Int. J. Biomedical Engineering and Technology, Vol. 15, No.

4, 2014 341

Biomechanics of hip joint: a review

Bhaskar Kumar Madeti*

Department of Mechanical Engineering,
Gayatri Vidya Parishad College of Engineering (A),
Visakhapatnam, India
Email: madetibhaskar@rediffmail.com
*Corresponding author

Chalamalasetti Srinivasa Rao and

B.S.K. Sundara Siva Rao
Department of Mechanical Engineering,
AU College of Engineering,
Andhra University,
Visakhapatnam, India
Email: csr_auce@yahoo.co.in
Email: bsk_sundara@yahoo.co.in

Abstract: The purpose of the present paper is to provide an overview of the

current biological and biomechanical knowledge on the hip. Various model
formulations by researchers are discussed. Hip geometry is one of the crucial
parts of human body movement. Researching on how various views of the hip
is shown in different planes and how the forces act on the femur leads to
learning of the various forces and torques acting on the hip joint. Hip anatomy,
musculoskeletal model and FEA models are shown, forces acting on hip shown
by various researchers are discussed and experimental studies are made.
In addition, joint kinematics of the hip is also discussed to some extent.

Keywords: biomechanics; hip geometry; musculoskeletal model; ligaments;

tendons; FEA finite element analysis; MRI; magnetic resonance imaging.

Reference to this paper should be made as follows: Madeti, B.K., Rao, C.S.
and Rao, B.S.K.S.S. (2014) ‘Biomechanics of hip joint: a review’, Int. J.
Biomedical Engineering and Technology, Vol. 15, No. 4, pp.341–359.

Biographical notes: Bhaskar Kumar Madeti received MTech degree from

Andhra University. Presently he is doing part-time PhD from Andhra
University, in Mechanical Engineering. He is working as Assistant Professor in
Mechanical Engineering Department of Gayatri College of Engineering
(autonomous) since eight years. His research interests are in field of
biomechanics.

Chalamalasetti Srinivasa Rao is Professor at Mechanical Engineering

Department of Andhra University. He has guided three students and currently
guiding 11 students. He has published eight papers in international journals and
50 in national and international conferences. He is also member of various
professional bodies like ISTE, IE etc. His area of interest is manufacturing
sciences, rapid prototyping and robotics.

Copyright © 2014 Inderscience Enterprises Ltd.

342 B.K. Madeti, C.S. Rao and B.S.K.S.S. Rao

B.S.K. Sundara Siva Rao is retried Professor of Andhra University. He was

Head of the Mechanical Engineering Department. He had guided four PhD
students. He has published 40 papers in national and international journals and
20 in national and international conferences.

1 Introduction

Biomechanics is the science concerned with the movement of the human body in which
muscles, bones, tendons and ligaments work together for the movement of the human
body. The mind controls the movements like a machine. The intrinsic mechanics of this
machine gradually became clear through the works of the scientists studying it. The hip
joint is flexed and attached to the bone of the trunk with muscles. These muscles are
bounded under the hip. Many investigations on the topic have been carried out, which
reveal a lot of information. Various forces acting on the hip, excessive pressure on the
ligaments due to overload in various activities, etc. affect the functioning of the hip,
leading to injuries such as rupture in the ligament. Hip ligament injuries are common
particularly in the field of sports and related activities. Rupture of these ligaments causes
imbalance between hip movement and stability, which results in abnormal hip kinematics
and damages the tissues in and around the joint, leading to severe pain. Some activities,
like stair ascent and descent, are complex and require more coordination between the
major joint muscles of the lower limb (Kumar et al., 2011).
The present paper provides an overview of the current biological and biomechanical
knowledge on the normal hip. Through the utilisation of robotics technology and
computational modelling, there is a better understanding of the kinematics of the hip and
replacement mechanics. The inter-segmental forces and torques calculated from inverse
dynamics are due to contributions from muscle, ligament and contact forces.
The functions of the hip muscles in the neutral position are well documented in the
anatomical literature (Fick, 1911; Gray and Clement, 1985; Frick et al., 1987; Schiebler
and Schmidt, 1991). In contrast, changes of muscle functions during hip joint motions are
presented in detail only in a few anatomical and biomechanical works (Strasser, 1917;
Lanz et al., 1972; Kapandji, 1970). Several groups have focused their research on the
development and testing of mathematical models of the lower limb muscle functions
(Inman, 1947; Jensen and Davy, 1975; Dostal and Andrews, 1981; Brand et al., 1982;
Pierrynowski and Morrison, 1985; Hoy et al., 1990; Delp et al., 1990; Delp et al., 1994;
Duda et al., 1996), but the functions of the actuators at the hip, depending on hip joint
angle, have been extensively evaluated by only a few investigators (Nemeth and Ohlsen,
1985; Dostal et al., 1986; Mansour and Pereira, 1987). In these works, hip motion was
restricted to flexion. Four Total Hip Arthroplasty (THA) patients were included in the
study. In all the patients, an instrumented femoral prosthesis was used to measure the in
vivo hip contact forces (Bergmann et al., 1988; Bergmann et al., 1993; Bergmann et al.,
1995a; Bergmann et al., 1995b).
 Biomechanics of hip joint 343

In human movement analysis, the HJC is used to define the anatomical frame of the
femur (Cappozzo et al., 1995; Wu et al., 2002) and as the reduction point of the external
loads when estimating the hip muscular moment. As such, it affects both hip and knee
joint kinematics and kinetics descriptions (Stagni et al., 2000). For this reason, the
accuracy with which the 3D HJC location is determined is of paramount importance and
considered by human movement analysts to be a critical challenge for the future (Holden
and Stanhope, 1998; Kirkwood et al., 1999; Alderink et al., 2000; Piazza et al., 2001;
Besier et al., 2003; Piazza et al., 2004). The subject-specific location of the HJC was
based on the 2D or 3D trajectories of markers located on the greater trochanter. It has
subsequently been shown that this approach led to errors that were unacceptable in most
applications (Cappozzo, 1991; Neptune and Hull, 1995). The most straight forward
alternative method is 3D medical imaging. The weight of the upper body, approximately
two-thirds the body weight (Pauwels, 1980), is mainly applied through the spine into the
sacrum, which lies behind the hips. This forms one arm of a lever. We propose that this is
balanced by ligamentous forces acting in front of the hips. The fibrous capsule
surrounding the articulation of the femoral head in the acetabulum is substantial (Hewitt
et al., 2001; Stewart et al., 2002). A part of the capsule, the ilio-femoral ligament has
been reported to be the strongest ligament in the body (Williams, 1995), and a major part
of this ligament runs vertically from the femur to the ilium.
The estimation of forces across the hip joint may provide insight into the aetiology of
hip pain. Abnormal or excessive loading of the hip has recently been recognised as a
potential cause of anterior hip pain and subtle hip instability (Shindle et al., 2006). Hip
instability and excessive hip forces may cause a tear in the acetabular labrum even in the
absence of a traumatic event (Mason, 2001; McCarthy et al., 2001). The human skeleton
is evolved for erect bipedal locomotion (Lovejoy, 1988) and is particularly fit for long-
distance running (Bramble and Lieberman, 2004). Human bones are thus light enough
to allow fast movements at low metabolic costs, stiff enough for proper leverage to
locomotive muscle forces and strong enough to bear habitual loads without breaking
(Currey, 2003). As the bone tissue adapts its structural design to accommodate prevailing
mechanical loads (Frost, 2003; Ruff et al., 2006), the bone phenotype reflects both its
structural rigidity and loading history. Total hip joint arthroplasty has contributed
towards improving the quality of life for millions of people around the world who suffer
from coxofemoral arthropathy. Before hip replacement arthroplasty was developed,
patients with advanced stages of osteoarthrosis with severe pain and serious functional
limitations remained confined to wheelchairs and dependent on special care (Garellick,
1998).
In the field of biomechanics, the mechanics part needs to be explained in detail by
drawing the free body diagrams and obtain equilibrium equations to try to resolve forces;
also, by taking moments, some unknown forces may be obtained. When there are two
equations and three unknowns, we can assume one force appropriately from previous
data and other forces can be obtained. In order to find these forces, some data need to be
collected like height of a person and lengths of head, neck, trunk, limbs, thighs and leg
can be measured with a tape; these data are required for a human model on how the
forces acted on a human body. We can substitute these values in CATIA for ergonomic
analysis of the human model. For calculating the tensions in tibia and femur or any other
bones, we need to measure the lengths with a tape. We cannot get the accurate measure
344 B.K. Madeti, C.S. Rao and B.S.K.S.S. Rao

through this; for this, we need X-rays. We get little or not at all accurate lengths. Using
these lengths in line diagram and applying weights to it, we can find moments. This holds
good for 2D values only, but by using M.R Scans there is a possibility of the accuracy of
the 3D values of the forces increasing.

Figure 1 (a) Side view of the hip joint showing the powerful iliofemoral ligament (shaded)
joining pelvis to femur (with kind permission of Primal Pictures) and the outline of the
sacrum. (b) The corresponding lever diagram showing how the body is balanced over
the hip and how the force and energy calculations were derived. F is two-thirds the
body weight applied through the sacrum. Ligament force and energy are doubled to
account for both legs

(a)

(b)

Notes: K: elastic spring constant of the iliofemoral ligament; F: force due to weight
of torso; L1: lever arm of F; L2: lever arm of iliofemoral ligament;
Llig: relaxed length of iliofemoral ligament; U: total energy of system; y: angle
of displacement of pelvis from equilibrium.
Source: Aspden et al. (2006)

2 Hip anatomy

From the hip geometry, we can have a clear idea of the forces and how they act on the
hip joints with respect to reference planes. With this geometry, we can draw FEA
models; then afterwards stress distribution is shown by using ANSYS software. But there
is a drawback in this: we cannot get the exact forces.
 Biomechanics of hip joint 345

Figure 2 (a) Pelvic anatomical frame defined as follows: the origin is the midpoint between the
anterior superior iliac spines (ASISs); the z-axis is defined as the line passing through
the ASISs with its positive direction from left to right; the x-axis lies in the quasi-
transverse plane defined by the ASISs and the midpoint between the posterior superior
iliac spines (PSISs) with its positive direction forward; the y-axis is orthogonal to the xz
plane with its positive direction proximal. Vector c identifies the HJC position with
respect to this reference frame. (b) Assembly of hip, femur and spinal cord

(a)

(b)

Source: Camomilla et al. (2006)

Figure 3 The 17 anatomical landmarks identified from the AP radiograph were digitised on the
computer screen in order to determine the anatomic parameters. The points close to the
femoral head were digitised on an enlarged image (2) to improve accuracy (right)

Source: Genda et al. (2001)

346 B.K. Madeti, C.S. Rao and B.S.K.S.S. Rao

3 Musculoskeletal model

A three-dimensional musculoskeletal model of the hip, knee and tibiotalar joint was
created (Stansfield, 2000). 48 muscle elements were defined (Brand et al., 1982) and
were adapted to take account of the situation where muscles wrapped around the
underlying structures. The work of Friederich and Brand (1990) was used to describe
the muscle physiological cross-sectional area. Muscle origin and insertion points were
scaled to the individual using externally measured anatomical dimensions. A ball
and socket joint was defined at the hip, with its location defined for each individual from
CT scan data and X-ray photographs. Knee joint contact movement was defined after
(Nisell, 1985) ensuring physiological representation of the location of the contact centre
throughout flexion.
A three-dimensional musculoskeletal model was used to estimate the hip joint forces.
The model was based on a bilateral model developed by Carhart (2003), which we
simplified to include only four segments: the pelvis, thigh, shank and foot of the right
leg. The model contained six Degrees of Freedom (DOF) to represent the primary
motions at the hip, knee and ankle (Figure 1). In general, the muscle forces play a key
role in the movements of human body; these forces should be considered as tensile
forces.

4 Various forces and torques acting on hip

The relative torque components of 26 hip muscles of about three joint axes were
calculated using a human multi-body model to determine muscle actions as a function of
hip joint angle. In order to calculate the torque a muscle can produce, the parameters
determining the muscle force must be known (Pierrynowski and Morrison, 1985). The
main functions of the muscles crossing the hip joint, derived from the relative torques
calculated in this study, show good agreement with the functions found in the literature
(Seireg and Arvikar, 1973; Tillmann and Tondury, 1987; Rohen, 1993).
The abductor muscle force direction was estimated using Ninomiya et al.’s (1975)
method. This method was used since the abductor muscle direction must be estimated
from the X-ray of the pelvis as opposed to that proposed by Pauwels (1976). The free-
body diagram was taken from the hip joint including the pelvis, upper body and the
suspended leg. Five-sixth of the body weight was assumed to apply through the fifth
lumbar vertebra in a vertical direction. There were several studies involved in joint
contact pressure estimation using numerical methods (Brinckmann et al., 1981; Bombelli
et al., 1984; Legal, 1987). However, these methods required the determination of joint
contact surface geometry first before applying the load for contact pressure calculation.
There are numerous reports of the calculation of hip joint contact forces (Paul, 1967;
Seireg and Arvikar, 1973; Crowninshield et al., 1978; Rohrle et al., 1984; Pedersen et al.,
1987) in the literature. Comparison between the hip joint contact forces calculated using
three-dimensional mathematical models and those measured using instrumented implants
can be seen even with different model configurations of Brand et al. (1994), Lu and
O’Connor (2000) and Heller et al. (2001). Long-distance runners may be particularly at
risk for increased anterior gliding due to the exaggerated hip extension position inherent
 Biomechanics of hip joint 347

in running (Sahrmann, 2002). This subtle instability along with repeated hip extension
position may lead to tearing of the acetabular labrum (Guanche and Sikka, 2005). People
with hip instability, anterior hip pain or acetabular labral tear report pain with certain hip
movements. Hip extension with external rotation produces pain in patients with anterior
hip pain and subtle instability (Philippon, 2001). Acetabular contact pressures during hip
extension and hip flexion exercises have been evaluated previously by Tackson et al.
(1997) in a single subject with an instrumented endoprosthesis. They found that
performing prone hip extension resulted in a maximum pressure of 4.4 MPa, while
supine hip flexion resulted in 3.7 MPa. However, hip joint contact force was calculated
taking into account the muscular forces given by the two methods. When adding the
effect of muscle contraction, the hip contact force increased to four times the Body
Weight (BW). Two load peaks were observed.: the first one at 20% of the cycle where
the load was 350% BW, and the second one at 50% of the cycle, prior to toe-off,
corresponding to an absolute maximal hip load of 400% BW. An increased peak contact
force of the hip joint has previously been shown in patients with disturbed gait patterns
(McGrory et al., 1995; Bergmann et al., 2001; Heller et al., 2005). Loading of the hip
joint can be achieved from moments acting on the whole body. External moments
provide a reflection on the muscle activity, and they can indicate which muscles are
compromised during surgery. With the help of these forces, we can use exact
biomaterials; these are used in human bodies to replace damaged tissues (Gill and
Munroe, 2012). There is a drawback in using biometerials or composites in replacing
bones or tissues: porosity may occur and due to this, there will be a failure in total hip
implants (Gould and Goswami, 2013).

Figure 4 (a) The CE angle of Wiberg; the sharp angle; the Acetabular Head Index (AHI); the
spherical sector angle; the Acetabular Cartilage angle (AC angle): the joint gap. (b) The
Articuratio Trochanter Distance (ATD); the Trochanter Ilium Angle (TIA); the pelvic
height (height), width (width) and the head-to-trochanter ratio. The abductor force is
assumed to be in the direction of line 1–C and C is 1/3 the distance of lines 12–15. The
joint resultant force was then calculated by applying static equilibrium at the hip joint
taking the free-body diagram including the pelvis, the upper body and the suspended
leg in one-leg standing position

Source: Genda et al. (2001)

348 B.K. Madeti, C.S. Rao and B.S.K.S.S. Rao

Figure 5 x, y, z is femur, based, x points medially, y ventrally and z proximally. x and z lie in the
frontal plane, defined by the knee axis and idealised long axis of the femur. The force
components – Fx – Fy – Fz, point towards the Centre of the implant’s head and add
vectorially to the resultant joint force R. Projections of R are shown. The load direction
F is defined in the frontal plane x-z, direction T in the transverse plane x-y. The
bending moment M pushes the implant’s head downwards/inwards, while the torsional
moment, M, rotates the prosthesis backwards. For their definition, the stem axis z
instead of the femur axis z is used. A is the anteversion angle of the implant

Source: Bergmann et al. (1995a, 1995b)

Figure 6 Applied load and boundary conditions of the developed FEA model
..

Source: Tsouknidas et al. (2012)

 Biomechanics of hip joint 349

Figure 7 Overview of the musculoskeletal model used in this study. Illustration of the segmental
reference frames in the frontal and sagittal plane for the pelvis (A), thigh (B), shank (C)
and foot (D) with the subject standing in the anatomical position. In the pelvic reference
frame, the superior/inferior axis is in line with the trunk when in a standing posture.
The anterior/posterior axis is perpendicular to the superior/inferior axis and in line with
the progression of movement in the anterior direction. The medial/lateral axis is defined
as the cross-product of the other two axes

Source: Carhart (2003); Lewis et al. (2007)

5 Experimental studies

The gait at a comfortable speed of nine healthy subjects was analysed following
the experimental protocol proposed by Doriot and Cheze (2004). 14 passive reflective
markers (14 mm diameter) were placed on anatomical landmarks of the pelvis
and the right lower limb. Besides, the hip joint centre was determined functionally using
the hip circumduction method developed by Cheze et al. (1996), long-term exercise
loading on cross-sectional geometry of the femoral neck cortex (Nikander et al., 2008).
Virtually, all such evidence (Heinonen et al., 2001; Nikander et al., 2005) has remained
coarse and indicative because of the inherent inaccuracies and methodological limitations
of the planar dual-energy X-ray absorptiometry to describe three-dimensional bone
geometry (Bolotin et al., 2001; Beck, 2007). In the present study, we assessed the
proximal femur with 3D Magnetic Resonance Imaging (MRI), a method found recently
useful for cortical bone evaluation (McKay et al., 2004; Gomberg et al., 2005; Sievanen
et al., 2007).
350 B.K. Madeti, C.S. Rao and B.S.K.S.S. Rao

16 triaxial strain gauges were bonded around each femur (anterior, posterior, medial
and lateral side) at four levels (head, neck, lesser trochanter and diaphysis) (Cristofolini
et al., 2009). Strain increased linearly when the load is applied for each individual strain
gauge, and each loading configuration for 98% of the cases where strains reached a value
of 100 microns or larger. Similarly, displacements measured by LVDTs increased
linearly with loads by 94% in the cases where displacements reached a value of 50 mm
or larger. This confirms that bone can be assumed to behave linearly with good
approximation for the strain range and strain rates used in this study.
Computed Tomography (CT) was employed to reconsider all anatomical aspects
in a 3D model. Even though both CT and MRI demonstrate high inherent image contrast
between bone and soft tissue, CT is slightly more accurate in the reconstruction
of skeletal characteristics, especially when examining longer bones like the femur
(Rathnayaka et al., 2012).

Figure 8 Exercises simulated using the musculoskeletal model. (A) Hip extension in prone:
gravity was specified as acting from posterior to anterior in line with the pelvic
reference frame. The hip started in 101 of hip flexion and moved through 301 to a final
position of 201 of hip extension. (B) Hip flexion in supine: gravity was specified as
acting from anterior to posterior in line with the pelvic reference frame. The hip started
in 101 of hip extension and was moved through 401 to a final position of 301 of hip
flexion

Note: Images created in SIMM (MusculoGraphics, Inc., Santa Rosa, CA).

Source: Fraysse et al. (2009)
 Biomechanics of hip joint 351

Figure 9 Geometrical representation of the bones for each lower limb segment. Top left: pelvis;
bottom left: foot; middle: thigh; right: shank. The positions of the local coordinate
frames are also represented in each segment (see online version for colours)

Source: Fraysse et al. (2009)

6 Finite element analysis

The majority of FE validation studies in literature focused on bone strength prediction in

quasi-axial loading configurations, while few works aimed at validating FE models in
sideways fall configurations. Among those who addressed sideways fall (Keyak et al.,
2001; Verhulp et al., 2008; Majumder et al., 2009; Wakao et al., 2009; Koivumäki et al.,
2010), most of them try to directly predict bone strength, without preliminarily assessing
the accuracy in elastic strain prediction, even if using a strain-based elastic limit criterion.
Recently, the authors developed a methodology to generate subject-specific FE models of
femurs from CT data (Taddei et al., 2006; Schileo et al., 2007; Schileo et al., 2008). This
methodology achieved under quasi-axial loading configurations a high in vitro strain
prediction accuracy, comparable to the authors’ knowledge only to Bessho et al. (2007)
and Phillips et al. (2007). Some of the authors presented in their work that the FE
modelling procedure proposed in Schileo et al. (2008) could accurately predict the strain
levels elicited by low magnitude loads applied in vitro in sideways loading conditions.
The assumption of forces must be predicted exactly, so the stress distribution may be
accurate. The maximum von Mises stress, contact pressure, contact radius and mean
contact pressure to yield strength ratio using two-dimensional finite element model of
acetabular component was developed for the different material combinations by Shankar
et al. (2013). Boundary conditions need to be taken in finite element analysis.
352 B.K. Madeti, C.S. Rao and B.S.K.S.S. Rao

Figure 10 Finite element model for the acetabular cup and the femoral head

Source: Queiroz et al. (2013)

Figure 11 Finite element model of the femoral head and acetabular cups at tilts of 01, 451 and 601

Source: Queiroz et al. (2013)

Figure 12 Calculated stress field on a reverse engineered model of the femur

Source: Tsouknidas et al. (2012)

 Biomechanics of hip joint 353

7 Joint kinematics

All joints were modelled as frictionless joints because kinematic and static analyses do
not require the definition of coefficients of friction. The hip joint is widely accepted as a
spherical joint in the anatomical literature (Gray and Clement, 1985; Tillmann and
Tondury, 1987; Drenckhahn and Zenker, 1994). Hip is modelled as joint with three
rotational DOF. A hip joint simulator should be capable of generating the angular range
of movements of the femoral component miming the natural human motion and loading
by adapting the DOF in kinematic motion. The great varieties of hip simulators
reproduce various DOF. In particular, a single-axis hip simulator mimics flexion/
extension movement (Beutler and Lehmann, 1975).
The boundary conditions of the multi-body model can be defined either by kinematic
data from a motion analysis or by the definition of angular displacements at the
connecting joints between the segments of the model. Since in the literature there are no
data available on the kinematics of the sit-to-stand movement for the complete body, the
activity of getting up from a chair was modelled by adjusting the joint angles by common
sense (Dumbleton et al., 1972).

8 Conclusions

In the field of biomechanics, research is widely spread out in the medical field, but not
much in the mechanical field. By drawing a free-body diagram using equilibrium
conditions, we can exactly predict the direction in which the forces act on. In hip
geometry, especially, there is a complexity in showing various reaction forces. We have
to assume appropriate forces to do calculations. Thereafter the remaining forces may be
calculated. Musculoskeletal models are helpful in understanding the reduction of the
forces in the joints of the human body due to muscles, ligaments and tendons. Failure
analysis of ligaments can be done by resolving the forces at the knee. With the help of
motion photography and force transducer, the forces on the knee joint are obtained.
Further forces acting on the hip can be calculated. Recently, the three-dimensional finite-
element analysis models have been generated to reduce complexity. Stress and strains
are also clearly observed in the hip joint using softwares. Accurate three-dimensional
models are made with the help of M.R.Scan. Finite-element analysis is done for the parts
of bones like femur, tibia and hip. Tendons and ligaments as tensile forces stress
distribution on the hip can be shown.

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