Ground reaction forces and external hip joint moments predict in vivo hip contact forces during gait

Younger patients increasingly receive total hip arthroplasty (THA) as therapy for end-stage osteoarthritis. To maintain the long-term success of THA in such patients, avoiding extremely high hip loads, i.e., in vivo hip contact force (HCF), is considered essential. However, in vivo HCFs are difficult to determine and their direct measurement is limited to instrumented joint implants. It remains unclear whether external measurements of ground reaction forces (GRFs), a non-invasive, markerless and clinic-friendly measure can estimate in vivo HCFs. Using data from eight patients with instrumented hip implants, this study determined whether GRF time series data, alone or combined with other scalar variables such as hip joint moments (HJMs) and lean muscle volume (LMV), could predict the resultant HCF (rHCF) impulse using a functional linear modeling approach. Overall, single GRF time series data did not predict in vivo rHCF impulses. However, when GRF time series data were combined with LMV of the gluteus medius or sagittal HJM using a functional linear modeling approach, the in vivo rHCF impulse could be predicted from external measures only. Accordingly, this approach can predict in vivo rHCF impulses, and thus provide patients with useful insight regarding their gait behavior to avoid hip joint overloading.