Anatomical Reference Planes

Summary (1-4 weeks)

Sagittal Plane (矢狀面)
Frontal Plane (冠狀面)
Transverse Plane (橫斷面)

Frontal Plane Movements

Abduction (AB-duction) 外展
Adduction (AD-duction) 內收
Right lateral rotation (trunk)
Left lateral rotation (trunk)
Elevation (shoulder)
Depression (shoulder)

Factors influence the ability of bone to withstand

mechanical loads
„ material constituents
structural organization
Human Bone Growth and
„

Development Process involved in normal growth and maturation of

bone

Influence of exercise and of weightlessness on bone

mineralization

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 Calcium carbonate & Calcium phosphate
Material Constituents

Calcium carbonate 碳酸鈣

Comprise approximately 60% to 70% of dry
Calcium phosphate 磷酸鈣 bone weight
Collagen 膠原 Give bone its stiffness and are primary
Water determiners of its compressive strength
The relative percentages of these materials vary
with the age and health of the bone

Collagen Water

Collagen is a protein that provides bone with flexibility The water content of bone makes up approximately 25%
and contributes to its tensile strength to 30% of the total bone weight.
There is a progressive loss of collagen and increase in
bone brittleness with age It is an important contributor to bone strength.

The bones of children are more pliable (Flexible) than

The bone specimens must not be dehydrated (脫水) when
the bones of adults
tested.

Structural Organization Cortical bone 皮質骨

If the porosity is low, with 5% to 30% of
Bone mineralization varies with age and specific bone volume occupied by nonmineralized
bone tissue, the tissue is termed cortical bone.
Porous: containing pores or cavities Compact bone 緻密骨
Bone tissue has been classified into two
categories based on porosity (cortical and
cancellous bones)

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Cancellous bone 疏鬆骨 Femoral neck :
Cancellous bone, Joint reaction force
Bone tissue with a relatively high porosity, with Medial and lateral trabecular
30% to greater than 90% of bone volume occupied system
Muscle force
by nonmineralized tissue, is known as spongy (海綿 *Joint reaction force parallels the
骨), cancellous, or trabecular bone. medial trabecular system
Trabecular bone (小樑骨) is a honeycomb structure
with mineralized vertical and horizontal rods, called
trabeculae, forming cells filled with marrow and fat.
medial trabecular system

Lateral trabecular system

Human Adult Cortical Bone

Cancellous Bone

Withstand
Withstand 50 MPa in compression
Compression > Tension > Shear 8 MPa in tension
190MPa 130MPa 70MPa

Bone Growth & Development Longitudinal Growth

Living bone is continually changing over a
person’s lifespan. Many of these changes
represent normal growth and maturation of
bone.
Longitudinal growth
Circumferential growth
Longitudinal growth of a bone occurs at the
epiphyseal plates.
The epiphyseal plates are cartilaginous discs
found near the ends of the long bones.
The central side of each epiphyseal plates
continually produces new bone cells.

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Epiphyseal plate
During or shortly following adolescence, the
plate disappears and the bone fuses, terminating
longitudinal growth.
Most epiphyses close around age 18, although
some may be present until about age 25.
Periosteum
Circumferential Growth
At the same time, bone is resorbed or eliminated
around the circumference of the medullary cavity,
so that the diameter of the cavity is continually
enlarged.
Circumferential Growth
Long bones grow in diameter throughout most of
the lifespan, although the most rapid bone
growth occurs before adulthood.
The internal layer of the periosteum (骨膜)
builds concentric (同心) layers of new bone
tissue on top of the existing ones.
Double-layered membrane covering bone; muscle tendons attach
to the outside layer, and the inner layer is a site of osteoblast
activity.
Osteoblast & Osteoclast
成骨細胞 & 噬骨細胞
Specialized cells called osteoblasts and
osteoclasts repectively form and resorb bone
tissue.
In healthy adult bone, the activity of
osteoblasts and osteoclasts is largely
balanced.
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Bone Response to Stress Femoral neck :
Cancellous bone, Joint reaction force
Bone responds dynamically to the presence or Medial and lateral trabecular
system
absence of different forces with changes in size, Muscle force
*Joint reaction force parallels the
shape, and density. medial trabecular system
This phenomenon was originally described by the
German scientist Wolff in 1892.

medial trabecular system

Lateral trabecular system

Wolff’s Law Wolff’s Law

Bone strength increases and decreases as
the functional forces on the bone increases
and decreases.
Wolff’s law is carried out through the actions
of osteoblasts and osteoclasts, which
continuously act to increase, decrease, or
reshape bone.

Acetabulum (髖臼)
Concave component of ball and socket

Experimental Mechanics of hip Cover with articular cartilage

Provide with static stability

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 Acetabulum
Labrum (髖臼唇): a flat rim of fibro cartilage

Transverse acetabular ligament

Femoral head and neck Femoral head and neck

Femoral head : convex component

Cover with cartilage

Femoral head and neck MOVEMENTS AT THE HIP

Neck-to-shaft angle : Motion: Flexion, Extension, Abduction, Adduction,

External and Internal rotation
125º, vary form 90º to 135º
Aspects: Anterior, Posterior, Lateral and Medial
Angle of anteversion :
12º Major plane: Saggital, Frontal and Transverse
>12º : internal rotation
<12º : external rotation

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 Kinematics
Rang of motion : sagittal, frontal, transverse

sagittal frontal
transverse

Load on the Hip Single-leg stance:

Force & moment acting on hip joint
Two-Legged Stance •Net force = 0
•Net moment = 0
Major forces on hip:
•Weight of body segments above the hip
•Tension of the muscle force (Fm) Net moment = 0
•Joint reaction force (R) • (5/6)W * b = A * c
• A = (5/6W) * (b/c)

Joint reaction force: Net force = 0

•Equal to BW during swing phase • Ax = Jx
(due to tension of abduction muscle) • Ay + (5/6)W = Jy
•3~4 times of BW during normal walking
•5.5 times of BW during fast walking •(c/b) ratio↓ → A↑→ J↑
•8.7 times of BW during stumbling •c (level arm) ↓ → J↑

Net moment = 0
Net moment = 0 Moment arm: Unknown
• (5/6)W * b = A * c
• A = (5/6W) * (b/c) Net force = 0
• Ax = Jx
Net force = 0 • Ay + W = Jy + 1/6 W
• Ax = Jx
• Ay + (5/6)W = Jy

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 Geometry of Hip Joint
High joint reaction force for Valgus position

High reaction moment High joint reaction force

High muscle force

Hip Joint Replacement

Biomechanics of Hip
Arthroplasty

History to Treat Hip Fracture

Year Investigator Development
Late 18th-19th century Various metal devices to fix fractures; wires and pins from Fe, Au, Ag, and Pt

1860-1870 J. Lister Aseptic surgical techniques developed

1886 H. Hansmann Ni-plated steel fracture plate
1893-1912 W. A. Lane Steel screws and plates for fracture fixation
1909 A. Lambotte Brass, Al, Ag, and Cu plate
1912 W. D. Sherman Vanadium steel plate, first alloy developed exclusively for medical use; lesser stress concentration and
corrosion
1924 A. A. Zierold (CoCrMo alloy), a better material than Cu, Zn, steels, Mg, Ge, Ag, Au and Al alloy
1926 M. Z. Large 18-8sMo(2-4% Mo) stainless steel for greater corrosion resistance than 18-8 stainless steel

1936 C. S. Venable, W. G. Stuck Vitallium(developed in 1929; 19w/o Cr-9w/o Ni stainless steel)

1939 J. C. Burch, H. M. Carney Ta

1926 E. W. Hey-Groves Used carpenter’s screw for femoral neck fracture

1931 M. N. Smith-Petersen Designed first femoral neck fracture fixation nail made originally from stainless steel, later changed to
Vitallium
1938 P. Wiles First total hip replacement
19746 J. and R. Judet First biomechanically designed hip prosthesis. First plastics used in joint replacement

1947 J. Cotton Ti and its alloys

1940s M. J. Dorzee, A. Franceschetti Acrylics for corneal replacement

1952 A. B. Voorhees, A. Jaretzta, A. H. Blackmore First blood vessel replacement made of cloth
1958 S. Furman, G. Robinson First successful direct stimulation of heart

1958 J. Charnley First use of acrylic bone cement in total hip replacements
1960 A. Starr, M. L. Edwards Heart valve

1970s W. J. Kolff Total heart replacement

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 Total Hip Replacement

Goals of THR
Long term restoration of function
Pain relief

Total Hip Replacement Total Hip Replacement

Mechanical problems of THR Methods to prolong the longevity of THR

• Wear of the bearing surface • Reducing the loads acting on joint

• Mechanical failure of the implant • Designing the implant to withstand the
• Loosening of the implant from the bone loads and avoid wearing
• Dislocation of the implant

HIP ARTHROPLASTY Reconstructed Joint Geometry

Parameters need to be considered

Stem design ( neck angle and length,
Reconstructed Joint Geometry anteversion )
Stem Position Within the Femoral Canal Cup position ( Hip center )
Periprosthetic Bone Loss

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 Reconstructed Joint Geometry
Stem Design

Varus
Head-neck angle ↓
Moment arm↑
• Advantage:
• Ability of the abductors ↑ (due to increase of moment
arm)
• Joint contact force ↓
• Joint stability↑(deeper insertion)
• Disadvantage:
• Bending moment ↑
• Life of prosthesis ↓
Valgus

Stem Position Within the Femoral Canal

High joint reaction force for Valgus position
High moment for Varus position
Periprosthetic Bone Loss
Bone Loss
• Osteolysis: (PE debris<micron)
• Foreign-body reaction
• Stress shielding:
• More stiffness of prosthesis ( CoCr > Ti )

High reaction moment High joint reaction force

High muscle force

History of THA
Periprosthetic Bone Loss
•Charnley (1967): Standard to date
•Steel femoral head + PE cup (Low friction)
•Bone cement
Fig. •Serves as shock absorber
(Change of •Pain relief
strain in cortex) •Standard to date
•To date, implants selection remains controversial
Stiffness:
(wide variety of implants)
CoCr>Ti>Com
p2> Comp1

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 Fixation of hip prosthesis Fixation with cement

•Advantages
•Cemented •Improve stem/femoral shaft bonding
•Faster rehabilitation
•Preparation of femur is not constrained by the stem shape
•Cementless Controversial •Provide perfect fitting regardless variability of femoral anatomy
•Disadvantages
•Hybrid •Mechanics
•Crack or fatigue fracture in cement Cement debris (Osteolysis)
•Biology
•Cement debris (Osteolysis)

Fixation without cement (Press-fit)

Hybrid Fixation
(Combination of cemented and cementless fixation)
•Advantages
•Biological fixation
•Porous coating
•HA coating
•Poor Acetabulum
•Cement cup + cementless stem
•Disadvantages
•Long healing period
•Poor femoral canal
•Loosening frequently if bone in-growth is not achieved
•Cementless cup + cemented stem

Case Reports
Case Reports
Low survival rate (PCA cementless)

•Hosli (1993): Low survival rate for PCA cementless THA High survival rate
•87 PCA cases, 5-7 yr- followup
•Moskal (2004): PCA with cementless fixation performed well
•50% thigh pain the first 6 month, 40% after 1 yr. •(137 cases, 11-13yr- followup, only 4 cases failure within 12.4 yrs)
•Complication: loosening
•Laupacis (2002): stem survival rate (cementless > cemened)
•Tanner (1999): Low survival rate (68%) for PCA cementless THA •Same stem design with or without cement fixation)
•124 cases with with cement; 126 without cement, 6.3yr- followup
•171 cases, 9yr- followup
•Revision: 13 (10.5%) for cement fixation; 6 (4.8%) for cementless fixation
•P=0.11 (Insignificant)
•Kim (1999): High complication rate of PCA prosthesis
•116 cases, 10-12yr- followup
•At 11 yr, femoral osteolysis was found in 69 hips (59%)

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 Ideal specification for a THA Clinical complications (long term) after THA

•Prevention of osteolysis Bone loss

•Allowing immediate stabilization
•Preservation of bone stock
•Physiological stress distribution on the proximal femur
Loosening (Stem or Cup)
Dislocation (Cup & Ball)
Infection
Age over 65, enjoy normal function until the end of life
Age under 50, up to 20% require 2nd op. within 10 yrs
THA is restricted to older patients

•Compliance with conventional THA system

•Easy revision without further bone loss

Factors causing bone loss after THA

Biomechanical factor :
„ Stress shielding effect (Wolff’s law)

Biological factor :
„ PE debris (Osteolysis)

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