

    Article  CAS  PubMed  Google Scholar 

  36. Spierings AB, Derler S (2006) Assessment of hip protectors and corresponding hip fracture risk using stress calculation in the femoral neck. Med Eng Phys 28:550–559. https://doi.org/10.1016/j.medengphy.2005.09.001

    Article  CAS  PubMed  Google Scholar 

  37. Robinovitch SN, Hayes WC, McMahon TA (1995) Energy-shunting hip padding system attenuates femoral impact force in a simulated fall. J Biomech Eng 117:409–413. https://doi.org/10.1115/1.2794200

    Article  CAS  PubMed  Google Scholar 

  38. Nabhani F, Bamford J (2002) Mechanical testing of hip protectors. J Mater Process Technol 124:311–318. https://doi.org/10.1016/S0924-0136(02)00200-5

    Article  Google Scholar 

  39. Mills NJ (1996) The biomechanics of hip protectors. Proc Inst Mech Eng H 210:259–266. https://doi.org/10.1243/PIME

    Article  CAS  PubMed  Google Scholar 

  40. Okuizumi H, Harada A, Iwata H, Konishi N (1998) Effect on the femur of a new hip fracture preventive system using dropped-weight impact testing. J Bone Miner Res 13:1940–1945. https://doi.org/10.1359/jbmr.1998.13.12.1940

    Article  CAS  PubMed  Google Scholar 

  41. Srewaradachpisal S, Tangtrakulwanich B, Dechwayukul C, Wongsiri S (2011) Hip protectors : comparative study of FEM simulation and testing. In: The Second TSME International Conference on Mechanical Engineering. TSME, Krabi, p BME09

  42. van Schoor NM, van der Veen AJ, Schaap LA, Smit TH, Lips P (2006) Biomechanical comparison of hard and soft hip protectors, and the influence of soft tissue. Bone 39:401–407. https://doi.org/10.1016/j.bone.2006.01.156

    Article  PubMed  Google Scholar 

  43. Mills NJ (2007) Chapter 17 - hip protector case study. Polym Foam Handb:403–424. https://doi.org/10.1016/B978-075068069-1/50018-0

    Chapter  Google Scholar 

  44. Laing AC, Robinovitch SN (2008) The force attenuation provided by hip protectors depends on impact velocity, pelvic size, and soft tissue stiffness. J Biomech Eng 130:061005–1–061005–9. https://doi.org/10.1115/1.2979867

  45. Choi WJ, Hoffer JA, Robinovitch SN (2010) The effect of positioning on the biomechanical performance of soft shell hip protectors. J Biomech 43:818–825. https://doi.org/10.1016/j.jbiomech.2009.11.023

    Article  CAS  PubMed  Google Scholar 

  46. van den Kroonenberg AJ, Hayes WC, McMahon TA (1995) Dynamic models for sideways falls from standing height. J Biomech Eng 117:309–318. https://doi.org/10.1115/1.2794186

    Article  PubMed  Google Scholar 

  47. Levine IC, Pretty SP, Nouri PK, Mourtzakis M, Laing AC (2018) Pelvis and femur geometry: relationships with impact characteristics during sideways falls on the hip. J Biomech 80:72–78. https://doi.org/10.1016/J.JBIOMECH.2018.08.029

    Article  PubMed  Google Scholar 

  48. Kannus P, Parkkari J, Poutala J (1999) Comparison of force attenuation properties of four different hip protectors under simulated falling conditions in the elderly: an in vitro biomechanical study. Bone 25:229–235. https://doi.org/10.1016/S8756-3282(99)00154-4

    Article  CAS  PubMed  Google Scholar 

  49. Robinovitch SN, McMahon TA, Hayes WC (1995) Force attenuation in trochanteric soft tissues during impact from a fall. J Orthop Res 13:956–962. https://doi.org/10.1002/jor.1100130621

    Article  CAS  PubMed  Google Scholar 

  50. Bouxsein ML, Szulc P, Munoz F, Thrall E, Sornay-Rendu E, Delmas PD (2007) Contribution of trochanteric soft tissues to fall force estimates, the factor of risk, and prediction of hip fracture risk. J Bone Miner Res 22:825–831. https://doi.org/10.1359/jbmr.070309

    Article  PubMed  Google Scholar 

  51. Etheridge BS, Beason DP, Lopez RR, Alonso JE, McGwin G, Eberhardt AW (2005) Effects of trochanteric soft tissues and bone density on fracture of the female pelvis in experimental side impacts. Ann Biomed Eng 33:248–254. https://doi.org/10.1007/s10439-005-8984-5

    Article  PubMed  Google Scholar 

  52. Laing AC, Robinovitch SN (2008) Effect of soft shell hip protectors on pressure distribution to the hip during sideways falls. Osteoporos Int 19:1067–1075. https://doi.org/10.1007/s00198-008-0571-9

    Article  CAS  PubMed  Google Scholar 

  53. Majumder S, Roychowdhury A, Pal S (2008) Effects of trochanteric soft tissue thickness and hip impact velocity on hip fracture in sideways fall through 3D finite element simulations. J Biomech 41:2834–2842. https://doi.org/10.1016/j.jbiomech.2008.07.001

    Article  PubMed  Google Scholar 

  54. Majumder S, Roychowdhury A, Pal S (2013) Hip fracture and anthropometric variations: dominance among trochanteric soft tissue thickness, body height and body weight during sideways fall. Clin Biomech 28:1034–1040. https://doi.org/10.1016/j.clinbiomech.2013

    Article  Google Scholar 

  55. Lotz JC, Hayes WC (1990) The use of quantitative computed tomography to estimate risk of fracture of the hip from falls. J bone Jt Surg 72:689–700

    Article  CAS  Google Scholar 

  56. Marques M, Terroso M, Freitas R, Marques AÓT, Gabriel J, Simoes R (2015) A procedure for a mechanical evaluation of an undefined osteo-protective material. Accid Anal Prev 75:285–291. https://doi.org/10.1016/j.aap.2014.12.009

    Article  PubMed  Google Scholar 

  57. ching SP, hoi CW, Qin L et al (2008) Biomechanical study of an anthropometrically designed hip protector for older Chinese women. Geriatr Nurs (Minneap) 29:64–69. https://doi.org/10.1016/j.gerinurse.2007.06.010

    Article  Google Scholar 

  58. Kannus P, Parkkari J (2007) Hip protectors for preventing hip fracture. JAMA 298:454–455. https://doi.org/10.1001/jama.298.4.454

    Article  CAS  PubMed  Google Scholar 

  59. Schmitt K-U, Spierings AB, Derler S (2004) A finite element approach and experiments to assess the effectiveness of hip protectors. Technol Health Care 12:43–49

    Article  Google Scholar 

  60. Laing AC, Robinovitch SN (2010) Characterizing the effective stiffness of the pelvis during sideways falls on the hip. J Biomech 43:1898–1904. https://doi.org/10.1016/j.jbiomech.2010.03.025

    Article  PubMed  Google Scholar 

  61. Hrysomallis C (2009) Surrogate thigh model for assessing impact force attenuation of protective pads. J Sci Med Sport 12:35–41. https://doi.org/10.1016/j.jsams.2007.07.013

    Article  PubMed  Google Scholar 

  62. Derler S, Spierings AB, Schmitt K-U (2005) Anatomical hip model for the mechanical testing of hip protectors. Med Eng Phys 27:475–485. https://doi.org/10.1016/j.medengphy.2005.02.001

    Article  PubMed  Google Scholar 

  63. Zhang T, Song Y, Gao S (2011) Research on the characteristics of buffer material used as hip protector. In: 5th International Conference on Bioinformatics and Biomedical Engineering, iCBBE 2011. IEEE, pp 1–4

  64. Choi WJ, Hoffer JA, Robinovitch SN (2010) Effect of hip protectors, falling angle and body mass index on pressure distribution over the hip during simulated falls. Clin Biomech 25:63–69. https://doi.org/10.1016/j.clinbiomech.2009.08.009

    Article  CAS  Google Scholar 

  65. Laing AC, Feldman F, Jalili M, Tsai CM(J), Robinovitch SN (2011) The effects of pad geometry and material properties on the biomechanical effectiveness of 26 commercially available hip protectors. J Biomech 44:2627–2635. https://doi.org/10.1016/j.jbiomech.2011.08.016

    Article  PubMed  PubMed Central  Google Scholar 

  66. Pinilla TP, Boardman KC, Bouxsein ML, Myers ER, Hayes WC (1996) Impact direction from a fall influences the failure load of the proximal femur as much as age-related bone loss. Calcif Tissue Int 58:231–235. https://doi.org/10.1007/s002239900040

    Article  CAS  PubMed  Google Scholar 

  67. Feldman F, Robinovitch SN (2007) Reducing hip fracture risk during sideways falls: evidence in young adults of the protective effects of impact to the hands and stepping. J Biomech 40:2612–2618. https://doi.org/10.1016/j.jbiomech.2007.01.019

    Article  PubMed  Google Scholar 

  68. Eckstein F, Wunderer C, Boehm H, Kuhn V, Priemel M, Link TM, Lochmüller EM (2003) Reproducibility and side differences of mechanical tests for determining the structural strength of the proximal femur. J Bone Miner Res 19:379–385. https://doi.org/10.1359/JBMR.0301247

    Article  PubMed  Google Scholar 

  69. Manske SL, Liu-Ambrose T, De Bakker PM et al (2006) Femoral neck cortical geometry measured with magnetic resonance imaging is associated with proximal femur strength. Osteoporos Int 17:1539–1545. https://doi.org/10.1007/s00198-006-0162-6

    Article  CAS  PubMed  Google Scholar 

  70. Smith KE, Parks SS, Hyjek MA, Downey SE, Gall K (2009) The effect of the glass transition temperature on the toughness of photopolymerizable (meth)acrylate networks under physiological conditions. Polymer (Guildf) 50:5112–5123. https://doi.org/10.1016/j.polymer.2009.08.040

    Article  CAS  PubMed Central  Google Scholar 

  71. Lotz JC, Cheal EJ, Hayes WC (1991) Fracture prediction for the proximal femur using finite element models: part I—linear analysis. J Biomech Eng 113:353–360. https://doi.org/10.1115/1.2895412

    Article  CAS  PubMed  Google Scholar 

  72. Choi WJ, Robinovitch SN (2018) Effect of pelvis impact angle on stresses at the femoral neck during falls. J Biomech 74:41–49. https://doi.org/10.1016/j.jbiomech.2018.04.015

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

Special thanks to the Tertiary Education Trust Fund (TETFund) and the University of Ilorin, Nigeria, for the TETF/ES/UNI/ILORIN/ASTD/2017 intervention.

Funding

Financial support provided under the USM grant 1001/PMEKANIK/8014070.

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  1. School of Mechanical Engineering, Engineering Campus, Universiti Sains Malaysia, 14300, Penang, Malaysia

    S.A. Yahaya, Z.M. Ripin & M.I.Z. Ridzwan

  2. Department of Biomedical Engineering, Faculty of Engineering, University of Ilorin, Ilorin, 234001, Nigeria

    S.A. Yahaya

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Yahaya, S., Ripin, Z. & Ridzwan, M. Test systems for the biomechanical evaluation of hip protectors: a systematic review. Osteoporos Int 31, 43–58 (2020). https://doi.org/10.1007/s00198-019-05128-x

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