Abstract
Purpose
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.
Methods
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.
Results
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).
Conclusions
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.
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References
Tonnis D, Behrens K, Tscharani F (1981) A modified technique of the triple pelvic osteotomy: early results. J Pediatr Orthop 1(3):241–249
Scott JT, Keith AM, Jeffrey WM (1999) The periacetabular osteotomy: minimum 2 year follow-up in more than 100 hips. Clin Orthop 363:54–63
Legal H, Ruder H (1977) Zur biostatischen Analyse des Hüft-gelenks. Z Orthop Ihre Grenzgeb 115(2):215–234
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 32:1229–1235
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 18:19–23
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):303–313
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):051008
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):127–131
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 15:632–640
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):1133–1139
Iglic A, Srakar F, Antolic V, Kralj-Iglic V, Bagatelj V (1990) Matematička analiza osteotomije po Chiariju. Acta Orthop Iugosl 20(2–3):35–39
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 1:207–212
Iglic A, Srakar F, Antolic V (1993) The influence of the pelvic shape on the biomechanical status of the hip. Clin Biomech 8:223–224
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 347–364
Murphy SM, Deshmukh R (2002) Periacetabular osteotomy: preoperative radiographic predictors of outcome. Clin Orthop 405:168–174
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):9–12
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 20:1025–1030
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):379–385
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):509–513
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 447:92–99
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 28:444–451
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):879–882
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):354–356
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):511–516
Herman S, Jaklic A, Herman S, Iglic A, Kralj-Iglic V (2002) Hip stress reduction after Chiari osteotomy. Med Biol Eng Comput 40(4):369–375
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):833–840
ImageJ (2007) Images processing and analysis in Java. http://rsbweb.nih.gov/ij. Accessed 14 August 2012
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 54:872–880
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):155–161
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):1884–1890
Acknowledgment
This work was supported by the Ministry of Education and Science of the Republic of Serbia, grant no. III 41004.
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Vukasinovic, Z., Spasovski, D., Kralj-Iglic, V. et al. Impact of triple pelvic osteotomy on contact stress pressure distribution in the hip joint. International Orthopaedics (SICOT) 37, 95–98 (2013). https://doi.org/10.1007/s00264-012-1727-y
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DOI: https://doi.org/10.1007/s00264-012-1727-y