Current Preclinical Testing of New Hip Arthroplasty Technologies Does Not Reflect Real-World Loadings: Capturing Patient-Specific and Activity-Related Variation in Hip Contact Forces

Abstract

Background: Total hip replacement (THR) implants are routinely tested for their tribological performance through regulatory pre-clinical wear testing (e.g. ISO-14242). The standardized loading conditions defined in these tests consist of simplified waveforms, which do not specifically represent in vivo loads in different groups of patients. The aim of this study was to investigate, through musculoskeletal modelling, patient-specific and activity-related variation in hip contact forces (HCFs) in a large cohort of THR patients during common activities of daily living (ADLs).

Methods: 132 THR patients participated in a motion-capture analysis while performing different ADLs, including walk, fast walk, stair ascent and descent (locomotor); sit-to-stand, stand-to-sit, squat and lunge (non-locomotor). HCFs were then calculated using the AnyBody Modelling System and qualitatively compared across all activities. The influence of gender on HCFs was analysed through statistical parametric mapping (SPM) analysis.

Results: Systematic differences were found in HCF magnitudes and individual components in both locomotor and non-locomotor ADLs. The qualitative analysis of the ADLs revealed a large range and a large variability of forces experienced at the hip during different activities. Significant differences in the three-dimensional loading patterns were observed between males and females across most activities.

Conclusions: THR patients present a large variability in the forces experienced at the hip joint during their daily life. The inter-patient variation might partially explain the heterogeneity observed in implant survival rates. A more extensive pre-clinical implant testing standard, under clinically relevant loading conditions has been advocated to better predict and avoid clinical wear problems.