Clinical Biomechanics 107 (2023) 106035

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Clinical Biomechanics
journal homepage: www.elsevier.com/locate/clinbiomech

Estimation of two wear factors for total hip arthroplasty: A simulation study
based on musculoskeletal modelling
Florent Moissenet a, b, *, Victor Beauseroy c, Xavier Gasparutto a, Stéphane Armand a,
Didier Hannouche d, Raphaël Dumas c
a
Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
b
Biomechanics Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
c
Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR T_9406, F-69622 Lyon, France
d
Department of Surgery, Geneva University Hospitals, Geneva, Switzerland

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Primary causes of surgical revision after total hip arthroplasty are polyethylene wear and implant
Wear estimation loosening. These factors are particularly related to joint friction and thus patients' physical activity. Assessing
Total hip arthroplasty implant wear over time according to patients' morphology and physical activity level is key to improve follow-up
Clinical gait analysis
and patients' quality of life.
Musculoskeletal modelling
Methods: An approach initially proposed for tibiofemoral prosthetic wear estimation was adapted to compute two
wear factors (force-velocity, directional wear intensity) using a musculoskeletal model. It was applied on 17
participants with total hip arthroplasty to compute joint angular velocity, contact force, sliding velocity, and
wear factors during common daily living activities.
Findings: Differences were observed between gait, sitting down, and standing up tasks. An incremental increase of
both global wear factors (time-integral) was observed during gait from slow to fast speeds (p ≤ 0.01). Inter­
estingly, these two wear factors did not result in same trend for sitting down and standing up tasks. Compared to
gait, one cycle of sitting down or standing up tends to induce higher friction-related wear but lower cross-shear-
related wear. Depending on the wear factor, significant differences can be found between sitting down and gait at
slow speed (p ≤ 0.05), and between sitting down (p ≤ 0.05) or standing up (p ≤ 0.05) and gait at fast speed.
Furthermore, depending on the activity, wear can be fostered by joint contact force and/or sliding velocity.
Interpretation: This study demonstrated the potential of wear estimation to highlight activities inducing a higher
risk of implant wear after total hip arthroplasty from motion capture data.

1. Introduction
Total hip arthroplasty (THA) is a surgical procedure that replaces
damaged parts of the hip joint (e.g. due to osteoarthritis), i.e. the
femoral head and the acetabulum, with artificial ones. It is a very
common, efficient, and cost-effective operation to relieve pain and
restore hip joint function (Ferguson et al., 2018). Hence, more than one
million patients undergo this surgery worldwide every year (Singh,
2011). Still, THA may require surgical revision and, in 20 to 40% of the
cases, the commonest reasons for revision are polyethylene wear and/or
loosening of the implants (Damm et al., 2013), which are particularly
related to friction of the bearing surfaces and thus to patients' physical
activity (Jamari et al., 2022). As the utilisation of THA in the young
population steadily increases (Ravi et al., 2012), so will the intensity of
daily physical and sports activities that will be performed by patients
undergoing hip replacement, with potentially a higher risk of wear.
Being able to assess the implant wear over time in a personalised way
according to the morphology and level of physical activity of the pa­
tients is therefore essential to improve the THA follow-up.
Hip implants wear is commonly assessed in vitro using joint simu­
lators, i.e. specific testing machines reproducing as close as possible in
vivo conditions during common physical activities such as walking
(Calonius and Saikko, 2002). It can also be estimated in silico using
numerical models as recently proposed by Mattei et al. with a finite
element (FE) model (Mattei et al., 2021). However, both mechanical
testing and FE modelling still present a limited clinical applicability. On

* Corresponding author at: Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
E-mail address: florent.moissenet@unige.ch (F. Moissenet).

https://doi.org/10.1016/j.clinbiomech.2023.106035
Received 4 January 2023; Accepted 26 June 2023
Available online 28 June 2023
0268-0033/© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
F. Moissenet et al. Clinical Biomechanics 107 (2023) 106035

one hand, the use of joint simulators is useful to compare different
generic implant shapes but not to embed the specificities of each implant
and patient. On the other hand, the use of FE models allows for a deeper
personalisation but is time consuming and complex to apply.
The aim of this study was to propose another approach based on two
wear factors: the force-velocity factor (FVF, a friction-related wear fac­
tor) and the directional wear intensity factor (DWIF, a cross-shear-
related wear factor). These two factors only consider joint kinematics
and loading without including material and deformation parameters.
They were initially proposed for in vitro tibiofemoral prosthetic knee
wear estimation (Laurent et al., 2003; Schwenke et al., 2005). A
musculoskeletal model was used to estimate prosthesis sliding velocity
and joint contact force based on motion capture data recorded on 17
participants with a THA, for several trials of common activities of daily
living. It was hypothesised that more demanding activities such as fast
walking or sitting down will have higher wear factors.
2. Methods
2.1. Dataset
The dataset used in this study was obtained from an ongoing research
project by the Orthopedic Surgery and Musculoskeletal Trauma Care
Division and the Kinesiology Laboratory of the Surgery Department of
the Geneva University Hospitals. An experimental protocol (described
thereafter) was conducted on 17 participants (7 women and 10 men,
age: 63.6 ± 12.2 years old, BMI: 28.1 ± 4.4 kg.m- 2, further character­
istics in Table 1) 3 months after surgery. They were operated for primary
osteoarthritis (except participant 16 with a bone necrosis) with a THA.
The Cantonal Commission for Research Ethics approved this study
(CCER-2017-00817). All procedures were performed in accordance with
the ethical standards of the institutional research committee and with
the 1964 Helsinki Declaration and later amendments. All participants
provided written informed consent prior to their participation.
A set of 5 common activities of daily living were evaluated: walking
at 3 different speeds (slow, self-selected, and fast), sitting down (stand-
to-sit), and standing up from a chair (sit-to-stand). For each participant
and each activity, between 1 and 4 cycles were recorded and used for
this study. A 12-cameras optoelectronic system sampled at 100 Hz
(OQUS7+, Qualisys, Sweden) was used to track the three-dimensional
(3D) trajectories of a set of cutaneous reflective markers. The marker
set was based on the Conventional Gait Model (CGM) 1.0 (Baker et al.,
2018) and completed with additional thigh, shank and foot markers as
well as thigh clusters of 4 markers (Fig. 1). The 3D ground reaction was
acquired using three force plates sampled at 1000 Hz (Accugait, AMTI,
USA) disposed on the acquisition path. Furthermore, biplanar low-dose
radiographs (EOS system, EOS Imaging, France) (Bendaya et al., 2015)
were acquired, before motion capture, in an upright standing position
with a subset of reflective markers (Fig. 1).
2.2. Musculoskeletal model
A previously described 3D lower limb musculoskeletal model was
used in this study (Dumas et al., 2019; Moissenet et al., 2014). Briefly,
this model is based on Delp's geometry (Delp et al., 2007) and composed
of 5 segments (pelvis, femur, patella, tibia/fibula, foot), 6 joint degrees-
of-freedom (hip modelled as spherical, tibiofemoral and patellofemoral
joints modelled as parallel mechanisms, and ankle modelled as universal
joint) and 43 muscular lines of action. The joint kinematics was pre­
dicted through a multibody kinematics optimisation (Begon et al., 2018;
Duprey et al., 2010) that minimises, under rigid body and kinematic
constraints, the distances between measured and model-determined skin
markers positions. As this model represents a right limb, a right-side
transformation was applied first on all recorded data before being
used as inputs of the model. This model was scaled to fit the participant
leg length measured by the optoelectronic system.
Using this model, musculo-tendon, joint contact, ligament, and bone
forces can be estimated simultaneously through a one-step optimisation
(Moissenet et al., 2014). The dynamics equation is written as a linear
system GQ̈ + KT λ = E + Lf where G is the generalised mass matrix, Q̈ is
the consistent generalised accelerations vector, KT is the Jacobian ma­
trix and λ is the Lagrange multipliers vector, both associated with joint
kinematics and rigid body constraints, E is the generalised external
forces vector, including both weight and ground reaction forces and
moments, L is the generalised muscular lever arms matrix, and f is the
musculo-tendon forces vector.
It has been demonstrated (Moissenet et al., 2012) that joint contact
forces, in particular hip joint contact force f hip
c , directly corresponds to
the Lagrange multipliers corresponding to the spherical joint con­
straints. Furthermore, this model allows to compute the hip sliding ve­
locity vhip
s defined by vs
hip
= ωhip × chip , where ωhip is the angular velocity
of the pelvic component relative to the femoral component, and chip is
the ilio-femoral contact point expressed in the pelvic component coor­
dinate system. In this spherical joint, the contact point can be defined as
the current point of the force track (i.e. the track drawn by f hipc ) on the
surface of the femoral head (Calonius and Saikko, 2003). In this study,
the position and radius of the femoral and acetabular components of the
implant were personalised using the biplanar radiographs. It must be
noted that both single (Pinnacle, Depuy Synthes; Versafit CC, Medacta)
and dual (Polarcup, Smith & Nephew) mobility cups have been
implanted in the present cohort (Table 1). In dual-mobility cups, implant

Table 1
Participant characteristics.
ID Gender Age Height Body Implant side Primary arthroplasty Femoral / Acetabular cup systems
(yrs) (cm) mass (kg)

01 Woman 55 164 62 Right Yes Pinnacle / Actis (Depuy Synthes)

02 Woman 72 158 64 Left Yes Versafit CC / Quadra (Medacta)
03 Woman 78 151 48 Right Yes Polarcup / Corail (Smith & Nephew)
04 Man 73 168 68 Right Yes Versafit CC / Quadra (Medacta)
05 Man 77 174 98 Left Yes Versafit CC / Quadra (Medacta)
06 Man 71 167 68 Left Yes Pinnacle / Actis (Depuy Synthes)
07 Man 55 165 85 Right Yes Pinnacle / Actis (Depuy Synthes)
08 Man 73 166 69 Right Yes Versafit CC / Quadra (Medacta)
09 Man 60 176 87 Left Yes Pinnacle / Corail (Depuy Synthes)
10 Woman 65 159 61 Right Yes Versafit CC / Quadra (Medacta)
11 Man 53 178 100 Right Yes Versafit CC / Quadra (Medacta)
12 Man 54 180 115 Right Yes Versafit CC / Quadra (Medacta)
13 Woman 79 156 62 Right Yes Pinnacle / Corail (Depuy Synthes)
14 Man 48 165 76 Left Yes Pinnacle / Corail (Depuy Synthes)
15 Woman 70 158 75 Right Yes Pinnacle / Corail (Depuy Synthes)
16 Man 35 175 100 Right Yes Versafit CC / Quadra (Medacta)
17 Woman 64 167 97 Left Yes Versafit CC / Quadra (Medacta)

2
F. Moissenet et al.
Fig. 1. Illustration of the musculoskeletal model used in this study (A: Experimental marker set used to drive the model; B: Segment parameters using natural
coordinates consisting of two position vectors rPi and rDi of the proximal endpoint Pi and the distal endpoint Di and of two unitary direction vectors ui and wi (Dumas
and Chèze, 2007); C: Joint kinematic constraints (Duprey et al., 2010); D: Muscle geometry (Delp et al., 2007); E: Estimation of the femoral head's centre position and
radius from biplanar radiographs in upright standing posture (Gasparutto et al., 2020)).
wear may vary during a task depending on the articulation used. Still,
Jorgensen et al. reported the majority of movement occurred in the
small articulation (Jørgensen et al., 2022). In the present study, dual-
mobility cups were thus assumed to operate as single-mobility cups
and wear was thus estimated using the same approach for both implant
designs.
2.3. Wear factors
Based on the work of Schwenke et al. (Schwenke et al., 2005) and
Laurent et al. (Laurent et al., 2003) on in vitro tibiofemoral prosthetic
knee wear estimation, two wear factors were adapted to the assessment
of wear in THA. The force-velocity factor (FVF) is a friction-related wear
factor corresponding to the product of the norm of the applied joint
contact force times the norm of the sliding velocity. It is expressed as
⃦ ⃦ ⃦ ⃦
follow: FVF = ⃦vhip
⃦ ⃦ ⃦ hip ⃦
s ⃦ × ⃦f c ⃦. The directional wear intensity factor
(DWIF) extends FVF by considering the effect of sliding directional
changes. It is a cross-shear-related wear factor that is expressed as
⃦ ⃦ ⃦ ⃦
follow: DWIF = ⃦vhip
⃦ ⃦ ⃦ hip ⃦
s ⃦ × ⃦f c ⃦ × sin(α), where α is the angular change in
the velocity vector between two consecutive time steps. These factors,
obtained for each frame of the activity, can be globalised by computing
their time integral through the whole activity duration (Laurent et al.,
∫T
2003). The resulting scalars gFVF = 0 FVF(t)dt and gDWIF = 0
∫T
DWIF(t) dt are called global FVF and global DWIF and give an overview
of the implant wear during a specific activity of duration T.
2.4. Statistical analysis
The parameters used for the statistics were the maximal value of joint
angular velocity, joint contact force, and joint sliding velocity, as well as
the value of gFVF and gDWFI. Descriptive statistics were applied on the
whole cohort (n = 17) to summarise the characteristics of these pa­
rameters. However, inferential statistics were only applied to a subset of
the cohort (n = 7, participants 01, 04, 10, 12, 13, 15, 16) due to
3
Clinical Biomechanics 107 (2023) 106035
discrepancies in the dataset. These discrepancies are related 1) to the
inability of some participants to perform some activities (sample sizes
are reported in Fig. 2 for each activity), or 2) to major occlusions in
marker trajectories (in particular, for sitting down and standing up).
Hence, regarding the resulting small sample size, only non-parametric
statistical tests were applied (p ≤ 0.05). For each parameter, the effect
of the activity was assessed, across all participants of the subset, by a
Friedman test (paired samples). For each participant, the mean value
across recorded cycles was used for each activity. The inter-task com­
parisons were then performed using a Fisher's least significant difference
procedure post-hoc analysis. This analysis was completed with the
computation of a set of correlations by computing the matrix of Spear­
man's rank correlation coefficients. Correlations between gFVF,gDWFI,
and participant BMI, participant age and maximal joint angular velocity
were assessed. Correlations were classified as small (0.10 ≤ rho <0.30),
medium (0.30 ≤ rho <0.50), and large (0.50 ≤ rho) (Cohen, 2013).
3. Results
Mean curves across all participants (n = 17) obtained for each
parameter and each task are reported in Fig. 2 (peak values obtained for
two young participants – ID12, ID16, and two older participants – ID04,
ID13, are reported as Supplementary Material, Fig. S1). Inferential sta­
tistics are reported in Fig. 3 using boxplots (values obtained for two
young participants – ID12, ID16, and two older participants – ID04,
ID13, are reported as Supplementary Material, Fig. S2). Median (inter­
quartile range) walking speed was 2.8 (0.5) km.h− 1 at slow speed, 4.0
(0.5) km.h− 1 at self-selected speed, and 4.9 (0.6) km.h− 1 at fast speed.
The difference between each walking speed was significant (p < 0.001).
Detailed results are given hereafter for each parameter.
3.1. Joint angular velocity
An incremental increase of maximal joint angular velocity was
observed during gait from slow to fast walking speeds. The mean value
F. Moissenet et al. Clinical Biomechanics 107 (2023) 106035

Joint angular velocity Joint contact force Joint sliding velocity Force-velocity factor Directional wear intensity factor
400 7 70 150 10

Parameter (N.m.s-1)

Parameter (N.m.s-1)
Parameter (mm.s-1)
300

Parameter (BW)
Value (deg.s-1) 6 60 125 8
Gait (slow)

200 5 50 100
(n = 10)

100 6
4 40
0 75
3 30 4
-100 50
-200 2 20
25 2
-300 1 10
-400 0 0 0 0
0 50 100 0 50 100 0 50 100 0 50 100 0 50 100

400 7 70 150 10

Parameter (N.m.s-1)

Parameter (N.m.s-1)
Parameter (mm.s-1)
300

Parameter (BW)
6 60
Value (deg.s-1)

125 8
200
Gait (self)

5 50 100
(n = 17)

100 6
4 40
0 75
3 30 4
-100 50
-200 2 20
25 2
-300 1 10
-400 0 0 0 0
0 50 100 0 50 100 0 50 100 0 50 100 0 50 100

400 7 70 150 10

Parameter (N.m.s-1)

Parameter (N.m.s-1)
Parameter (mm.s-1)
300
Parameter (BW)

6 60
Value (deg.s-1)

125 8
200
Gait (fast)

5 50 100
(n = 13)

100 6
4 40
0 75
3 30 4
-100 50
-200 2 20
25 2
-300 1 10
-400 0 0 0 0
0 50 100 0 50 100 0 50 100 0 50 100 0 50 100

400 7 70 150 10

Parameter (N.m.s-1)

Parameter (N.m.s-1)
Parameter (mm.s-1)

300
Parameter (BW)

6 60
Value (deg.s-1)

125 8
Sitting down

200 5 50 100
(n = 14)

100 6
4 40
0 75
3 30 4
-100 50
-200 2 20
25 2
-300 1 10
-400 0 0 0 0
0 50 100 0 50 100 0 50 100 0 50 100 0 50 100

400 7 70 150 10
Parameter (N.m.s-1)

Parameter (N.m.s-1)
Parameter (mm.s-1)

300
Parameter (BW)

6 60
Value (deg.s-1)

125 8
Standing up

200 5 50 100
(n = 16)

100 6
4 40
0 75
3 30 4
-100 50
-200 2 20
25 2
-300 1 10
-400 0 0 0 0
0 50 100 0 50 100 0 50 100 0 50 100 0 50 100
Motion cycle (%) Motion cycle (%) Motion cycle (%) Motion cycle (%) Motion cycle (%)

Fig. 2. Overview of the parameter estimations obtained for each task across participants (Line: mean value across participants; surface: ± 1 standard deviation
corridor; n: sample size of the assessed activity; BW: body weight).

sitting down and standing up tasks.

±1 standard deviation was 191.6 ± 31.7 deg.s− 1 at slow speed, 236.3 ±
Maximal hip contact force observed during gait remains similar from
23.9 deg.s− 1 at self-selected speed, and 256.7 ± 28.0 deg.s− 1 at fast
slow to fast walking speeds. The mean value ±1 standard deviation was
speed (n = 17). On the subset of the cohort (participants that performed
3.2 ± 0.8 body weight (BW) at slow speed, 2.8 ± 0.6 BW at self-selected
all tasks, n = 7), a significant difference (p ≤ 0.01) was observed be­
speed, and 3.0 ± 0.5 BW at fast speed (n = 17). On the subset of the
tween gait at slow speed and fast speed (Fig. 3).
cohort (participants that performed all tasks, n = 7), no significant dif­
Compared to gait tasks, sitting down, and standing up tasks induced
ference (p > 0.05) was observed between gait tasks (Fig. 3).
lower maximal joint angular velocities. The mean value ±1 standard
Compared to gait tasks, sitting down, and standing up tasks induced
deviation was 139.4 ± 35.2 deg.s− 1 during sitting down, and 115.4 ±
higher maximal hip contact forces while demonstrating a higher vari­
43.6 deg.s− 1 during standing up (n = 17). On the subset of the cohort
ability across participants. The mean value ±1 standard deviation was
(participants that performed all tasks, n = 7), a significant difference was
4.5 ± 1.6 BW during sitting down, and 3.9 ± 1.5 BW during standing up
observed between sitting down and gait at self-selected speed (p ≤ 0.05),
(n = 17). On the subset of the cohort (participants that performed all
and gait at fast speed (p ≤ 0.001) (Fig. 3). A significant difference was
tasks, n = 7), a significant difference was observed between sitting down
observed between standing up and gait at self-selected speed (p ≤ 0.01)
and gait at self-selected speed (p ≤ 0.05) (Fig. 3). A significant difference
and gait at fast speed (p ≤ 0.001) (Fig. 3).
was observed between standing up and gait at slow speed (p ≤ 0.05), gait
at self-selected speed (p ≤ 0.01), and gait at fast speed (p ≤ 0.05)
3.2. Hip contact force (Fig. 3).

The contact point path (represented by the force track) estimated

during each activity is illustrated on Fig. 4 for one arbitrarily chosen 3.3. Sliding velocity
participant (02). During gait tasks, the contact point path had an elliptic-
shape surrounding the pole along the spherical surface, while it had a An incremental increase of maximal joint sliding velocity was
line-shape along the posterior aspect of the spherical surface during observed during gait from slow to fast walking speeds. The mean value

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F. Moissenet et al. Clinical Biomechanics 107 (2023) 106035

Fig. 3. Boxplots of the parameter estimations obtained for each activity across participants (n = 7; Boxplots: Red lines are medians, red areas are interquartile ranges
IQR from 25th percentile Q1 to 75th percentile Q3, blue areas are ranges from minimum = Q1–1.5xIQR to maximum = Q3 + 1.5xIQR, grey dots are: outliers;
Inferential statistics: * p ≤ 0.05, ** p ≤ 0.01, *** p ≤ 0.001; Tasks: Gait (slow): walking at slow speed; Gait (self): walking at self-selected speed; Gait (fast): walking at
fast speed; Sitting down: sit-to-stand; Standing up: stand-to-sit). (For interpretation of the references to colour in this figure legend, the reader is referred to the web
version of this article.)

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F. Moissenet et al. Clinical Biomechanics 107 (2023) 106035

Fig. 4. Illustration of the contact point path during each activity (Based on the results obtained from one arbitrarily chosen participant (ID02, right hip joint); Black
line: contact point path).

3.5. Correlations between global wear factors and participant or task

±1 standard deviation was 26.5 ± 7.5 mm.s− 1 at slow speed, 34.6 ± 8.0
specificities
mm.s− 1 at self-selected speed, and 41.3 ± 9.0 mm.s− 1 at fast speed (n =
17). On the subset of the cohort (participants that performed all tasks, n
Concerning gFVF, a medium correlation was found with participant
= 7), a significant difference (p ≤ 0.01) was observed between gait at
BMI (rho = 0.35, p ≤ 0.05) and age (rho = − 0.38, p ≤ 0.05) across all
slow speed and fast speed (Fig. 3).
tasks. Additionally, a medium correlation was observed during gait
Compared to gait tasks, sitting down, and standing up tasks induced
between gFVF and joint angular velocity (rho = 0.46, p ≤ 0.05). Con­
higher maximal joint sliding velocities. Standing up task also demon­
cerning gDWIF, a medium correlation was found with participant age
strated a higher variability across participants than all other tasks. The
(rho = − 0.40, p ≤ 0.05) across all tasks. Additionally, a large correlation
mean value ±1 standard deviation was 53.1 ± 17.6 mm.s− 1 during
was observed during gait between gDWIF and joint angular velocity (rho
sitting down, and 47.3 ± 15.3 mm.s− 1 during standing up (n = 17). On
= 0.60, p ≤ 0.01).
the subset of the cohort (participants that performed all tasks, n = 7), a
significant difference was observed between sitting down and gait at
4. Discussion
slow speed (p ≤ 0.001), and gait at self-selected speed (p ≤ 0.01) (Fig. 3).
A significant difference was observed between standing up and gait at
The aim of this study was to propose two wear factors that allows a
slow speed (p ≤ 0.01), and gait at self-selected speed (p ≤ 0.05) (Fig. 3).
fast and simple computation of the implant wear following total hip
arthroplasty (THA). As hypothesised, more demanding activities
3.4. Global wear factors
demonstrated higher wear factors. In particular, it can be observed that
1) the faster the participants walk, the higher the wear factors are, 2) one
An incremental increase of gFVF and gDWIF was observed during gait
cycle of sitting down or standing up tasks is more detrimental in terms of
from slow to fast walking speeds.
friction-related wear (but not cross-shear-related wear) than one gait
The mean values ±1 standard deviation were respectively 2055 ±
cycle, and 3) depending on the activity, the wear factors can be fostered
804 N.m and 116 ± 48 N.m at slow speed, 2762 ± 952 N.m and 186 ±
by the joint contact force and/or the joint sliding velocity.
68 N.m at self-selected speed, and 3495 ± 933 N.m and 274 ± 85 N.m at
Compared to the results of Schwenke et al. (Schwenke et al., 2005),
fast speed (n = 17). On the subset of the cohort (participants that per­
the peak of friction-related wear (FVF) observed during gait at self-
formed all tasks, n = 7), a significant difference (p ≤ 0.01) was observed
selected walking speed was lower in hip than in tibiofemoral joint
between gait at slow speed and fast speed for gFVF. (Fig. 3). Similarly,
(ratio of 1:2). This can be explained by a lower sliding velocity at the
significant differences were observed between gait at slow speed and
interface between prosthesis components in the hip joint. Indeed, the
self-selected speed (p ≤ 0.05), between gait at self-selected speed and
sliding velocity can reach up to 200 mm.s− 1 in the knee during the swing
fast speed (p ≤ 0.05), and between gait at slow speed and fast speed (p ≤
phase of gait (Dumas et al., 2020; Johnson et al., 2001; Schwenke et al.,
0.001) for gDWIF (Fig. 3).
2005), while it remains lower than 50 mm.s− 1 in the hip joint. In the
Interestingly, gFVF and gDWIF did not result in same trend for sitting
present study, both gFVF and gDWIF were positively correlated with
down and standing up tasks. While sitting down (4270 ± 1457 N.m) and
joint angular velocity and thus walking speed during gait. This is
standing up (3497 ± 1286 N.m) tasks resulted in values higher than for
consistent with the results of Mattei et al. (Mattei et al., 2021) who re­
gait tasks using gFVF, the highest values were obtained for gait at fast
ported higher wear depth and volume in gait at fast speed than during
speed using gDWIF (sitting down: 165 ± 51 N.m, standing up: 128 ± 52
gait at self-selected speed. In the present population, this increase was
N.m) (Fig. 3). On the subset of the cohort (participants that performed
related to an increase of joint sliding velocity as the maximum joint
all tasks, n = 7), a significant difference was observed between sitting
contact force did not demonstrate significant differences. The intensifi­
down and gait at slow speed for both gFVF (p ≤ 0.01) and gDWIF (p ≤
cation of hip contact force reported by Giarmatzis et al. (Giarmatzis
0.05) (Fig. 3). For gFVF, a significant difference was observed between
et al., 2015) with increasing walking speed was thus not observed here
standing up and gait at slow speed (p ≤ 0.001), as well as between
between 3 km.h− 1, 4 km.h− 1 and 5 km.h− 1 (i.e. median walking speeds
standing up and gait at self-selected speed (p ≤ 0.01) (Fig. 3). For gDWIF,
in the present dataset). The peak of joint contact force observed during
a significant difference was observed between sitting down and gait at
gait at self-selected speed was also lower of 1 to 2 BW in the present
fast speed (p ≤ 0.05), as well as between standing up and gait at fast
population (2.8 ± 0.6 BW) than in the young healthy population
speed (p ≤ 0.05).
(ranging from 4.2 to 5.7 BW across all tested walking speeds) in the

6
F. Moissenet et al.
study of Giarmatzis et al. (Giarmatzis et al., 2015) but compare
favourably with Bergmann et al. in vivo measurements (mean 2.6 BW
ranging from 2.2 to 2.9 BW) in a similar THA population (Bergmann
et al., 2016). The motor strategy might thus differ between populations,
as already suggested by Kerrigan et al. (Kerrigan et al., 1998) when
comparing healthy elderly and healthy young adult subjects.
From a motion cycle point of view, transfer tasks (i.e. sitting down
and standing up) appeared to induce higher friction-related wear but
lower cross-shear-related wear than gait at fast speed. These results are
consistent with the ones reported by Mattei et al. (Mattei et al., 2021)
with a more complex model based on a finite element analysis and
Archard law to compute wear volume. In particular, the authors found
that squatting led to a higher wear volume than gait (at whatever speed).
In the present population, the increase in FVF was related both to an
increase of joint sliding velocity and to an increase of maximum joint
contact force. On one hand, a higher maximum joint sliding velocity was
observed during transfer tasks while a lower maximum joint angular
velocity appeared. Furthermore, a negative correlation was observed
between gFVF (and gDWIF) and age during all activities, while the
younger patients are more likely to perform faster movements. This can
be explained by variations in the contact point paths, between the pa­
tients and between the explored activities. In the present results, the
path had an ellipse-shape around the pole during gait. This compares
favourably with the experimental results from Saikko and Calonius
(Saikko and Calonius, 2002) using hip simulators, and with the simu­
lation results from Damm et al. (Damm et al., 2021). In their study,
Meinders et al. (Meinders et al., 2022) also observed an ellipse-shape
path during gait, but with a more anterior-superior path centre. Still,
the related dataset was obtained from a young healthy population and
may not be directly comparable to the present results on a different
population. In the case of transfer tasks, this path changed for a posterior
curve-shape. To the best of our knowledge, only the study of Meinders
et al. (Meinders et al., 2022) reported the force track in a transfer task, i.
e. a squat task in their study. Even if the populations differ between our
studies, a posterior curve-shape was also observed by these authors,
while being more oriented to a superior-posterior path than in our re­
sults. On the other hand, the impact of the joint contact force on the FVF
is highlighted by a medium correlation between gFVF during all activ­
ities and the participants' BMI. Furthermore, a higher maximum joint
contact force was observed during transfer tasks than during gait.
Similarly to the measurements of Bergmann et al. (Bergmann et al.,
2016) with instrumented THA, a wide range of hip joint loadings was
observed in our population, especially during transfer tasks. As reported
in their study for HIGH100 (i.e. reflecting a 100 kg subject), a higher
maximum joint contact force was observed in transfer tasks compared to
gait. However, in their results, sit down task led to lower loadings than
standing up task, while the opposite was observed in the present results.
Still, the same trend as in the present results was reported by Layton
et al. (Layton et al., 2022) between gait, sitting down and standing up
activities. The present maximum joint contact force also compares
favourably with their results for gait and standing up activities. Inter­
estingly, a factor of 10 was obtained between FVF and DWIF, in favour of
the friction-related wear. Still, Schwencke and Wimmer (Schwenke and
Wimmer, 2013) reported the fact that the cross-shear-related wear was
6.4 times more detrimental than friction-related wear in terms of unit
wear volume of polyethylene. Hence, gait at fast speed should be
considered as a task potentially leading to high wear risk.
This study has several limitations. First, the present dataset was
obtained from a limited number of participants. Furthermore, due to
discrepancies in recorded activities, it was not possible to perform
inferential statistics on the whole dataset. Thus, the present results must
be verified on a wider dataset. Still, the estimation of the wear factors
was possible with these data and allowed to demonstrate its potential for
a simple computation of the implant wear after total hip arthroplasty.
Second, measures were acquired only 3 months after surgery. Remaining
pain may have influenced the achievement of some activities in several
7
Clinical Biomechanics 107 (2023) 106035
participants (e.g. through unequal weight repartition on both legs dur­
ing sitting down and standing up from a chair or altered co-contraction
patterns). Third, these wear factors only allow for qualitative compari­
sons. Indeed, they cannot predict how much polyethylene material will
be lost, how deep the wear will be, nor provide a spatial description of
the wear effects. Nonetheless, by being time efficient and based on
clinical gait analysis measurements, such a factor could be a useful
metric for comparing daily activities or patients. Fourth, the modelling
approach used in this study simplifies the complex wear process
observed experimentally. Still, such an approach is appropriate for
multibody modelling and can be useful to provide a simple and time-
efficient way to provide a first estimation of implant wear in daily
living conditions. Although the present wear factors do not provide
volumetric wear values, their definition provides a global trend of the
implant wear as demonstrated in the literature. Indeed, even with large
simplifications made on the wear process (i.e. not considering implant
lubrification), the present approach showed strong correlations between
predicted and measured wear on knee implants (Knowlton et al., 2020)
and hip implants (Schmalzried et al., 2000). Both studies have found
correlations between in vivo experimental wear (measured on explants
or X-rays) and the product of estimated contact force and sliding dis­
tance (i.e. the time integral of the sliding velocity). Moreover, when
tested on simulators, a reasonable agreement was also found between
the tibiofemoral joint gDWIF and the medial-to-lateral differences in
wear volume (Laurent et al., 2003). Fifth, the impact of the positioning
of the implants (anteversion and inclination) on wear factors was not
assessed. However, several studies have pointed out that the risk of edge
loading and wear could be at least related to this positioning (O'Dwyer
Lancaster-Jones et al., 2018; Palit et al., 2022). Still, the fusion between
motion capture data and biplanar radiographs available in the present
dataset could be explored in a future study to investigate this issue.
Sixth, dual-mobility cups were assumed in this study to operate as
single-mobility cups and wear was estimated using the same approach
for both implant designs. Other approaches should be considered for
high amplitude movements such as squat. Seventh, the present results
are reported per motion cycle. This means that they may not reflect the
real implant wear that will be correlated to the duration and frequency
of these activities, for example during a day. Additional data, e.g.
actimetry data, could help to fill this gap as previously proposed for the
knee by Seedhom et al. (Seedhom et al., 1972) and for the hip by
Schmalzried et al. (Schmalzried et al., 2000) using a pedometer.
5. Conclusion
To conclude, this study demonstrated the potential of two wear
factors to estimate the implant wear after THA from motion capture
data. To go further, it would be interesting to use actimetry data to
extend the results with the frequency of each activity of daily living for
every participant. The second avenue for improvement would be to use
the geometric data embedded in the medical images (e.g. femur torsion,
femoral overhead) to reach a higher level of musculoskeletal model
personalisation (Lenaerts et al., 2009).
Declaration of Competing Interest
The authors certify that they have no affiliations with or involvement
in any organisation or entity with any financial interest, or non-financial
interest in the subject matter or materials discussed in this manuscript.
Acknowledgments
This study was supported by the Fonds Alliance Campus Rhodanien
(France - Switzerland), La Région Auvergne-Rhône-Alpes (France), and
the Department of Surgery of the Geneva University Hospitals
(Switzerland).
F. Moissenet et al.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.clinbiomech.2023.106035.
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