Computational modelling of hip resurfacing arthroplasty investigating the effect of femoral version on hip biomechanics

Jonathan Bourget-Murray; Ashish Taneja; Sadegh Naserkhaki; Marwan El-Rich; Samer Adeeb; James Powell; Kelly Johnston

doi:10.1371/journal.pone.0252435

Peer Review History

Original SubmissionNovember 6, 2020
6 Jan 2021 Decision Letter - Jose Manuel Garcia Aznar, Editor PONE-D-20-34959 Computational Modelling of Hip Resurfacing Arthroplasty Investigating the Effect of Femoral Version on Hip Biomechanics PLOS ONE Dear Dr. Bourget-Murray, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Feb 20 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Jose Manuel Garcia Aznar Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables should be uploaded as separate "supporting information" files. 3. 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Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: No ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The aim of this paper is to study the effect of the hip resurfacing position in the mechanical loading scenario manly related with hip contact pressure and hip impingement. The paper is well write in English and structure is well defined. The introduction presents a lack of other previous published works related with hip resurfacing offset and position. The materials and methods presents a lack of information to understand the simulation and the results. Some important technical aspects are critical to analyze the results. The results are in agreement with previous publications an presents an obvious situation, if the implant position reduces the contact area is obvious increase the contact stress. Other important and critical aspect is the bone geometry, in the neck of femur and anatomic condition of one patient. ****** 6. 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Revision 1
30 Jan 2021 Author Response Dear Dr. Anzar, RE: PONE-D-20-34959. Thank you for reviewing the manuscript of our original research article entitled “Computational Modelling of Hip Resurfacing Arthroplasty Investigating the Effect of Femoral Version on Hip Biomechanics” for consideration for publication in the PLOS One. After careful review of PLOS ONE’s publication criteria, we have edited our manuscript according to the journal’s standards. We hope you find the corrections within our revised manuscript acceptable. Notable changes include: Level 1 heading used for all major sections. Bold type, 18pt font. Level 2 heading used for all sub-sections of major sections. Bold type, 16pt font. Figure citation corrected across all the text. Each figure caption now appears directly after the paragraph in which they are first cited. All figure titles are now bolded. Tables are now presented directly after the paragraph in which they are first cited. Tables are all cell-based. References with more than six authors now list the first six author names, followed by “et al.” The authors would also like to thank the reviewer and academic editor for their comments. We value your insightful input and have attempted to edit our manuscript in a way that reflects these. Reviewer 1 comment: The introduction presents a lack of other previous published works related with hip resurfacing offset and position. Author response: There is unfortunately a lack of scientific evidence regarding the impact of femoral retroversion on hip biomechanics and the impact of this hip resurfacing. The purpose of our Finite Element Analysis was to explore this in a computational model given the paucity of research in this field. Insight on femoral retroversion on HRA with respect to impingement and force transmission across the hip joint may encourage further clinical research in this field. In light of your comment, we have edited our introduction in order to highlight this issue more clearly. We hope you appreciate the new changes. Reviewer 1 comment: The materials and methods presents a lack of information to understand the simulation and the results. Some important technical aspects are critical to analyze the results. Author response: We have reviewed our Materials and Methods section of our paper. The authors believed to have successfully explained both the computational model techniques used to create the finite element analysis as well as the different models analysed. Did the reviewer feel strongly about any specific aspect of the methods that may need clarity? However, we have edited some parts of the methods in order to improve the understanding of our approach. We believe this now reads better and may facilitate understanding. Most of these edits are found in the last two paragraphs of the methods. The authors wishes to thank both the reviewer and academic editor for their time in reviewing these changes. We hope these are satisfactory to proceed with publication in PLOS One. Should you have further comments of concerns, please feel free to contact us. There have been no changes to our financial disclosures. Thank you for your consideration. Sincerely, Jonathan Bourget-Murray, MD CM FRCSC Senior Orthopaedic Trauma Fellow John Radcliffe Hospital \| Oxford University Hospitals NHS Trust University of Oxford, Oxford, UK Attachments Attachment Submitted filename: Response to Reviewers_PLOSone.pdf https://doi.org/10.1371/journal.pone.0252435.r002
17 Mar 2021 Decision Letter - Jose Manuel Garcia Aznar, Editor PONE-D-20-34959R1 Computational Modelling of Hip Resurfacing Arthroplasty Investigating the Effect of Femoral Version on Hip Biomechanics PLOS ONE Dear Dr. Bourget-Murray, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 01 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Jose Manuel Garcia Aznar Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Specific comments: Introduction The introduction should updated to include some recent studies in Hip resurfacing position, manly the offset and acetabular position. Uemura, K., Boughton, O.R., Logishetty, K., Halewood, C., Clarke, S.G., Harris, S.J., Sugano, N., Cobb, J.P. A single-use, size-specific, nylon arthroplasty guide: a preliminary study for hip resurfacing (2020) HIP International, 30 (1), pp. 71-77. Izmin, N.A.N., Todo, M., Abdullah, A.H. Prediction of bone damage formation in resurfacing hip arthroplasty (2019) International Journal of Engineering and Advanced Technology, 9 (1), pp. 5879-5885. Ramos, A., Soares dos Santos, M.P., Mesnard, M. Predictions of Birmingham hip resurfacing implant offset - In vitro and numerical models (2019) Computer Methods in Biomechanics and Biomedical Engineering, 22 (4), pp. 352-363. Materials and METHODS “….usual surgical operation with a layer of cement between the femoral head “ Please identify the thickness of cement mantle in the simulation. Is not an important aspect in the results of contact pressure and MOM. “…The cortical bone was meshed with 3-node shell elements with a uniform thickness of 1.5mm, …” Justify why use this option, because the CT scan presents the cortical and cancellous bone? This cortical is important in the model stiffness and can change the results? “….. The BHR implant and cement were meshed with 8-node hexahedral elements….” Why the authors use tetrahedral linear elements in the bone and hexahedral elements in the cement? Why use tetramesh in the bones? and not a solid body if the results are only in the contact between hip resurfacing components “…., hence the results were insensitive to the mesh size …” what kind of results in this model was insensitive to the mesh size? To determine the contact area in the hip resurfacing the mesh size is important? “…..inner surface of the cup with 80μm of clearance….” Please explain that, because is important to identify the mesh size to guarantee that clearance, 0.08mm. “… A concentrated load was applied to a reference point defined at the center of the femoral head….” This point seams the most critical in the study. In addition, is not well defined where the load is applied? In the femoral neck? “..RV0,..” Please change for neutral “….This included simulation of hip flexion up to 90° through a virtual maneuver of the femur in the sagittal plane….” Explain how do you detect the contact? What is the tolerance? How the model calculate the volume of impingement? DISCUSSION The authors do not compare the results of contact stress with other studies. “…….However, our study does present results of a hip that is loaded in three different positions, which is unparalleled to any previous study.” This sentence is not true, the published papers presented always 3 direction loads Reviewer #2: I reviewed a revised version of this paper not being the original reviewer. The paper reads well and to me is clear. Authors seems to have addressed the original reviewer comments which seems to be very minor. In such cases I respect the original review and response and avoid any further comment. However, in this case I would be grateful if authors can add a few lines to the limitations of this paper saying that no direct validation was performed here or somewhere just comment on how confident they are as per validity of the FE results. I understand that the relative comparisons that authors have made remains valuable and perhaps valid. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0252435.r003
Revision 2
16 Apr 2021 Author Response Dear Dr. Anzar, PONE-D-20-34959R1 Thank you for reviewing the revised manuscript of our original research article entitled “Computational Modelling of Hip Resurfacing Arthroplasty Investigating the Effect of Femoral Version on Hip Biomechanics” for consideration for publication in the PLOS One. We have carefully reviewed all reviewer comments and addressed all of these. We are convinced this will satisfy Reviewer #1’s comments on our methodology. In fact, there have been notable changes in our Methods sections. Please see below for the list of edits. Reviewer #1: Specific comments: Introduction We have updated our introduction and have included two recent studies as suggested: Izmin NAN, Todo M, Abdullah AH. Prediction of bone damage formation in resurfacing hip arthroplasty. International Journal of Engineering and Advanced Technology 2019;9(1): 5879-5885. Ramos A, Soares dos Santos MP, Mesnard M. Predictions of Birmingham hip resurfacing implant offset - In vitro and numerical models. Comput Methods Biomech Biomed Engin. 2019 Mar;22(4):352-363. The main changes are found in the second paragraph of the introduction, which now reads: “In light of these adverse events, several studies have identified risk factors attributed to early failure, which include: implant design, component position and size, female sex, patient age, and surgeon inexperience [8,12,15-17]. As a means to investigate the association between femoral implant malposition on damage formation of the femur, a recent finite element analysis was developed. This model was developed from a 47-year old patient’s computed tomography (CT) image and the loading simulation was that of normal walking condition. The analysis showed that the model experienced the most damage when the femoral head implant was in varus position (>130°), but was reduced significantly when the implant was placed in valgus position (<130°) [16]. On the other hand, Ramos et al. developed experimental and numerical models to analyze whether the positioning of the resurfacing head implant is important in the distribution of bone strains and in the risk of fracture of the femur [17]. They found that valgus position reduces strain distribution in the medial aspect of the femur and brings about a lower shear stress, thus reducing the risk of femoral neck fracture. However, despite appropriate patient selection and precise implant positioning, there continues to be a subset of patients who experience early failure following HRA. Structural abnormalities of the hip may serve as an explanation for some of these failures.” Materials and METHODS “….usual surgical operation with a layer of cement between the femoral head “ Please identify the thickness of cement mantle in the simulation. Is not an important aspect in the results of contact pressure and MOM. The thickness of cement mantle was 0.5 mm. We used one layer of brick solid elements to simulate the cement layer and the minimum size of the elements was 0.5 mm. “…The cortical bone was meshed with 3-node shell elements with a uniform thickness of 1.5mm, …” Justify why use this option, because the CT scan presents the cortical and cancellous bone? This cortical is important in the model stiffness and can change the results? The reviewer is absolutely right about the cortical thickness and its stiffness; however, it does not affect/change results of this research. Thickness of the cortical bone along with its material property determines its stiffness and affects the developed stresses. Since the load was applied as a concentrated force to the head center, there was no developed stresses in the cortical bone. In this research we did not investigated the bone stresses. We only focused on the stresses between the implant head and cup (contact pressure). When reconstructing the cortical bone, its superficial surface was very important for us so we could capture the impingement. “….. The BHR implant and cement were meshed with 8-node hexahedral elements….” Why the authors use tetrahedral linear elements in the bone and hexahedral elements in the cement? Why use tetramesh in the bones? and not a solid body if the results are only in the contact between hip resurfacing components Our preferred mesh was structured mesh with hexahedral elements technically and computationally. The difference between bone and cement which determined their mesh type was their geometry. The cement was geometrically very regular so we could use structured mesh with hexahedral elements. While cancellous bone had irregular shape and difficult to be meshed using hexahedral elements. As the reviewer commented, the bone was not the main focus of this research. If assigning the rigid body we still could perform the analyses and calculate the contact pressure between implant head and cup. In our model both options (rigid body bone or meshed bone) were almost the same in a computational point of view (computational time and size). We used meshed bone model as the preferred one so we could use the same model in future projects were the bone stress is in demand. “…., hence the results were insensitive to the mesh size …” what kind of results in this model was insensitive to the mesh size? To determine the contact area in the hip resurfacing the mesh size is important? The results were insensitive to the mesh size because we had to use very fine mesh (if the mesh was coarse it definitely could affect the results). In order to mesh the relatively thin implant (mesh it with several layers) and to manage the aspect ratio of the elements, we had to use very small size elements. Finer mesh although affects the results, but negligibly in our case. “…..inner surface of the cup with 80μm of clearance….” Please explain that, because is important to identify the mesh size to guarantee that clearance, 0.08mm. Despite real geometry of other elements of the model, its contact elements were virtual. The clearance of 0.08mm, was determined by property of contact element, not its geometry. In this way, the clearance of the contact became independent from mesh size. We defined the contact by pairing to surfaces. When these two surfaces were getting close together, at one defined distance (which was defined to be 0.08mm in our model) the contact was detected. “… A concentrated load was applied to a reference point defined at the center of the femoral head….” This point seams the most critical in the study. In addition, is not well defined where the load is applied? In the femoral neck? As shown in Fig. 1 (tip of the white arrow), the load was applied as a concentrated force to a single point located on the center of femoral head. “….This included simulation of hip flexion up to 90° through a virtual maneuver of the femur in the sagittal plane….” Explain how do you detect the contact? What is the tolerance? How the model calculate the volume of impingement? Impingement analysis was performed using Hypermesh (Altair, USA) using virtual maneuver of the femur simulating flexion up to 90°. By this simulation, the angle of flexion at which impingement started was detected and area of impingement was calculated each case. For each case, the flexion rotation was simulated from 1° to 90° at 1 degree rotation steps (the tolerance of rotation). At each step, "trim with surfs/plane" was used. If two surfaces (surface of femoral neck and surface of cup) penetrated each other, then both surfaces would be trimmed; otherwise they would be remained intact. If the surfaces were trimmed, then the trimmed surface and the volume between two surfaces could be selected and area and volume of impingement could be calculated. Discussion We have also updated our discussion as per the reviewer’s suggestions. Reviewer #2: I reviewed a revised version of this paper not being the original reviewer. The paper reads well and to me is clear. Authors seems to have addressed the original reviewer comments which seems to be very minor. In such cases I respect the original review and response and avoid any further comment. However, in this case I would be grateful if authors can add a few lines to the limitations of this paper saying that no direct validation was performed here or somewhere just comment on how confident they are as per validity of the FE results. I understand that the relative comparisons that authors have made remains valuable and perhaps valid. The Authors Attachments Attachment Submitted filename: Response to Reviewers_PLOSone_April2021.docx https://doi.org/10.1371/journal.pone.0252435.r004
17 May 2021 Decision Letter - Jose Manuel Garcia Aznar, Editor Computational Modelling of Hip Resurfacing Arthroplasty Investigating the Effect of Femoral Version on Hip Biomechanics PONE-D-20-34959R2 Dear Dr. Bourget-Murray, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Jose Manuel Garcia Aznar Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: I have no further comment on this paper, a valuable study for the literature on biomechanics of hip resurfacing. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No https://doi.org/10.1371/journal.pone.0252435.r005
Formally Accepted
19 May 2021 Acceptance Letter - Jose Manuel Garcia Aznar, Editor PONE-D-20-34959R2 Computational modelling of hip resurfacing arthroplasty investigating the effect of femoral version on hip biomechanics Dear Dr. Bourget-Murray: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Jose Manuel Garcia Aznar Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0252435.r006

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