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Research Papers

Hip Joint Contact Pressure Distribution During Pavlik Harness Treatment of an Infant Hip: A Patient-Specific Finite Element Model

[+] Author and Article Information
Behzad Vafaeian

Department of Civil and
Environmental Engineering,
University of Alberta,
7-203 Donadeo Innovation
Centre for Engineering,
9211–116 Street,
Edmonton, AB T6G 1H9, Canada
e-mail: vafaeian@ualberta.ca

Samer Adeeb

Associate Professor
Department of Civil and
Environmental Engineering,
University of Alberta,
7-203 Donadeo Innovation
Centre for Engineering,
9211–116 Street,
Edmonton, AB T6G 1H9, Canada
e-mail: adeeb@ualberta.ca

Marwan El-Rich

Associate Professor
Department of Mechanical Engineering,
Khalifa University,
Abu Dhabi, UAE
e-mail: elrich@ualberta.ca

Dornoosh Zonoobi

Department of Radiology and
Diagnostic Imaging,
University of Alberta,
2A2.41 WMC, 8440-112 Street,
Edmonton, AB T6G 2B7, Canada
e-mail: zonoobi@ualberta.ca

Abhilash R. Hareendranathan

Department of Radiology and
Diagnostic Imaging,
University of Alberta,
2A2.41 WMC, 8440-112 Street,
Edmonton, AB T6G 2B7, Canada
e-mail: hareendr@ualberta.ca

Jacob L. Jaremko

Assistant Professor
Department of Radiology and
Diagnostic Imaging,
University of Alberta,
2A2.41 WMC, 8440-112 Street,
Edmonton, AB T6G 2B7, Canada
e-mail: jjaremko@ualberta.ca

1Corresponding author.

Manuscript received November 3, 2017; final manuscript received March 26, 2018; published online April 30, 2018. Assoc. Editor: Tammy L. Haut Donahue.

J Biomech Eng 140(7), 071009 (Apr 30, 2018) (10 pages) Paper No: BIO-17-1503; doi: 10.1115/1.4039827 History: Received November 03, 2017; Revised March 26, 2018

Developmental dysplasia of the hip (DDH) in infants under 6 months of age is typically treated by the Pavlik harness (PH). During successful PH treatment, a subluxed/dislocated hip is spontaneously reduced into the acetabulum, and DDH undergoes self-correction. PH treatment may fail due to avascular necrosis (AVN) of the femoral head. An improved understanding of mechanical factors accounting for the success/failure of PH treatment may arise from investigating articular cartilage contact pressure (CCP) within a hip during treatment. In this study, CCP in a cartilaginous infant hip was investigated through patient-specific finite element (FE) modeling. We simulated CCP of the hip equilibrated at 90 deg flexion at abduction angles of 40 deg, 60 deg, and 80 deg. We found that CCP was predominantly distributed on the anterior and posterior acetabulum, leaving the superior acetabulum (mainly superolateral) unloaded. From a mechanobiological perspective, hypothesizing that excessive pressure inhibits growth, our results qualitatively predicted increased obliquity and deepening of the acetabulum under such CCP distribution. This is the desired and observed therapeutic effect in successful PH treatment. The results also demonstrated increase in CCP as abduction increased. In particular, the simulation predicted large magnitude and concentrated CCP on the posterior wall of the acetabulum and the adjacent lateral femoral head at extreme abduction (80 deg). This CCP on lateral femoral head may reduce blood flow in femoral head vessels and contribute to AVN. Hence, this study provides insight into biomechanical factors potentially responsible for PH treatment success and complications.

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Figures

Grahic Jump Location
Fig. 1

(a) Joint components marked in two sample MR images and manual segmentation of the components for the left hip and (b) examples of segmentation challenges locating the boundary between the acetabulum and the femoral head (later resolved by radiologist review)

Grahic Jump Location
Fig. 2

(a) Three-dimensional closed computational surfaces of the joint's components, (b) closer view of the femoral head and acetabulum, and anatomical regions defined on the acetabulum, and (c) reconstructed 3D geometry of a 5-day-old male infant's lower extremity skeleton

Grahic Jump Location
Fig. 3

(a) L–M and I–S axes of the pelvis, and horizontal and vertical axes of image, (b) femur's longitudinal axis determined by a best fit cylinder to its shaft, (c) femur's CEA, and (d) different views of the model in its reference configuration

Grahic Jump Location
Fig. 4

(a) Selected views of the FE meshes for the cortical and cancellous bones, and cartilage, (b) the points of the origin and insertion of the adductor muscles modeled by spring elements, and (c) different views of the iliofemoral and pubofemoral ligaments modeled by spring elements

Grahic Jump Location
Fig. 5

(a) Specification of the three KC constraints, (b) BCs assigned in step 1, and (c) BCs assigned in steps 2 and 3 (figure shows some abducted position of the femur). Note the directions of the pelvic axes, i.e., A–P, I–S, and L–M.

Grahic Jump Location
Fig. 6

Distributions of CCP on the acetabular surface for different abduction angles of the hip and different analysis cases. Externally rotated lateral view of the acetabulum clearly shows CCP on the posterior acetabular surface.

Grahic Jump Location
Fig. 7

Envelope distributions of CCP on the femoral contact surface for different abduction angles of the hip. Two views are demonstrated for each case.

Grahic Jump Location
Fig. 8

L–M, I–S, and A–P components of the unit vectors indicating the directions of the resultant muscle forces, each ligament, and total muscle-and-ligament forces acting on the femur under equilibrium at different abduction angles. The horizontal and vertical axes show the directions and the values of the force components, respectively. The first row shows approximate directions of the forces for visualization.

Grahic Jump Location
Fig. 9

(a) Schematic demonstration of increased obliquity and shallowness of acetabulum due to a subluxated femoral head and (b) simulated acetabular area in contact in PH situation, and qualitative prediction of adaptive deformation and growth leading to a deeper acetabulum

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