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Skeletal deformities undeniably contribute to detrimental biomechanical loading in dysplastic hips, but cannot explain all types of damage and symptoms that patients with DDH experience. Characterizing the geometry and function of the muscles spanning the hip is a logical next step in our progression of knowledge about DDH pathomechanics. In this study, we compared skeletal geometry, muscle volumes, intramuscular fatty infiltration, moment arms, and isometric strength in patients with DDH (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u200920) to healthy controls (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u200915). Femoral coverage was significantly less in patients (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001, Cohen's\n                    <jats:italic>d<\/jats:italic>\n                    effect size\u2009=\u20092.2), femoral neck\u2010shaft angles were larger (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001,\n                    <jats:italic>d<\/jats:italic>\n                    \u2009=\u20091.3), and hip joint centers (HJCs) were more lateral (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001,\n                    <jats:italic>d<\/jats:italic>\n                    \u2009=\u20091.3). These skeletal abnormalities were associated with smaller abductor muscle moment arms in patients with DDH (e.g., gluteus medius [GMED]:\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001,\n                    <jats:italic>d<\/jats:italic>\n                    \u2009=\u20091.2). Patients with DDH also had larger GMED volumes (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.02,\n                    <jats:italic>d<\/jats:italic>\n                    \u2009=\u20090.83), but no differences in fatty infiltration, compared to controls. Isometric strength of the hip abductors, extensors, and flexors was lower in patients, but not significantly different from controls. The abnormal skeletal geometry, lateralized HJC, and reduced muscle moment arms represent a chronic biomechanical disadvantage under which patients with DDH operate. This phenomenon causes increased demand on the abductor muscles and results in high medially and superiorly directed joint reaction forces, which can explain reports of superomedial femoral cartilage damage in patients. The abnormal muscle geometry and function, in context with abnormal skeletal structure, are likely strong, but underappreciated, contributors to damaging loads in DDH.\n                  <\/jats:p>","DOI":"10.1002\/jor.25165","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T08:52:51Z","timestamp":1629449571000},"page":"1387-1396","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["The biomechanical disadvantage of dysplastic hips"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3475-819X","authenticated-orcid":false,"given":"Michael D.","family":"Harris","sequence":"first","affiliation":[{"name":"Program in Physical Therapy Washington University School of Medicine in St. Louis St. Louis Missouri USA"},{"name":"Department of Orthopaedic Surgery Washington University School of Medicine in St. Louis St. Louis Missouri USA"},{"name":"Department of Mechanical Engineering and Materials Science Washington University in St. Louis St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly C.","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Program in Physical Therapy Washington University School of Medicine in St. Louis St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8987-2523","authenticated-orcid":false,"given":"Ke","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering and Materials Science Washington University in St. Louis St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brecca M. M.","family":"Gaffney","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering University of Colorado\u2010Denver Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis J.","family":"Hillen","sequence":"additional","affiliation":[{"name":"Department of Radiology Washington University School of Medicine in St. Louis St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4274-1651","authenticated-orcid":false,"given":"Marcie","family":"Harris\u2010Hayes","sequence":"additional","affiliation":[{"name":"Program in Physical Therapy Washington University School of Medicine in St. Louis St. Louis Missouri USA"},{"name":"Department of Orthopaedic Surgery Washington University School of Medicine in St. Louis St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Clohisy","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Washington University School of Medicine in St. Louis St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,8,30]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-016-4815-2"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2003.009860"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2013.11.003"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.O.00109"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01734"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.01.060"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/jhps\/hnx041"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01735"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/1120700020912169"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-014-3297-6"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-12003-0_3"},{"key":"e_1_2_7_13_1","first-page":"V07BT10A052","article-title":"What is a moment arm? 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