THE GEOMETRY AND BIOMECHANICS OF NORMAL AND PATHOMORPHOLOGIC HUMAN ...

209 Pages·2013·9.68 MB·English

by  Martha Klein

THE GEOMETRY AND BIOMECHANICS OF NORMAL
AND PATHOMORPHOLOGIC HUMAN HIPS

by

Michael Dennison Harris

A dissertation submitted to the faculty of
The University of Utah
in partial fulfillment of the requirements for the degree of

Doctor of Philosophy

Department of Bioengineering

The University of Utah

August 2013
Copyright © Michael Dennison Harris 2013

All Rights Reserved
The University of Utah Graduate School

STATEMENT OF DISSERTATION APPROVAL

The dissertation of Michael Dennison Harris
has been approved by the following supervisory committee members:

Andrew E. Anderson , Chair 3/29/2013
Date Approved

Robert W. Hitchcock , Member 3/29/2013
Date Approved

Bruce A. MacWilliams , Member 3/29/2013
Date Approved

Christopher L. Peters , Member 3/27/2013
Date Approved

Richard D. Rabbitt , Member 3/27/2013
Date Approved

Jeffrey A. Weiss , Member 3/27/2013
Date Approved

and by Patrick Tresco , Chair of
the Department of Bioengineering

and by Donna M. White, Interim Dean of The Graduate School.
ABSTRACT

Geometric abnormalities of the human hip joint, as found in femoroacetabular
impingement (FAI) and acetabular dysplasia, alter hip biomechanics and may be the
primary causes of osteoarthritis in young adults. However, empirical evidence of direct
correlations between abnormal geometry, altered biomechanics, and osteoarthritis is
scarce. Also, clinical measures used to diagnose FAI and dysplasia still have substantial
limitations, including questions about their reliability, assumptions about hip joint
geometry and their ability to definitively distinguish pathologic from normal hips. The
goals of this dissertation are twofold. First, a set of tools are presented and applied to
quantify three-dimensional (3D) anatomical differences between hips with FAI and
control subjects. The 3D tools were developed, validated and applied to patients with a
subtype of FAI, called cam FAI, to improve basic understanding of the spectrum of FAI
deformities, and to provide meaningful new metrics of morphology that are relatable to
current diagnostic methods and translate easily for clinical use. The second goal of this
dissertation is to improve our understanding of intra-articular hip contact mechanics as
well as hip joint kinematics and muscle forces. To do so, a finite element study of intra-
articular cartilage contact mechanics was completed with a cohort of live human subjects,
using a validated modeling protocol. Finally, musculoskeletal modeling was used with
gait data from healthy subjects and acetabular dysplasia patients to provide preliminary
estimates of hip joint kinematics, kinetics, and muscle forces and compare differences
between the groups. The translational methods of this dissertation utilized techniques
from orthopaedics, computer science, physical therapy, mechanics, and medical imaging.
Results from this dissertation offer new insight into the complex pathomechanics and
pathomorphology of FAI and acetabular dysplasia. Application and extension of the
work of this dissertation has the potential to help establish links between FAI and
dysplasia with osteoarthritis and to improve patient care.
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To my wife, Hannah.
You are exceptional in every way.
TABLE OF CONTENTS

ABSTRACT………………………………………………………………………... iii
LIST OF TABLES………………………………………………………………… x
LIST OF FIGURES…………………………………………………………………. xi
ACKNOWLEDGEMENTS………………………………………………………... xiv
Chapters
1. INTRODUCTION……………………………………………………………... 1
1.1 Motivation……..……………………………………………………….. 1
1.2 Research Goals…………………………………………………............. 4
1.3 Summary of Chapters..…………………………………………………. 5
1.4 References……………….……………………………………………… 8

2. BACKGROUND…………………………………..…………………………... 13

2.1 The Human Hip Joint: Anatomy and Function………………………… 13
2.1.1 Pelvis and Femur Bones..………………………………………... 13
2.1.2 Articular Cartilage…...…………………………………………... 15
2.1.3 Acetabular Labrum and Hip Joint Capsule..…………………….. 17
2.1.4 Surrounding Musculature….…………………………………….. 17
2.2 Pathologies of the Hip………………………………………………….. 18
2.2.1 Osteoarthritis..…………………………………………………… 19
2.2.2 Acetabular Dysplasia……………………………………………. 20
2.2.3 Femoroacetabular Impingement………………………………..... 22
2.3 Measurement of Hip Morphology.……………………………………... 25
2.3.1 Radiographic Measures………………………………………….. 25
2.3.3 Three-dimensional Characterization of Hip Morphology……….. 26
2.4 Measurement of Hip Mechanics………………………………………... 28
2.4.1 Intra-articular Cartilage Contact Mechanics…………………….. 29
2.4.2 Whole-joint Mechanics (Kinematics and Kinetics)……………... 31
2.4.3 Muscle Force Modeling…………………………………………. 32
2.5 References……………………………………………………………… 34
3. THREE-DIMENSIONAL QUANTIFICATION OF FEMORAL HEAD
SHAPE IN CONTROLS AND PATIENTS WITH CAM-TYPE
FEMOROACETABULAR IMPINGEMENT…………………………………. 51

3.1 Abstract….……………………………………………………………… 51
3.2 Introduction…………………………………………………………….. 52
3.3 Patients and Methods…………………………………………………… 54
3.3.1 Subject Selection……………………………………………...... 54
3.3.2 3D Reconstruction……………………………………………… 55
3.3.3 Comparison to Ideal Geometries……………………………...... 56
3.3.4 Regionalization of the Femoral Head and Characterization
of the Protrusion………………………………………………... 57
3.3.5 Statistical Analysis……………………………………………… 58
3.4 Results………………………………………………………………….. 58
3.5 Discussion………………………………………………………………. 60
3.6 Acknowledgements…………………………………………………….. 65
3.7 References……………………………………………………………… 65

4. CORRELATIONS BETWEEN THE ALPHA ANGLE AND FEMORAL
HEAD ASPHERICITY: IMPLICATIONS AND RECOMMENDATIONS
FOR DIAGNOSING CAM FEMOROACETABULAR IMPINGEMENT….... 77

4.1 Abstract………………………………………………………………… 77
4.2 Introduction…………………………………………………………….. 78
4.3 Patients and Methods…………………………………………………… 79
4.3.1 Subject Selection……………………………………………….. 79
4.3.2 3D Reconstruction and Sphere Fitting…………………………. 80
4.3.3 Generation and Alignment of Digitally Reconstructed
Radiographs………………………………….............................. 81
4.3.4 Generation and Alignment of Radial CT and Oblique
Axial Views…………………………………………………….. 82
4.3.5 Measurement of the Alpha Angle………………………………. 83
4.3.6 Statistical Analysis……………………………………………… 83
4.4 Results…………………………………………………………………... 84
4.5 Discussion………………………………………………………………. 85
4.6 Appendix……………………………………………………………….. 89
4.6.1 DRR Validation: Methods……………………………………… 89
4.6.2 DRR Validation: Results……………………………………….. 90
4.7 Acknowledgements…………………………………………………….. 91
4.8 References………………………………………………………………. 91

5. STATISTICAL SHAPE MODELING OF CAM FEMOROACETBAULAR
IMPINGEMENT……………………………………………………………….. 104

5.1 Abstract…………………………………………………………………. 104
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5.2 Introduction…………………………………………………………….. 105
5.3 Methods………………………………………………………………… 107
5.3.1 Subject Selection……………………………………………….. 107
5.3.2 Three-dimensional Reconstruction and SSM Preprocessing…… 108
5.3.3 Statistical Shape Modeling……………………………………... 109
5.3.4 Analysis………………………………………………………… 111
5.4 Results………………………………………………………………….. 112
5.5 Discussion………………………………………………………………. 114
5.6 Acknowledgements…………………………………………………….. 118
5.7 References……………………………………………………………… 118

6. FINITE ELEMENT PREDICTION OF CARTILAGE CONTACT
STRESSES IN NORMAL HUMAN HIPS…………………………………….. 127

6.1 Abstract……………………………………………………………….... 127
6.2 Introduction…………………………………………………………….. 128
6.3 Methods………………………………………………………………… 129
6.3.1 Subject Selection and CT Imaging……………………………... 129
6.3.2 Surface Reconstruction, Mesh Generation and
Constitutive Models…………………………………………….. 131
6.3.3 Model Positioning, Boundary Conditions and Loading………... 132
6.3.4 Contact Areas and Stresses……………………………………... 133
6.3.5 Statistical Analysis……………………………………………… 133
6.4 Results…………………………………………………………………... 133
6.4.1 Contact Stress Distributions and Contact Area………………… 133
6.4.2 Peak and Average Contact Stresses…………………………...... 134
6.4.3 Regional Differences in Average Contact Stresses…………….. 135
6.5 Discussion………………………………………………………………. 136
6.6 Acknowledgments……………………………………………………… 140
6.7 References………………………………………………………………. 141

7. JOINT ANGLES, MOMENTS, MUSCLE FORCES, AND REACTION
FORCES IN NORMAL AND DYSPLASTIC HIPS………………………….. 150

7.1 Abstract………………………………………………………………… 150
7.2 Introduction…………………………………………………………….. 151
7.3 Methods………………………………………………………………… 153
7.3.1 Data Collection and Processing (Feasibility Study)……………. 153
7.3.2 Musculoskeletal Modeling (Feasibility Study)………………… 155
7.3.3 Modeling Control Subjects and Dysplastic Patients…………… 156
7.3.4 Analysis………………………………………………………… 157
7.4 Results………………………………………………………………….. 158
7.4.1 Feasibility and Validation……………………………………… 158
7.4.2 Demographics, Joint Angles, and Moments……………………. 159
7.4.3 Joint Reaction and Muscle Forces………………………………. 160
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7.5 Discussion………………………………………………………………. 161
7.6 Acknowledgements…………………………………………………….. 169
7.7 References………………………………………………………………. 169

8. CONCLUSION………………….……………………………………………... 184

8.1 Summary and Impact…………………………………………………… 184
8.1.1 Objective 1……………………………………………………… 184
8.1.2 Objective 2……………………………………………………… 187
8.2 Limitations and Future Work…………………………………………… 188
8.3 References………………………………………………………………. 192

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