International Orthopaedics

, Volume 37, Issue 1, pp 95–98 | Cite as

Impact of triple pelvic osteotomy on contact stress pressure distribution in the hip joint

  • Zoran VukasinovicEmail author
  • Dusko Spasovski
  • Veronika Kralj-Iglic
  • Jelena Marinkovic-Eric
  • Igor Seslija
  • Zorica Zivkovic
  • Vesna Spasovski
Original Paper



We studied changes of contact stress distribution in the hip joint after Tonnis triple pelvic osteotomy applied in the treatment of dysplasia and hip joint incongruence in adolescents.


In a group of 75 patients, 54 (72 %) female, who underwent surgery by triple pelvic osteotomy in adolescence for developmental disorder of the hip and avascular necrosis of the femoral head, a three-dimensional hip joint model was used based on the radiography of the pelvis with hips. The following biomechanical parameters were calculated: resultant hip force normalised to body weight (R/Wb), inclination of the resultant hip force (θ−R), the position of the stress pole (θ), peak contact hip stress (Pmax), and peak contact hip stress normalised to body weight (Pmax/Wb). Gait quality was also assessed.


After surgery the Wiberg CE angle was increased by 17.85° (114 %), resultant hip force normalised to body weight (R/Wb) was decreased by 0.107 (3.3 %), the position of the stress pole was shifted medially by 27.59° (63.5 %), and peak contact hip stress normalised to body weight (Pmax/Wb) was decreased by 2249.74 (55.9 %). Waddling gait was reduced from 17 (23.9 %) to four cases (5.6 %). All changes were statistically highly significant (p<0.01).


The effect of Tonnis triple pelvic osteotomy lies in the improvement of stress distribution across the acetabular cartilage of the hip joint, thus slowing down the degenerative damage of the hip joint.


Femoral Head Biomechanical Parameter Periacetabular Osteotomy Acetabular Cartilage Stress Pole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by the Ministry of Education and Science of the Republic of Serbia, grant no. III 41004.


  1. 1.
    Tonnis D, Behrens K, Tscharani F (1981) A modified technique of the triple pelvic osteotomy: early results. J Pediatr Orthop 1(3):241–249PubMedCrossRefGoogle Scholar
  2. 2.
    Scott JT, Keith AM, Jeffrey WM (1999) The periacetabular osteotomy: minimum 2 year follow-up in more than 100 hips. Clin Orthop 363:54–63Google Scholar
  3. 3.
    Legal H, Ruder H (1977) Zur biostatischen Analyse des Hüft-gelenks. Z Orthop Ihre Grenzgeb 115(2):215–234PubMedGoogle Scholar
  4. 4.
    Ipavec M, Brand RA, Pedersen DR, Mavcic B, Kralj-Iglic V, Iglic A (1999) Mathematical modeling of stress in the hip during gait. J Biomech 32:1229–1235PubMedCrossRefGoogle Scholar
  5. 5.
    Wang XS, Jiang FC, Jian MA, Hou XP (2006) The peak stress, weight bearing area and stress distributions at human hip joint. Biomed Eng Appl Basis Comm 18:19–23CrossRefGoogle Scholar
  6. 6.
    Armand M, Lepisto J, Tallroth K, Elias J, Chao E (2005) Outcome of periacetabular osteotomy: joint contact pressure calculation using standing AP radiographs, 12 patients followed for average 2 years. Acta Orthop 76(3):303–313PubMedGoogle Scholar
  7. 7.
    Anderson AE, Ellis BJ, Maas SA, Peters CL, Weiss JA (2008) Validation of finite element predictions of cartilage contact pressure in the human hip joint. J Biomech Eng 130(5):051008PubMedCrossRefGoogle Scholar
  8. 8.
    Park WM, Kim YH, Kim K, Oh TY (2009) Non-destructive biomechanical analysis to evaluate surgical planning for hip joint diseases. Int J Precis Eng Manuf 10(3):127–131CrossRefGoogle Scholar
  9. 9.
    Zhao X, Chosa E, Totoribe K, Deng G (2010) Effect of periacetabular osteotomy for acetabular dysplasia clarified by three-dimensional finite element analysis. J Orthop Sci 15:632–640PubMedCrossRefGoogle Scholar
  10. 10.
    Harris MD, Anderson AE, Henak CR, Ellis BJ, Peters CL, Weiss JA (2012) Finite element prediction of cartilage contact stresses in normal human hips. J Orthop Res 30(7):1133–1139PubMedCrossRefGoogle Scholar
  11. 11.
    Iglic A, Srakar F, Antolic V, Kralj-Iglic V, Bagatelj V (1990) Matematička analiza osteotomije po Chiariju. Acta Orthop Iugosl 20(2–3):35–39Google Scholar
  12. 12.
    Iglic A, Kralj-Iglic V, Antolic V, Srakar F, Stanic U (1993) Effect of the periacetabular osteotomy of the stress on the human hip joint articular surface. IEEE Trans Rehab Eng 1:207–212CrossRefGoogle Scholar
  13. 13.
    Iglic A, Srakar F, Antolic V (1993) The influence of the pelvic shape on the biomechanical status of the hip. Clin Biomech 8:223–224CrossRefGoogle Scholar
  14. 14.
    Kralj-Iglic V, Dolinar D, Ivanovski M, List I, Daniel M (2012) Role of biomechanical parameters in hip osteoarthritis and avascular necrosis of the femoral head. In: Ganesh RN (ed), 1st edn. Applied Biological Engineering—Principles and Practice, InTech, Rijeka, pp 347–364Google Scholar
  15. 15.
    Murphy SM, Deshmukh R (2002) Periacetabular osteotomy: preoperative radiographic predictors of outcome. Clin Orthop 405:168–174PubMedCrossRefGoogle Scholar
  16. 16.
    Zupanc O, Antolic V, Iglic A, Jaklic A, Kralj-Iglic V, Stare J, Vengust R (2001) The assessment of contact stress in the hip joint after operative treatment for severe slipped capital femoral epiphysis. Int Orthop 25(1):9–12PubMedCrossRefGoogle Scholar
  17. 17.
    Mavcic B, Pompe B, Antolic V, Daniel M, Iglic A, Kralj-Iglic V (2002) Mathematical estimation of stress distribution in normal and dysplastic human hips. J Orthop Res 20:1025–1030PubMedCrossRefGoogle Scholar
  18. 18.
    Pompe B, Daniel M, Sochor M, Vengust R, Kralj-Iglic V, Iglic A (2003) Gradient of contact stress in normal and dysplastic human hips. Med Eng Phys 25(5):379–385PubMedCrossRefGoogle Scholar
  19. 19.
    Dolinar D, Antolic V, Herman S, Iglic A, Kralj-Iglic V, Pavlovcic V (2003) Influence of contact hip stress on the outcome of surgical treatment of hips affected by avascular necrosis. Arch Orthop Trauma Surg 123(10):509–513PubMedCrossRefGoogle Scholar
  20. 20.
    Daniel M, Dolinar D, Herman S, Sochor M, Iglic A, Kralj-Iglic V (2006) Contact stress in hips with osteonecrosis of the femoral head. Clin Orthop Rel Res 447:92–99CrossRefGoogle Scholar
  21. 21.
    Zupanc O, Krizanic M, Daniel M, Mavcic B, Antolic V, Iglic A, Kralj-Iglic V (2008) Shear stress in epiphyseal growth plate is a risk factor for slipped capital femoral epiphysis. J Ped Orthop 28:444–451CrossRefGoogle Scholar
  22. 22.
    Recnik G, Kralj-Iglic V, Iglic A, Antolic V, Kramberger S, Rigler I, Pompe B, Vengust R (2009) The role of obesity, biomechanical constitution of the pelvis and contact joint stress in progression of hip osteoarthritis. Osteoarthr Cartil 17(7):879–882PubMedCrossRefGoogle Scholar
  23. 23.
    Antolic V, Srakar F, Iglic A, Macek-Lebar A, Herman S, Kralj-Iglic V (1995) Relative abductor strength after varus and valgus osteotomy of the proximal femur. Acta Chir Orthop Traumatol Cech 62(6):354–356PubMedGoogle Scholar
  24. 24.
    Vengust R, Daniel M, Antolic V, Zupanc O, Iglic A, Kralj-Iglic V (2001) Biomechanical evaluation of hip joint after Salter innominate osteotomy—a long-term follow-up study. Arch Orthop Trauma Surg 121(9):511–516PubMedCrossRefGoogle Scholar
  25. 25.
    Herman S, Jaklic A, Herman S, Iglic A, Kralj-Iglic V (2002) Hip stress reduction after Chiari osteotomy. Med Biol Eng Comput 40(4):369–375PubMedCrossRefGoogle Scholar
  26. 26.
    Kralj M, Mavcic B, Antolic V, Iglic A, Kralj-Iglic V (2005) The Bernese periacetabular osteotomy: clinical, radiographic and mechanical 7–15-year follow-up of 26 hips. Acta Orthop 76(6):833–840PubMedCrossRefGoogle Scholar
  27. 27.
    ImageJ (2007) Images processing and analysis in Java. Accessed 14 August 2012
  28. 28.
    Buckland-Wright JC, Macfarlane DG, Williams SA, Ward RJ (1995) Accuracy and precision of joint space width measurements in standard and macroradiographs of osteoarthritic knees. Ann Rheum Dis 54:872–880PubMedCrossRefGoogle Scholar
  29. 29.
    Armiger RS, Armand M, Tallroth K, Lepisto J, Mears SC (2009) Three-dimensional mechanical evaluation of joint contact pressure in 12 periacetabular osteotomy patients with 10-year follow-up. Acta Orthop 80(2):155–161PubMedCrossRefGoogle Scholar
  30. 30.
    Mechlenburg I, Nyengaard JR, Gelineck J, Soballe K, Troelsen A (2010) Cartilage thickness in the hip measured by MRI and stereology before and after periacetabular osteotomy. Clin Orthop Relat Res 468(7):1884–1890PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Zoran Vukasinovic
    • 1
    Email author
  • Dusko Spasovski
    • 1
  • Veronika Kralj-Iglic
    • 2
  • Jelena Marinkovic-Eric
    • 3
  • Igor Seslija
    • 4
  • Zorica Zivkovic
    • 5
  • Vesna Spasovski
    • 6
  1. 1.University of Belgrade, Faculty of MedicineInstitute for Orthopaedic Surgery “Banjica”BelgradeSerbia
  2. 2.University of Ljubljana, Faculty of Health SciencesBiomedical Research GroupLjubljanaSlovenia
  3. 3.University of Belgrade, Faculty of MedicineInstitute for Medical Statistics and InformaticsBelgradeSerbia
  4. 4.Institute for Orthopaedic Surgery “Banjica”BelgradeSerbia
  5. 5.European University, Medical Academy “US Medical School”Medical Center “Dr Dragisa Misovic”BelgradeSerbia
  6. 6.University of BelgradeInstitute of Molecular Genetics and Genetic EngineeringBelgradeSerbia

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