1

Biomechanics of the hip disarticulation prosthesis

S. E. S O L O M O N I D I S , A. J. L O U G H R A N , J. T A Y L O R a n d J. P. P A U L

Bioengineering Unit, University of Strathclyde, Glasgow

Introduction Other i m p o r t a n t aspects of the prosthesis a r e :

M o r e t h a n twenty years a g o , M c L a u r i n (1954) (a) the knee joint is set posterior t o the hip
published his first r e p o r t o n the C a n a d i a n hip joint in such a m a n n e r that if a line is d r a w n
disarticulation prosthesis. His w o r k was aimed through the hip a n d knee centres it will strike
at improving the conventional design of the the g r o u n d a b o u t 20 m m behind the heel,
saucer-type a n d tilting table prostheses. this is t o ensure knee stability especially at
A measure of his success can be seen in that heel strike,
the Canadian-type h a s m a d e t h e other t w o
almost obsolete. Since its introduction, the
prosthesis has changed very little. Modifications
have been m a d e t o the socket a n d hip joint, b u t
the principles have remained the same.
T w o papers have been published t o date which
deal with the biomechanics of the prosthesis,
Radcliffe (1957) a n d M c L a u r i n (1969). A l t h o u g h
b o t h a u t h o r s gave a n indication of force
directions, it was n o t possible for either t o
indicate magnitudes since n o experimental
results were available at that time.
T h e test reported here provides quantitative
information o n the variation with time of hip,
a n d knee m o m e n t s in b o t h antero/posterior a n d
medio/lateral planes, axial t o r q u e a n d axial force
in the s h a n k during the stance phase.
T h e r e are two m a i n features in M c L a u r i n ' s
prosthesis c o m p a r e d t o the other types:
(a) t h e design a n d position of the hip joint,
(b) the socket design.
T h e hip joint is a b r o a d hinge placed well
forward a n d below the anatomical hip joint. T h e
joint allows free r o t a t i o n in the antero/posterior
plane, i.e. flexion/extension. It is rigidly fixed in
the medio/lateral plane thus giving lateral
stability.
T h e socket is a bucket-type seat which fits
snugly a r o u n d the pelvis a n d t h u s minimizes
stump/socket movement. T h e suspension is
provided b y m o u l d i n g over t h e iliac crests.

Fig. 1. The Winnipeg Modular Hip Disarticulation

Prosthesis.
1
Previously published in Orthopadie Technik, 4/76,
58-60.
(b) excessive hip flexion is prevented by a
limiting device,
(c) hip joint hyper-extension is prevented by
m e a n s of a " h i p b u m p e r " or extension stop
secured to the b o t t o m of the socket.
Subject and Prosthesis
T h e subject used in the test was a 21 years old
active female a m p u t e e of mass 51 kg approxi­
mately a n d with a height of 1.65 m . A m p u t a t i o n
h a d been performed o n t h e right side for
pathological reasons a n d she h a d been wearing a
hip disarticulation prosthesis for two years. T h e
prosthesis used was the Winnipeg M o d u l a r H i p
Disarticulation Prosthesis (Fig. 1) incorporating
a N o r t h w e s t e r n hip joint a n d uniaxial knee joint
fitted with pneumatic swing p h a s e control. T h e
flexion limiter consisted of a leather strap a n d
buckle attached between the hip fork a n d the
seat of the socket. A n O t t o Bock S A C H foot
was used a n d n o cosmesis was fitted. Socket
manufacture a n d alignment were as recom­
m e n d e d by M c L a u r i n a n d H a m p t o n (1962).
Equipment and Procedure
A strain gauged pylon dynamometer a n d a knee
goniometer, as described by L o w e (1969), were
incorporated in the s h a n k of the prosthesis.
Following dynamic alignment the patient was
asked t o walk a b o u t for a b o u t half a n h o u r in
order t o accustom herself to the limb. T h e types
of activity investigated were level walking at
various speeds and walking u p a n d d o w n a r a m p
(1:7 gradient). Analysis of the results was partly
m a n u a l a n d partly with the aid of a P D P 12
computer. T h e transducer r a w d a t a were
sampled at a frequency of 10 H z .
Fig. 2. Axial force on shank along axis of pylon. Level walking.
Results and Discussion
Using the information obtained from the
dynamometer, force analysis allowed the cal­
culation of:
(a) antero/posterior (A/P) m o m e n t s at hip, knee
a n d ankle,
(b) medio/lateral ( M / L ) m o m e n t s at hip, knee
a n d ankle,
(c) t o r q u e a b o u t the long axis of the leg,
(d) axial load along the axis of the pylon
dynamometer,
(e) A / P a n d M / L shears at right angles to the
pylon axis,
(f) resultant force.
T h e results for A / P knee m o m e n t (level, up-
r a m p a n d d o w n - r a m p walking), A / P a n d M / L
hip m o m e n t , axial force and t o r q u e (level
walking only) during the stance phase are shown
graphically. Six cycles for level walking a n d
three cycles for u p - r a m p a n d d o w n - r a m p
walking were analysed.
T h e results display considerable scatter which
cannot be wholly attributed t o the d y n a m o ­
meter or associated instrumentation a n d must
therefore be due t o uncontrollable parameters
related t o the patient, such as effects of change
of speed. T h e first a n d last 5 per cent of the
stance phase cannot be considered as accurate
because the sampling frequency used was t o o
low for these areas.
Axial force. This displays a double p e a k
pattern (Fig. 2). There is, however, a m u c h
slower increase in value of the axial force when
c o m p a r e d with the results obtained with B K a n d
A K amputees (U.C.B. 1947). T h e peaks occur
later in the stance phase, are closer together a n d
less p r o n o u n c e d . T h e m a x i m u m value is
approximately 650 N .
Fig. 4. A/P hip moment. Level walking.
 A/P knee moment (level walking). Knee
extension m o m e n t is low u p t o a b o u t 30 p e r cent
of the cycle (Fig. 3). This is d u e partly t o the
slow increase in axial load a n d partly t o t h e
b a c k w a r d A / P shear which exists in the first
half of the stance phase. T h e m a x i m u m knee
extension m o m e n t is a b o u t 35 N m . T h e flexion
m o m e n t s recorded at the beginning and end of
the stance phase can be absorbed by t h e
restraining action of the swing phase control
unit.
A/P hip moment (level walking). T h e graph
(Fig. 4) indicates that following heel strike there
is a flexion m o m e n t which is due t o the resistance
of t h e hip flexion limiter. Between 10 a n d 20 per
cent of the cycle the direction of the m o m e n t
reverses, indicating that the h i p extension r u b b e r
s t o p comes into action in this region of the cycle
a n d remains in contact t o the end of the stance
phase. T h e p e a k extension m o m e n t is a b o u t
50 N m . Prior to toe off the patient initiates knee
flexion p r e p a r a t o r y t o the swing phase as the line
of action of t h e resultant force between s t u m p
a n d socket passes progressively posteriorly.
M/L hip moment (level walking). T h e shape
of this curve is as expected (Fig. 5) a n d is similar
t o that of a n o r m a l subject. T h e m o m e n t is
predominantly adducting the hip joint with a
m a x i m u m value of approximately 55 N m .
Fig. 5. M/L hip moment. Level walking.
A/P knee moment (walking up-ramp and down-
ramp). A s expected when walking u p - r a m p the
knee is stable whereas d o w n - r a m p it is unstable
(Figs. 6 a n d 7). This is due t o the geometry of the
limb configuration in relation t o t h e force
actions. T h e m a x i m u m values are 80 N m for
u p - r a m p and 10 N m for d o w n - r a m p walking.
It was also clear during the tests t h a t the
a m p u t e e h a d little difficulty in walking u p - r a m p
b u t great difficulty walking d o w n - r a m p .
Torque (level walking). T h e t o r q u e curves
(Fig. 8) show a p a t t e r n remarkably similar t o
that obtained for n o r m a l locomotion with
m a x i m u m value of the order of 8 N m .
Conclusions
T h e wide scatter of the results, however,
m a k e s it difficult t o form precise judgements
concerning assessment of a m p u t e e performance.
Before this can be studied in greater depth, the
reasons for the scatter m u s t be determined, a n d
attempts m a d e t o eliminate the scatter as far as
possible. Thereafter, by acquiring a sufficient
volume of data, a realistic statistical assessment
could be m a d e . However, the information
presented in this p a p e r is of value t o the designer
of prosthetic devices as it provides information
o n the n a t u r e a n d a p p r o x i m a t e value of the
load actions.
 Fig. 6. A/P knee moment. Walking up ramp.

Fig. 7.A/P knee moment. Walking down ramp.

 Fig. 8. Torque. Level walking.
REFERENCES
LOWE, P. J. (1969). Knee mechanism performance in
amputee activity. Ph.D. thesis—University of
Strathclyde, Glasgow, Scotland.
MCLAURIN C. A. (1954). Hip disarticulation
prosthesis. Report N o . 15, Prosthetic Services
Centre, Department of Veterans Affairs, Toronto,
Canada.
MCLAURIN, C. A. (1969). The Canadian hip dis­
articulation prosthesis. Prosthetic and Orthotic
Practice. Ed. Murdoch G., 285-304, E. Arnold,
London.
MCLAURIN, C. A. and HAMPTON, F. (1962).
Diagonal type socket for hip disarticulation
amputees. Northwestern University Prosthetic
Research Centre, Chicago, Illinois, U.S.A.
RADCLIFFE, C. W. (1957). The biomechanics of th
Canadian-type hip disarticulation prosthesis.
Art. Limbs 4: 29-38.
U.C.B. (1947). Report on fundamental studies of
limb locomotion and other information relating
to design of artificial limbs. September 1945 to
June 1947, University of California, Berkeley,
U.S.A.