Articular Asphericity of the Arthritic Hip
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The predominant model of the human hip is a mechanical ball-and-socket joint. This description has two key implications: that the motion of the hip is purely rotational, and that the rigid articulating geometry of the hip is a sphere-on-sphere contact. Since the widespread adoption of this model, in the late 1960s, there has however been a persistent thread of literature suggesting that the articulating geometry of the hip is aspherical. The recent widespread availability of three-dimensional medical imaging now makes it possible to empirically assess the applicability of the predominant model. For this research dissertation, two arthritic groups were examined: patients either had primary early-life osteoarthritis of the hip, or hip dysplasia with secondary osteoarthritis. Computed tomography scans, taken as part of routine preoperative preparation, served as the source data for this work. The scans were manually segmented to produce 3D models of the bones of the hip, which were further refined to isolate the bony articular surfaces. These surfaces were fit to general ellipsoids and to spheres, the latter being the ball-and-socket model. The arthritic hips examined had comparable fitting accuracy for both ellipsoids and spheres; however, sixteen of nineteen hips formed geometrically incompatible ball-and-socket joints. The dysplastic hips examined had a notable difference in fitting accuracy, with ellipsoids being a statistically significantly better fit to the hip geometry. The ellipsoid shapes in all cases were aspherical, and in each population formed a statistically significantly aspherical group. There were no trends relating the ellipsoid shapes of bones of an individual joint, nor were there practical differences between the ellipsoid shapes between the two populations. Despite patient groups not being controlled for age, sex, or race, and accounting for typical manual segmentation errors, these results suggest that the hip is aspherically shaped. Thus, the geometric foundation of the ball-and-socket motion may be unsupported, and the conventional kinematic description of the hip may be called into question.