Hip Joint Contact Pressure Distribution During Pavlik Harness Treatment of an Infant Hip: A Patient-Specific Finite Element ModelSource: Journal of Biomechanical Engineering:;2018:;volume( 140 ):;issue: 007::page 71009Author:Vafaeian, Behzad
,
Adeeb, Samer
,
El-Rich, Marwan
,
Zonoobi, Dornoosh
,
Hareendranathan, Abhilash R.
,
Jaremko, Jacob L.
DOI: 10.1115/1.4039827Publisher: The American Society of Mechanical Engineers (ASME)
Abstract: 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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contributor author | Vafaeian, Behzad | |
contributor author | Adeeb, Samer | |
contributor author | El-Rich, Marwan | |
contributor author | Zonoobi, Dornoosh | |
contributor author | Hareendranathan, Abhilash R. | |
contributor author | Jaremko, Jacob L. | |
date accessioned | 2019-02-28T11:11:26Z | |
date available | 2019-02-28T11:11:26Z | |
date copyright | 4/30/2018 12:00:00 AM | |
date issued | 2018 | |
identifier issn | 0148-0731 | |
identifier other | bio_140_07_071009.pdf | |
identifier uri | http://yetl.yabesh.ir/yetl1/handle/yetl/4253636 | |
description abstract | 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. | |
publisher | The American Society of Mechanical Engineers (ASME) | |
title | Hip Joint Contact Pressure Distribution During Pavlik Harness Treatment of an Infant Hip: A Patient-Specific Finite Element Model | |
type | Journal Paper | |
journal volume | 140 | |
journal issue | 7 | |
journal title | Journal of Biomechanical Engineering | |
identifier doi | 10.1115/1.4039827 | |
journal fristpage | 71009 | |
journal lastpage | 071009-10 | |
tree | Journal of Biomechanical Engineering:;2018:;volume( 140 ):;issue: 007 | |
contenttype | Fulltext |