101
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Curreli C, Di Puccio F, Davico G, Modenese L, Viceconti M. Using Musculoskeletal Models to Estimate in vivo Total Knee Replacement Kinematics and Loads: Effect of Differences Between Models. Front Bioeng Biotechnol 2021; 9:703508. [PMID: 34395407 PMCID: PMC8357266 DOI: 10.3389/fbioe.2021.703508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/23/2021] [Indexed: 01/29/2023] Open
Abstract
Total knee replacement (TKR) is one of the most performed orthopedic surgeries to treat knee joint diseases in the elderly population. Although the survivorship of knee implants may extend beyond two decades, the poor outcome rate remains considerable. A recent computational approach used to better understand failure modes and improve TKR outcomes is based on the combination of musculoskeletal (MSK) and finite element models. This combined multiscale modeling approach is a promising strategy in the field of computational biomechanics; however, some critical aspects need to be investigated. In particular, the identification and quantification of the uncertainties related to the boundary conditions used as inputs to the finite element model due to a different definition of the MSK model are crucial. Therefore, the aim of this study is to investigate this problem, which is relevant for the model credibility assessment process. Three different generic MSK models available in the OpenSim platform were used to simulate gait, based on the experimental data from the fifth edition of the "Grand Challenge Competitions to Predict in vivo Knee Loads." The outputs of the MSK analyses were compared in terms of relative kinematics of the knee implant components and joint reaction (JR) forces and moments acting on the tibial insert. Additionally, the estimated knee JRs were compared with those measured by the instrumented knee implant so that the "global goodness of fit" was quantified for each model. Our results indicated that the different kinematic definitions of the knee joint and the muscle model implemented in the different MSK models influenced both the motion and the load history of the artificial joint. This study demonstrates the importance of examining the influence of the model assumptions on the output results and represents the first step for future studies that will investigate how the uncertainties in the MSK models propagate on disease-specific finite element model results.
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Affiliation(s)
- Cristina Curreli
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Di Puccio
- Dipartimento di Ingegneria Civile e Industriale, Università di Pisa, Pisa, Italy
| | - Giorgio Davico
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Modenese
- Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom
| | - Marco Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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102
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Accuracy of Measuring Knee Flexion after TKA through Wearable IMU Sensors. J Funct Morphol Kinesiol 2021; 6:jfmk6030060. [PMID: 34287303 PMCID: PMC8293382 DOI: 10.3390/jfmk6030060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
Wearable sensors have the potential to facilitate remote monitoring for patients recovering from knee replacement surgery. Using IMU sensors attached to the patients' leg, knee flexion can be monitored while the patients are recovering in their home environment. Ideally, these flexion angle measurements will have an accuracy and repeatability at least on par with current clinical standards. To validate the clinical accuracy of a two-sensor IMU system, knee flexion angles were measured in eight subjects post-TKA and compared with other in-clinic angle measurement techniques. These sensors are aligned to the patients' anatomy by taking a pose resting their operated leg on a box; an initial goniometer measurement defines the patients' knee flexion while taking that pose. The repeatability and accuracy of the system was subsequently evaluated by comparing knee flexion angles against goniometer readings and markerless optical motion capture data. The alignment pose was repeatable with a mean absolute error of 1.6 degrees. The sensor accuracy through the range of motion had a mean absolute error of 2.6 degrees. In conclusion, the presented sensor system facilitates a repeatable and accurate measurement of the knee flexion, holding the potential for effective remote monitoring of patients recovering from knee replacement surgery.
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103
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Dependency of lower limb joint reaction forces on femoral version. Gait Posture 2021; 88:318-321. [PMID: 34246172 DOI: 10.1016/j.gaitpost.2021.06.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Musculoskeletal (MSK) models based on literature data are meant to represent a generic anatomy and are a popular tool employed by biomechanists to estimate the internal loads occurring in the lower limb joints, such as joint reaction forces (JRFs). However, since these models are normally just linearly scaled to an individual's anthropometry, it is unclear how their estimations would be affected by the personalization of key features of the MSK anatomy, one of which is the femoral version angle. RESEARCH QUESTION How are the lower limb JRF magnitudes computed through a generic MSK model affected by changes in the femoral version? METHODS We developed a bone-deformation tool in MATLAB (shared at https://simtk.org/projects/bone_deformity) and used it to create a set of seven OpenSim models spanning from 2˚ femoral retroversion to 40˚ anteversion. We used these models to simulate the gait of an elderly individual with an instrumented prosthesis implanted at their knee joint (5th Grand Challenge dataset) and quantified both the changes in JRFs magnitude due to varying the skeletal anatomy and their accuracy against the correspondent in vivo measurements at the knee joint. RESULTS Hip and knee JRF magnitudes were affected by the femoral version with variations from the unmodified generic model up to 17.9 ± 4.5% at the hip and 43.4 ± 27.1% at the knee joint. The ankle joint was unaffected by the femoral geometry. The MSK models providing the most accurate knee JRFs (root mean squared error: 0.370 ± 0.068 body weight, coefficient of determination: 0.757 ± 0.104, peak error range: 0.09-0.42 body weight) were those with femoral anteversion angle closer to that measured on the segmented bone of the individual. SIGNIFICANCE Femoral version substantially affects hip and knee JRFs estimated with generic MSK models, suggesting that personalizing key MSK anatomical features might be necessary for accurate estimation of JRFs with these models.
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104
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Abstract
BACKGROUND Nowadays, osteotomy near the knee joint for axial deformities has become an indispensable surgical procedure for joint preservation in the orthopaedic-surgical spectrum. The exact localization and analysis of the deformity are crucial to restoring physiological loading conditions of the entire leg by means of a suitable osteotomy. PROCEDURES Thus, above all, the medial "open-wedge" osteotomy has established itself as a standard procedure for the treatment of gonarthrosis caused by varus malalignment. Furthermore, the varus closed-wedge osteotomy of the distal femur also shows very good long-term results. Basically, osteotomies close to the knee are causal corrections in which biological and mechanical aspects must be taken into account. Thus, the correct indication, attention to risk factors, and surgical technique determine the long-term success of the procedure. The doctrine of femoral valgus deformity and the resulting lateral arthrosis, on the other hand, must be reconsidered according to the latest knowledge.
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105
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Shu L, Sato T, Hua X, Sugita N. Comparison of Kinematics and Contact Mechanics in Normal Knee and Total Knee Replacements: A Computational Investigation. Ann Biomed Eng 2021; 49:2491-2502. [PMID: 34142278 DOI: 10.1007/s10439-021-02812-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
An objective of total knee replacement (TKR) is to restore the mechanical function of a normal knee. Joint kinematics and contact mechanics performance are two of the primary indices that indicate the success of TKR devices. The aim of this study was to compare the kinematics and contact mechanics of TKR and normal knee joints. An experimentally evaluated finite-element (FE) knee model was developed and used to investigate the performance of four TKR designs (fixed cruciate-retaining (CR), mobile CR, posterior-stabilized (PS), medial pivot design (MP)) and the normal knee joint during a gait cycle. The predicted kinematic results showed that the MP design presented similar kinematics to those of the normal knee joint and did not demonstrate paradoxical motion of the femur. A considerably larger contact area and lower contact pressure were found on the normal knee joint (1315 mm2, and 14.8 MPa, respectively) than on the TKRs, which was consistent with the previous in-vivo fluoroscopic investigation. The mobile CR and PS designs exhibited the smallest and greatest contact pressures of the four TKR designs, respectively. The results of the present study help to understand the kinematics and contact mechanics in the TKR during the gait cycle, and provide comprehensive information about the performance of the normal knee joint.
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Affiliation(s)
- Liming Shu
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan.
| | | | - Xijin Hua
- Department of Engineering, Institute for Manufacturing, University of Cambridge, Cambridge, CB2 1PZ, UK
| | - Naohiko Sugita
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
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106
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Viceconti M, Curreli C, Bottin F, Davico G. Effect of Suboptimal Neuromuscular Control on the Risk of Massive Wear in Total Knee Replacement. Ann Biomed Eng 2021; 49:3349-3355. [PMID: 34076785 PMCID: PMC8671275 DOI: 10.1007/s10439-021-02795-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/12/2021] [Indexed: 11/21/2022]
Abstract
The optimal neuromuscular control (muscle activation strategy that minimises the consumption of metabolic energy) during level walking is very close to that which minimises the force transmitted through the joints of the lower limbs. Thus, any suboptimal control involves an overloading of the joints. Some total knee replacement patients adopt suboptimal control strategies during level walking; this is particularly true for patients with co-morbidities that cause neuromotor control degeneration, such as Parkinson’s Disease (PD). The increase of joint loading increases the risk of implant failure, as reported in one study in PD patients (5.44% of failures at 9 years follow-up). One failure mode that is directly affected by joint loading is massive wear of the prosthetic articular surface. In this study we used a validated patient-specific biomechanical model to estimate how a severely suboptimal control could increase the wear rate of total knee replacements. Whereas autopsy-retrieved implants from non-PD patients typically show average polyethylene wear of 17 mm3 per year, our simulations suggested that a severely suboptimal control could cause a wear rate as high as of 69 mm3 per year. Assuming the risk of implant failure due to massive wear increase linearly with the wear rate, a severely suboptimal control could increase the risk associated to that failure mode from 0.1% to 0.5%. Based on these results, such increase would not be not sufficient to justify alone the higher incidence rate of revision in patients affected by Parkinson’s Disease, suggesting that other failure modes may be involved.
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Affiliation(s)
- Marco Viceconti
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna (IT), Bologna, Italy. .,Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna (IT), Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - Cristina Curreli
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna (IT), Bologna, Italy.,Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna (IT), Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Francesca Bottin
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna (IT), Bologna, Italy.,Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna (IT), Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Giorgio Davico
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna (IT), Bologna, Italy.,Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna (IT), Via di Barbiano 1/10, 40136, Bologna, Italy
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107
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Caravaggi P, Assirelli E, Ensini A, Ortolani M, Mariani E, Leardini A, Neri S, Belvedere C. Biomechanical-Based Protocol for in vitro Study of Cartilage Response to Cyclic Loading: A Proof-of-Concept in Knee Osteoarthritis. Front Bioeng Biotechnol 2021; 9:634327. [PMID: 34012954 PMCID: PMC8126668 DOI: 10.3389/fbioe.2021.634327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/08/2021] [Indexed: 12/28/2022] Open
Abstract
Osteoarthritis (OA) is an evolving disease and a major cause of pain and impaired mobility. A deeper understanding of cartilage metabolism in response to loading is critical to achieve greater insight into OA mechanisms. While physiological joint loading helps maintain cartilage integrity, reduced or excessive loading have catabolic effects. The main scope of this study is to present an original methodology potentially capable to elucidate the effect of cyclic joint loading on cartilage metabolism, to identify mechanisms involved in preventing or slowing down OA progression, and to provide preliminary data on its application. In the proposed protocol, the combination of biomechanical data and medical imaging are integrated with molecular information about chondrocyte mechanotransduction and tissue homeostasis. The protocol appears to be flexible and suitable to analyze human OA knee cartilage explants, with different degrees of degeneration, undergoing ex vivo realistic cyclic joint loading estimated via gait analysis in patients simulating mild activities of daily living. The modulation of molecules involved in cartilage homeostasis, mechanotransduction, inflammation, pain and wound healing can be analyzed in chondrocytes and culture supernatants. A thorough analysis performed with the proposed methodology, combining in vivo functional biomechanical evaluations with ex vivo molecular assessments is expected to provide new insights on the beneficial effects of physiological loading and contribute to the design and optimization of non-pharmacological treatments limiting OA progression.
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Affiliation(s)
- Paolo Caravaggi
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisa Assirelli
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- I Orthopaedic and Traumatologic Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erminia Mariani
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Neri
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
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108
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Ku JP, Sim I. Mobile Health: making the leap to research and clinics. NPJ Digit Med 2021; 4:83. [PMID: 33990671 PMCID: PMC8121913 DOI: 10.1038/s41746-021-00454-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/22/2020] [Indexed: 11/09/2022] Open
Abstract
Health applications for mobile and wearable devices continue to experience tremendous growth both in the commercial and research sectors, but their impact on healthcare has yet to be fully realized. This commentary introduces three articles in a special issue that provides guidance on how to successfully address translational barriers to bringing mobile health technologies into clinical research and care. We also discuss how the cross-organizational sharing of data, software, and other digital resources can lower such barriers and accelerate progress across mobile health.
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Affiliation(s)
- Joy P Ku
- Department of Bioengineering, Stanford University, Stanford, CA, USA.
| | - Ida Sim
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
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109
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Zhang Q, Chen Z, Jin Z, Muratoglu OK, Varadarajan KM. Patient-specific musculoskeletal models as a framework for comparing ACL function in unicompartmental versus bicruciate retaining arthroplasty. Proc Inst Mech Eng H 2021; 235:861-872. [PMID: 33913346 DOI: 10.1177/09544119211011827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unicompartmental knee arthroplasty has been shown to provide superior functional outcomes compared to total knee arthroplasty and have motivated development of advanced implant designs including bicruciate retaining knee arthroplasty. However, few validated frameworks are available to directly compare the effect of implant design and surgical techniques on ligament function and joint kinematics. In the present study, the subject-specific lower extremity models were developed based on musculoskeletal modeling framework using force-dependent kinematics method, and validated against in vivo telemetric data. The experiment data of two subjects who underwent TKA were obtained from the SimTK "Grand Challenge Competition" repository, and integrated into the subject-specific lower extremity model. Five walking gait trials and three different knee implant models for each subject were used as partial inputs for the model to predict knee biomechanics for unicompartmental, bicruciate retaining, and total knee arthroplasty. The results showed no significant differences in the tibiofemoral contact forces or angular kinematic parameters between three groups. However, unicompartmental knee arthroplasty demonstrated significantly more posterior tibial location between 0% and 40% of the gait cycle (p < 0.017). Significant differences in range of tibiofemoral anterior/posterior translation and medial/lateral translation were also observed between unicompartmental and bicruciate retaining arthroplasty (p < 0.017). Peak values of anterior cruciate ligament forces differed between unicompartmental and bicruciate retaining arthroplasty from 10% to 30% of the gait cycle. Findings of this study indicate that unicompartmental and bicruciate retaining arthroplasty do not have identical biomechanics and point to the complementary role of anterior cruciate ligament and articular geometry in guiding knee function. Further, the patient-specific musculoskeletal model developed provides a reliable framework for assessing new implant designs, and effect of surgical techniques on knee biomechanics following arthroplasty.
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Affiliation(s)
- Qida Zhang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.,Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang'an University, Xi'an, China
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.,Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China.,Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Orhun K Muratoglu
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kartik M Varadarajan
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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110
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Burton WS, Myers CA, Rullkoetter PJ. Machine learning for rapid estimation of lower extremity muscle and joint loading during activities of daily living. J Biomech 2021; 123:110439. [PMID: 34004394 DOI: 10.1016/j.jbiomech.2021.110439] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 03/25/2021] [Accepted: 04/09/2021] [Indexed: 01/09/2023]
Abstract
Joint contact and muscle forces estimated with musculoskeletal modeling techniques offer useful metrics describing movement quality that benefit multiple research and clinical applications. The expensive processing of laboratory data associated with generating these outputs presents challenges to researchers and clinicians, including significant time and expertise requirements that limit the number of subjects typically evaluated. The objective of the current study was to develop and compare machine learning techniques for rapid, data-driven estimation of musculoskeletal metrics from derived gait lab data. OpenSim estimates of patient joint and muscle forces during activities of daily living were simulated using laboratory data from 70 total knee replacement patients and used to develop 4 different machine learning algorithms. Trained machine learning models predicted both trend and magnitude of estimated joint contact (mean correlation coefficients ranging from 0.93 to 0.94 during gait) and muscle forces (mean correlation coefficients ranging from 0.83 to 0.91 during gait) based on anthropometrics, ground reaction forces, and joint angle data. Patient mechanics were accurately predicted by recurrent neural networks, even after removing dependence on key subsets of predictor features. The ability to quickly estimate patient mechanics from derived measurements of movement has the potential to broaden the impact of musculoskeletal modeling by enabling faster assessment in both clinical and research settings.
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Affiliation(s)
- William S Burton
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
| | - Casey A Myers
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
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111
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Loi I, Stanev D, Moustakas K. Total Knee Replacement: Subject-Specific Modeling, Finite Element Analysis, and Evaluation of Dynamic Activities. Front Bioeng Biotechnol 2021; 9:648356. [PMID: 33937216 PMCID: PMC8085535 DOI: 10.3389/fbioe.2021.648356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
This study presents a semi-automatic framework to create subject-specific total knee replacement finite element models, which can be used to analyze locomotion patterns and evaluate knee dynamics. In recent years, much scientific attention was attracted to pre-clinical optimization of customized total knee replacement operations through computational modeling to minimize post-operational adverse effects. However, the time-consuming and laborious process of developing a subject-specific finite element model poses an obstacle to the latter. One of this work's main goals is to automate the finite element model development process, which speeds up the proposed framework and makes it viable for practical applications. This pipeline's reliability was ratified by developing and validating a subject-specific total knee replacement model based on the 6th SimTK Grand Challenge data set. The model was validated by analyzing contact pressures on the tibial insert in relation to the patient's gait and analysis of tibial contact forces, which were found to be in accordance with the ones provided by the Grand Challenge data set. Subsequently, a sensitivity analysis was carried out to assess the influence of modeling choices on tibial insert's contact pressures and determine possible uncertainties on the models produced by the framework. Parameters, such as the position of ligament origin points, ligament stiffness, reference strain, and implant-bone alignment were used for the sensitivity study. Notably, it was found that changes in the alignment of the femoral component in reference to the knee bones significantly affect the load distribution at the tibiofemoral joint, with an increase of 206.48% to be observed at contact pressures during 5° internal rotation. Overall, the models produced by this pipeline can be further used to optimize and personalize surgery by evaluating the best surgical parameters in a simulated manner before the actual surgery.
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Affiliation(s)
- Iliana Loi
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Dimitar Stanev
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece.,School of Engineering, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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112
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Ding Z, Jarvis HL, Bennett AN, Baker R, Bull AMJ. Higher knee contact forces might underlie increased osteoarthritis rates in high functioning amputees: A pilot study. J Orthop Res 2021; 39:850-860. [PMID: 32427347 DOI: 10.1002/jor.24751] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 02/04/2023]
Abstract
High functioning military transtibial amputees (TTAs) with well-fitted state of the art prosthetics have gait that is indistinguishable from healthy individuals, yet they are more likely to develop knee osteoarthritis (OA) of their intact limbs. This contrasts with the information at the knees of the amputated limbs that have been shown to be at a significantly reduced risk of pain and OA. The hypothesis of this study is that biomechanics can explain the difference in knee OA risk. Eleven military unilateral TTAs and eleven matched healthy controls underwent gait analysis. Muscle forces and joint contact forces at the knee were quantified using musculoskeletal modeling, validated using electromyography measurements. Peak knee contact forces for the intact limbs on both the medial and lateral compartments were significantly greater than the healthy controls (P ≤ .006). Additionally, the intact limbs had greater peak semimembranosus (P = .001) and gastrocnemius (P ≤ .001) muscle forces compared to the controls. This study has for the first time provided robust evidence of increased force on the non-affected knees of high functioning TTAs that supports the mechanically based hypothesis to explain the documented higher risk of knee OA in this patient group. The results suggest several protentional strategies to mitigate knee OA of the intact limbs, which may include the improvements of the prosthetic foot control, socket design, and strengthening of the amputated muscles.
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Affiliation(s)
- Ziyun Ding
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Hannah L Jarvis
- Faculty of Science and Engineering, School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, Epsom, United Kingdom.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Richard Baker
- School of Health Sciences, University of Salford, Salford, United Kingdom
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London, United Kingdom
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113
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Li Y, Sang J, Wei X, Yu W, Tian W, Liu GR. Inverse identification of hyperelastic constitutive parameters of skeletal muscles via optimization of AI techniques. Comput Methods Biomech Biomed Engin 2021; 24:1647-1659. [PMID: 33787398 DOI: 10.1080/10255842.2021.1906235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Studies on the deformation characteristics and stress distribution in loaded skeletal muscles are of increasing importance. Reliable prediction of hyperelastic material parameters requires an inverse process, which possesses challenges. This work proposes two inverse procedures to identify the hyperelastic material parameters of skeletal muscles. The first one integrates nonlinear finite element method (FEM), random forest (RF) model, and Bayesian optimization (BO) algorithm. The other one integrates FEM, RF and hybrid Grid Search (GS), and Random Search (RS) algorithm. FEM models are first established to simulate nonlinear deformation of skeletal muscles subject to compression based on nonlinear mechanics principals. A dataset of nonlinear relationship between the nominal stress and principal stretch of skeletal muscles is created using our FEM models and the nonlinear relationship is learned through RF model. The BO, hybrid GS and RS algorithms are used to adjust the major model parameters in RF. Then the optimized RF is utilized to predict hyperelastic material parameters of skeletal muscles, with the help of uniaxial compression experiments. Intensive studies also have been carried out to compare the RF-BO approach with RF-Search approach, and the comparison results show that RF-BO approach is an effective and accurate approach to identify the hyperelastic material parameters of skeletal muscles. The present RF-BO model can be further extended for the predictions of constitutive parameters of other types of nonlinear soft materials.
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Affiliation(s)
- Yang Li
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, P.R. China
| | - Jianbing Sang
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, P.R. China
| | - Xinyu Wei
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, P.R. China
| | - Wenying Yu
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, P.R. China
| | - Weichang Tian
- School of Mechanical Engineering, Hebei University of Technology, Tianjin, P.R. China
| | - G R Liu
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, Ohio, USA
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Biomechanical Consequences of Tibial Insert Thickness after Total Knee Arthroplasty: A Musculoskeletal Simulation Study. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The thickness of the tibial polyethylene (PE) insert is a critical parameter to ensure optimal soft-tissue balancing in the intraoperative decision-making procedure of total knee arthroplasty (TKA). However, there is a paucity of information about the kinetic response to PE insert thickness variations in the tibiofemoral (TF) joint, and subsequently, the secondary effects on the patellofemoral (PF) biomechanics. Therefore, the purpose of this study was to investigate the influence of varying PE insert thickness on the ligament and TF compressive forces, as well as on the PF forces and kinematics, after a cruciate-retaining TKA. A previous patient-specific musculoskeletal model of TKA was adapted to simulate a chair-rising motion in which PE insert thickness was varied with 2 mm increments or decrements compared to the reference case (9 mm), from 5 mm up to 13 mm. Greater PE insert thickness resulted in higher ligament forces and concurrently increased the TF compressive force by 21% (13 mm), but slightly unloaded the PF joint with 7% (13 mm) while shifting the patella distally in the trochlear groove, compared to the reference case. Thinner PE inserts showed an opposite trend. Our findings suggest that the optimal PE insert thickness selection is a trade-off between the kinetic outcomes of the TF and PF joints.
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Shu L, Yao J, Yamamoto K, Sato T, Sugita N. In vivo kinematical validated knee model for preclinical testing of total knee replacement. Comput Biol Med 2021; 132:104311. [PMID: 33721735 DOI: 10.1016/j.compbiomed.2021.104311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE A computational knee model facilitates efficient component design evaluations and preclinical testing under various dynamic loadings. However, the development of a highly mimicked dynamic whole knee model with specified ligament constraints that provides high predictive accuracy with in-vivo experiments remains a challenge. METHODS In the present study, a musculoskeletal integrated force-driven explicit finite-element knee model with tibiofemoral and patellofemoral joints constrained with detailed soft tissue was developed. A proportional-integral-derivative controller was concurrently added to the knee model to track the boundary conditions. The actuations of the quadriceps and hamstrings were predicted via a subject-specific musculoskeletal model and matched with electromyography results. RESULTS Compared to in-vivo fluoroscopic results in a gait cycle, the predicted results of the kinematics of the tibiofemoral joint exhibited an agreement in terms of tendency and magnitude (anterior-posterior translation: RMSE = 1.1 mm, r2 = 0.87; inferior-superior translation: RMSE = 0.83 mm, r2 = 0.84; medial-lateral translation: RMSE = 0.82 mm, r2 = 0.05; flexion-extension rotation: RMSE = 0.23°, r2 = 1; internal-external rotation: RMSE = 1.85°, r2 = 0.65; varus-valgus rotation: RMSE = 1.39°, r2 = 0.08). Contact mechanics, including the contact area, pressure, and stress, were synchronously simulated on the tibiofemoral and patellofemoral joints. CONCLUSIONS The study provides a calibrated knee model and a kinematical validation approach that can be widely used in preclinical testing and knee prosthesis design.
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Affiliation(s)
- Liming Shu
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan.
| | - Jiang Yao
- Dassault Systemes Simulia Corp, Johnston, RI, USA
| | - Ko Yamamoto
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | | | - Naohiko Sugita
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
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Review of musculoskeletal modelling in a clinical setting: Current use in rehabilitation design, surgical decision making and healthcare interventions. Clin Biomech (Bristol, Avon) 2021; 83:105292. [PMID: 33588135 DOI: 10.1016/j.clinbiomech.2021.105292] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Musculoskeletal modelling is a common means by which to non-invasively analyse movement. Such models have largely been used to observe function in both healthy and patient populations. However, utility in a clinical environment is largely unknown. The aim of this review was to explore existing uses of musculoskeletal models as a clinical intervention, or decision-making, tool. METHODS A literature search was performed using PubMed and Scopus to find articles published since 2010 and relating to musculoskeletal modelling and joint and muscle forces. FINDINGS 4662 abstracts were found, of which 39 relevant articles were reviewed. Journal articles were categorised into 5 distinct groups: non-surgical treatment, orthoses assessment, surgical decision making, surgical intervention assessment and rehabilitation regime assessment. All reviewed articles were authored by collaborations between clinicians and engineers/modellers. Current uses included insight into the development of osteoarthritis, identifying candidates for hamstring lengthening surgery, and the assessment of exercise programmes to reduce joint damage. INTERPRETATION There is little evidence showing the use of musculoskeletal modelling as a tool for patient care, despite the ability to assess long-term joint loading and muscle overuse during functional activities, as well as clinical decision making to avoid unfavourable treatment outcomes. Continued collaboration between model developers should aim to create clinically-friendly models which can be used with minimal input and experience by healthcare professionals to determine surgical necessity and suitability for rehabilitation regimes, and in the assessment of orthotic devices.
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117
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A Conceptual Blueprint for Making Neuromusculoskeletal Models Clinically Useful. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The ultimate goal of most neuromusculoskeletal modeling research is to improve the treatment of movement impairments. However, even though neuromusculoskeletal models have become more realistic anatomically, physiologically, and neurologically over the past 25 years, they have yet to make a positive impact on the design of clinical treatments for movement impairments. Such impairments are caused by common conditions such as stroke, osteoarthritis, Parkinson’s disease, spinal cord injury, cerebral palsy, limb amputation, and even cancer. The lack of clinical impact is somewhat surprising given that comparable computational technology has transformed the design of airplanes, automobiles, and other commercial products over the same time period. This paper provides the author’s personal perspective for how neuromusculoskeletal models can become clinically useful. First, the paper motivates the potential value of neuromusculoskeletal models for clinical treatment design. Next, it highlights five challenges to achieving clinical utility and provides suggestions for how to overcome them. After that, it describes clinical, technical, collaboration, and practical needs that must be addressed for neuromusculoskeletal models to fulfill their clinical potential, along with recommendations for meeting them. Finally, it discusses how more complex modeling and experimental methods could enhance neuromusculoskeletal model fidelity, personalization, and utilization. The author hopes that these ideas will provide a conceptual blueprint that will help the neuromusculoskeletal modeling research community work toward clinical utility.
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118
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Askari E, Andersen MS. Effect of Ligament Properties on Nonlinear Dynamics and Wear Prediction of Knee Prostheses. J Biomech Eng 2021; 143:021014. [PMID: 33030212 DOI: 10.1115/1.4048707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Indexed: 11/08/2022]
Abstract
Although wear is known as the primary cause of long-time failure of total knee arthroplasty (TKA), it can be vital in short- and midterm TKA failure due to laxity. One of the reasons leading to joint laxity and instability is ligamentous insufficiency. This study, therefore, aims to investigate the effects of insufficient ligaments-related knee laxity on both nonlinear dynamics and wear of TKA. The study hypothesizes (a) ligamentous insufficiency can increase TKA damage; (b) stiffness reduction of each of the posterior cruciate ligament (PCL) and medial-lateral collateral ligaments (MCL-LCL) can differently contribute to TKA damage. A forward dynamics methodology is developed and the ligament behavior is simulated employing an asymmetric nonlinear elastic model. External loads and moment, due to the presence of all soft tissues, e.g., muscles and hip joint reaction forces, applied to the femoral bone are determined using a musculoskeletal approach linked to the developed model. A mesh density analysis is performed and comparing outcomes with that available in the literature allows for the assessment of our approach. From the results acquired, reduced PCL stiffness leads to an increase in linear wear rates and results in the maximum damage in TKAs. However, the maximum linear wear rates on both condyles occur once the stiffness of all ligaments is reduced. Moreover, the worn area of the tibia surface increases with the reduction in MCL-LCL stiffness on the medial condyle. The joint with insufficient PCL also shows a considerable increase in ligament forces right after toe-off.
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Affiliation(s)
- Ehsan Askari
- Department of Electromechanical, Systems and Metal Engineering, Ghent University, Zwijnaarde B-9052, Belgium
| | - Michael S Andersen
- Department of Materials and Production, Aalborg University, Aalborg 9220, Denmark
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119
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Bennett HJ, Valenzuela KA, Lynn SK, Weinhandl JT. Foot Rotation Gait Modifications Affect Hip and Ankle, But Not Knee, Stance Phase Joint Reaction Forces During Running. J Biomech Eng 2021; 143:021001. [PMID: 32734282 DOI: 10.1115/1.4047994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Indexed: 07/25/2024]
Abstract
Alterations of foot rotation angles have successfully reduced external knee adduction moments during walking and running. However, reductions in knee adduction moments may not result in reductions in knee joint reaction forces. The purpose of this study was to examine the effects of internal and external foot rotation on knee, hip, and ankle joint reaction forces during running. Motion capture and force data were recorded of 19 healthy adults running at 3.35 m/s during three conditions: (1) preferred (normal) and with (2) internal and (3) external foot rotation. Musculoskeletal simulations were performed using opensim and the Rajagopal 2015 model, modified to a two degree-of-freedom knee joint. Muscle excitations were derived using static optimization, including muscle physiology parameters. Joint reaction forces (i.e., the total force acting on the joints) were computed and compared between conditions using one-way analyses of variance (ANOVAs) via statistical parametric mapping (SPM). Internal foot rotation reduced resultant hip forces (from 18% to 23% stride), while external rotation reduced resultant ankle forces (peak force at 20% stride) during the stance phase. Three-dimensional and resultant knee joint reaction forces only differed at very early and very late stance phase. The results of this study indicate, similar to previous findings, that reductions in external knee adduction moments do not mirror reductions in knee joint reaction forces.
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Affiliation(s)
- Hunter J Bennett
- Department of Human Movement Sciences, 2016 Student Recreation Center, Old Dominion University, Norfolk, VA 23529
| | - Kevin A Valenzuela
- Department of Kinesiology, HHS2-203, California State University, Long Beach, CA 90840
| | - Scott K Lynn
- Department of Kinesiology, KHS 224, California State University, Fullerton, CA 92834
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, 322 HPER Building, Knoxville, TN 37996-2700
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120
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McGibbon CA, Brandon S, Bishop EL, Cowper-Smith C, Biden EN. Biomechanical Study of a Tricompartmental Unloader Brace for Patellofemoral or Multicompartment Knee Osteoarthritis. Front Bioeng Biotechnol 2021; 8:604860. [PMID: 33585409 PMCID: PMC7876241 DOI: 10.3389/fbioe.2020.604860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Off-loader knee braces have traditionally focused on redistributing loads away from either the medial or lateral tibiofemoral (TF) compartments. In this article, we study the potential of a novel "tricompartment unloader" (TCU) knee brace intended to simultaneously unload both the patellofemoral (PF) and TF joints during knee flexion. Three different models of the TCU brace are evaluated for their potential to unload the knee joint. Methods: A sagittal plane model of the knee was used to compute PF and TF contact forces, patellar and quadriceps tendon forces, and forces in the anterior and posterior cruciate ligaments during a deep knee bend (DKB) test using motion analysis data from eight participants. Forces were computed for the observed (no brace) and simulated braced conditions. A sensitivity and validity analysis was conducted to determine the valid output range for the model, and Statistical Parameter Mapping was used to quantify the effectual region of the different TCU brace models. Results: PF and TF joint force calculations were valid between ~0 and 100 degrees of flexion. All three simulated brace models significantly (p < 0.001) reduced predicted knee joint loads (by 30-50%) across all structures, at knee flexion angles >~30 degrees during DKB. Conclusions: The TCU brace is predicted to reduce PF and TF knee joint contact loads during weight-bearing activity requiring knee flexion angles between 30 and 100 degrees; this effect may be clinically beneficial for pain reduction or rehabilitation from common knee injuries or joint disorders. Future work is needed to assess the range of possible clinical and prophylactic benefits of the TCU brace.
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Affiliation(s)
- Chris A McGibbon
- Faculty of Kinesiology and Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
| | - Scott Brandon
- School of Engineering, University of Guelph, Guelph, ON, Canada
| | - Emily L Bishop
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB, Canada
| | | | - Edmund N Biden
- Department of Mechanical Engineering and Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
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121
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Michaud F, Lamas M, Lugrís U, Cuadrado J. A fair and EMG-validated comparison of recruitment criteria, musculotendon models and muscle coordination strategies, for the inverse-dynamics based optimization of muscle forces during gait. J Neuroeng Rehabil 2021; 18:17. [PMID: 33509205 PMCID: PMC7841909 DOI: 10.1186/s12984-021-00806-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/11/2021] [Indexed: 11/15/2022] Open
Abstract
Experimental studies and EMG collections suggest that a specific strategy of muscle coordination is chosen by the central nervous system to perform a given motor task. A popular mathematical approach for solving the muscle recruitment problem is optimization. Optimization-based methods minimize or maximize some criterion (objective function or cost function) which reflects the mechanism used by the central nervous system to recruit muscles for the movement considered. The proper cost function is not known a priori, so the adequacy of the chosen function must be validated according to the obtained results. In addition of the many criteria proposed, several physiological representations of the musculotendon actuator dynamics (that prescribe constraints for the forces) along with different musculoskeletal models can be found in the literature, which hinders the selection of the best neuromusculotendon model for each application. Seeking to provide a fair base for comparison, this study measures the efficiency and accuracy of: (i) four different criteria within the static optimization approach (where the physiological character of the muscle, which affects the constraints of the forces, is not considered); (ii) three physiological representations of the musculotendon actuator dynamics: activation dynamics with elastic tendon, simplified activation dynamics with rigid tendon and rigid tendon without activation dynamics; (iii) a synergy-based method; all of them within the framework of inverse-dynamics based optimization. Motion/force/EMG gait analyses were performed on ten healthy subjects. A musculoskeletal model of the right leg actuated by 43 Hill-type muscles was scaled to each subject and used to calculate joint moments, musculotendon kinematics and moment arms. Muscle activations were then estimated using the different approaches, and these estimates were compared with EMG measurements. Although no significant differences were obtained with all the methods at statistical level, it must be pointed out that a higher complexity of the method does not guarantee better results, as the best correlations with experimental values were obtained with two simplified approaches: the static optimization and the physiological approach with simplified activation dynamics and rigid tendon, both using the sum of the squares of muscle forces as objective function.
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Affiliation(s)
- Florian Michaud
- Laboratory of Mechanical Engineering, University of La Coruña, Ferrol, Spain.
| | - Mario Lamas
- Laboratory of Mechanical Engineering, University of La Coruña, Ferrol, Spain
| | - Urbano Lugrís
- Laboratory of Mechanical Engineering, University of La Coruña, Ferrol, Spain
| | - Javier Cuadrado
- Laboratory of Mechanical Engineering, University of La Coruña, Ferrol, Spain
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122
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Ao D, Shourijeh MS, Patten C, Fregly BJ. Evaluation of Synergy Extrapolation for Predicting Unmeasured Muscle Excitations from Measured Muscle Synergies. Front Comput Neurosci 2020; 14:588943. [PMID: 33343322 PMCID: PMC7746870 DOI: 10.3389/fncom.2020.588943] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/09/2020] [Indexed: 12/14/2022] Open
Abstract
Electromyography (EMG)-driven musculoskeletal modeling relies on high-quality measurements of muscle electrical activity to estimate muscle forces. However, a critical challenge for practical deployment of this approach is missing EMG data from muscles that contribute substantially to joint moments. This situation may arise due to either the inability to measure deep muscles with surface electrodes or the lack of a sufficient number of EMG channels. Muscle synergy analysis (MSA) is a dimensionality reduction approach that decomposes a large number of muscle excitations into a small number of time-varying synergy excitations along with time-invariant synergy weights that define the contribution of each synergy excitation to all muscle excitations. This study evaluates how well missing muscle excitations can be predicted using synergy excitations extracted from muscles with available EMG data (henceforth called "synergy extrapolation" or SynX). The method was evaluated using a gait data set collected from a stroke survivor walking on an instrumented treadmill at self-selected and fastest-comfortable speeds. The evaluation process started with full calibration of a lower-body EMG-driven model using 16 measured EMG channels (collected using surface and fine wire electrodes) per leg. One fine wire EMG channel (either iliopsoas or adductor longus) was then treated as unmeasured. The synergy weights associated with the unmeasured muscle excitation were predicted by solving a nonlinear optimization problem where the errors between inverse dynamics and EMG-driven joint moments were minimized. The prediction process was performed for different synergy analysis algorithms (principal component analysis and non-negative matrix factorization), EMG normalization methods, and numbers of synergies. SynX performance was most influenced by the choice of synergy analysis algorithm and number of synergies. Principal component analysis with five or six synergies consistently predicted unmeasured muscle excitations the most accurately and with the greatest robustness to EMG normalization method. Furthermore, the associated joint moment matching accuracy was comparable to that produced by initial EMG-driven model calibration using all 16 EMG channels per leg. SynX may facilitate the assessment of human neuromuscular control and biomechanics when important EMG signals are missing.
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Affiliation(s)
- Di Ao
- Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States
| | - Mohammad S. Shourijeh
- Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States
| | - Carolynn Patten
- Biomechanics, Rehabilitation, and Integrative Neuroscience (BRaIN) Lab, VA Northern California Health Care System, Martinez, CA, United States
- Department of Physical Medicine and Rehabilitation, Davis School of Medicine, University of California, Sacramento, CA, United States
| | - Benjamin J. Fregly
- Rice Computational Neuromechanics Lab, Department of Mechanical Engineering, Rice University, Houston, TX, United States
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123
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Giarmatzis G, Zacharaki EI, Moustakas K. Real-Time Prediction of Joint Forces by Motion Capture and Machine Learning. SENSORS (BASEL, SWITZERLAND) 2020; 20:E6933. [PMID: 33291594 PMCID: PMC7730598 DOI: 10.3390/s20236933] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023]
Abstract
Conventional biomechanical modelling approaches involve the solution of large systems of equations that encode the complex mathematical representation of human motion and skeletal structure. To improve stability and computational speed, being a common bottleneck in current approaches, we apply machine learning to train surrogate models and to predict in near real-time, previously calculated medial and lateral knee contact forces (KCFs) of 54 young and elderly participants during treadmill walking in a speed range of 3 to 7 km/h. Predictions are obtained by fusing optical motion capture and musculoskeletal modeling-derived kinematic and force variables, into regression models using artificial neural networks (ANNs) and support vector regression (SVR). Training schemes included either data from all subjects (LeaveTrialsOut) or only from a portion of them (LeaveSubjectsOut), in combination with inclusion of ground reaction forces (GRFs) in the dataset or not. Results identify ANNs as the best-performing predictor of KCFs, both in terms of Pearson R (0.89-0.98 for LeaveTrialsOut and 0.45-0.85 for LeaveSubjectsOut) and percentage normalized root mean square error (0.67-2.35 for LeaveTrialsOut and 1.6-5.39 for LeaveSubjectsOut). When GRFs were omitted from the dataset, no substantial decrease in prediction power of both models was observed. Our findings showcase the strength of ANNs to predict simultaneously multi-component KCF during walking at different speeds-even in the absence of GRFs-particularly applicable in real-time applications that make use of knee loading conditions to guide and treat patients.
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Affiliation(s)
- Georgios Giarmatzis
- VVR Group, Department of Electrical and Computer Engineering, University of Patras, 26504 Patras, Greece; (E.I.Z.); (K.M.)
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Accuracy of the tibiofemoral contact forces estimated by a subject-specific musculoskeletal model with fluoroscopy-based contact point trajectories. J Biomech 2020; 113:110117. [PMID: 33197692 DOI: 10.1016/j.jbiomech.2020.110117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
Abstract
Accurate estimation of the tibiofemoral contact forces relies on exact kinematics and joint geometry. Subject-specific kinematic constraints representing contact point trajectories derived from fluoroscopic measurements during lunge are introduced in a musculoskeletal model of the lower limb and compared to generic kinematic constraints. The medial, lateral, and total contact forces during gait and squat are validated using the data of four patients with an instrumented prosthesis. The accuracy of the estimated contact forces (both with subject-specific and generic kinematic constraints) remains close to the level reported in the literature. The mean root mean square errors range from 0.32 to 0.52 body weights for gait and from 0.27 to 0.72 body weights for squat. The impact of the subject-specific contact point trajectories is not found substantial or consistent between patients and tasks. Indeed, the kinematics of the total knee prostheses remains close to the kinematics of a hinge joint and the contact point locations remain generally centred at 20 mm from the tibia centreline (close to the constant value defined in the generic constraints). The contact point trajectories are also suspected to differ between tasks (lunge vs. gait and squat). While the contact point trajectories have been reported to be sensitive model parameters, no clear improvement of the contact force accuracy is demonstrated on patients with instrumented prosthesis. The introduction (as kinematic constraints) of fluoroscopy-based contact point trajectories may be considered in cases where these trajectories are significantly altered, as reported for osteoarthritis patients.
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125
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Conconi M, Pompili A, Sancisi N, Parenti-Castelli V. Quantification of the errors associated with marker occlusion in stereophotogrammetric systems and implications on gait analysis. J Biomech 2020; 114:110162. [PMID: 33310277 DOI: 10.1016/j.jbiomech.2020.110162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/30/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022]
Abstract
Optoelectronic stereophotogrammetric systems (OSSs) represent the standard for gait analysis. Despite widespread, their reported accuracy in nominal working conditions shows a variability of several orders of magnitude, ranging from few microns to several millimetres. No clear explanation for this variability has been provided yet. We hypothesized that this reflects an error affecting OSS outcomes when some of the tracked markers are totally or partially occluded. The aim of this paper is to quantify this error in static and dynamic conditions, also distinguishing between total and partial marker occlusion. A Vicon system featuring 8 cameras is employed in this study. Two camera distributions, one designed to maximize OSS accuracy and another one representative of a typical gait setup, are investigated. For both the setups, static and dynamic tests are performed, evaluating the different impact of partial and total marker occlusions. Marker occlusions significantly affected the system performances. The maximum measure variation reached 1.86 mm and 7.20 mm in static and dynamic conditions, respectively, both obtained in the case of partial occlusion. This systematic source of error is likely to affect gait measures: markers placed on the patient body are often visible only by half of the cameras, with swinging arms and legs providing moving occlusions. The maximum error observed in this study can potentially affect the kinematics outcomes of conventional gait models, particularly on frontal and coronal plane, and consequently the peak muscle forces estimated with musculoskeletal models.
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Affiliation(s)
- Michele Conconi
- Dept. Of Industrial Engineering - DIN, University of Bologna, Italy.
| | | | - Nicola Sancisi
- Dept. Of Industrial Engineering - DIN, University of Bologna, Italy
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126
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Kingston DC, Acker SM. Development of a Full Flexion 3D Musculoskeletal Model of the Knee Considering Intersegmental Contact During High Knee Flexion Movements. J Appl Biomech 2020; 36:444-456. [PMID: 32846408 DOI: 10.1123/jab.2019-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/12/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
A musculoskeletal model of the right lower limb was developed to estimate 3D tibial contact forces in high knee flexion postures. This model determined the effect of intersegmental contact between thigh-calf and heel-gluteal structures on tibial contact forces. This model includes direct tracking and 3D orientation of intersegmental contact force, femoral translations from in vivo studies, wrapping of knee extensor musculature, and a novel optimization constraint for multielement muscle groups. Model verification consisted of calculating the error between estimated tibial compressive forces and direct measurements from the Grand Knee Challenge during movements to ∼120° of knee flexion as no high knee flexion data are available. Tibial compression estimates strongly fit implant data during walking (R2 = .83) and squatting (R2 = .93) with a root mean squared difference of .47 and .16 body weight, respectively. Incorporating intersegmental contact significantly reduced model estimates of peak tibial anterior-posterior shear and increased peak medial-lateral shear during the static phase of high knee flexion movements by an average of .33 and .07 body weight, respectively. This model supports prior work in that intersegmental contact is a critical parameter when estimating tibial contact forces in high knee flexion movements across a range of culturally and occupationally relevant postures.
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Dembia CL, Bianco NA, Falisse A, Hicks JL, Delp SL. OpenSim Moco: Musculoskeletal optimal control. PLoS Comput Biol 2020; 16:e1008493. [PMID: 33370252 PMCID: PMC7793308 DOI: 10.1371/journal.pcbi.1008493] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/08/2021] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
Musculoskeletal simulations are used in many different applications, ranging from the design of wearable robots that interact with humans to the analysis of patients with impaired movement. Here, we introduce OpenSim Moco, a software toolkit for optimizing the motion and control of musculoskeletal models built in the OpenSim modeling and simulation package. OpenSim Moco uses the direct collocation method, which is often faster and can handle more diverse problems than other methods for musculoskeletal simulation. Moco frees researchers from implementing direct collocation themselves-which typically requires extensive technical expertise-and allows them to focus on their scientific questions. The software can handle a wide range of problems that interest biomechanists, including motion tracking, motion prediction, parameter optimization, model fitting, electromyography-driven simulation, and device design. Moco is the first musculoskeletal direct collocation tool to handle kinematic constraints, which enable modeling of kinematic loops (e.g., cycling models) and complex anatomy (e.g., patellar motion). To show the abilities of Moco, we first solved for muscle activity that produced an observed walking motion while minimizing squared muscle excitations and knee joint loading. Next, we predicted how muscle weakness may cause deviations from a normal walking motion. Lastly, we predicted a squat-to-stand motion and optimized the stiffness of an assistive device placed at the knee. We designed Moco to be easy to use, customizable, and extensible, thereby accelerating the use of simulations to understand the movement of humans and other animals.
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Affiliation(s)
- Christopher L. Dembia
- Department of Mechanical Engineering, Stanford University, Stanford, California, United States of America
| | - Nicholas A. Bianco
- Department of Mechanical Engineering, Stanford University, Stanford, California, United States of America
| | - Antoine Falisse
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Jennifer L. Hicks
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
| | - Scott L. Delp
- Department of Mechanical Engineering, Stanford University, Stanford, California, United States of America
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, United States of America
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128
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Ménard M, Lacouture P, Domalain M. ILIOTIBIAL BAND SYNDROME IN CYCLING: A COMBINED EXPERIMENTAL-SIMULATION APPROACH FOR ASSESSING THE EFFECT OF SADDLE SETBACK. Int J Sports Phys Ther 2020; 15:958-966. [PMID: 33344012 PMCID: PMC7727429 DOI: 10.26603/ijspt20200958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Despite abundant literature, the treatment of iliotibial band syndrome (ITBS) in cyclists remains complicated as it lacks evidence-based recommendations. PURPOSE The aim of this study was to develop a musculoskeletal modelling approach that investigates three potential biomechanical determinants of ITBS (strain, strain rate and compression force) and to use this approach to investigate the effect of saddle setback. DESIGN Cross-sectional. METHODS An existing 3D lower-body musculoskeletal model was adapted to cycling and to the computation of three putative pathomechanisms responsible for ITBS: ITB strain, ITB strain rate, and compression force between ITB and the lateral femoral epicondyle (LFE). Lower limb kinematics recorded from ten well-trained healthy cyclists served as input data of the model. Cyclists pedalled at a steady state (90rpm and 200W) on an ergometer, and three different saddle setback conditions were tested. The theoretical combined influence of hip and knee joint angles on ITBS was investigated and analysed through the lens of individual pedalling technique. RESULTS ITB-LFE compression force was the only parameter significantly affected by saddle setback and supports the hypothesis that compression force is likely to be a determinant factor in ITBS etiology. Furthermore, results showed that ITB-LFE compression force increases in individuals whose pedalling technique exacerbates hip extension-adduction and/or knee extension-internal rotation. CONCLUSION This approach has the potential to be advantageously implemented as an additional tool to help diagnose/correct potentially harmful sport techniques and optimize equipment setup/design. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
| | - Patrick Lacouture
- Institut PPrime, CNRS - Université de Poitiers - ENSMA, UPR 3346, 11 bd Marie et Pierre Curie, BP 30179 - 86962 Futuroscope, France
| | - Mathieu Domalain
- Institut PPrime, CNRS - Université de Poitiers - ENSMA, UPR 3346, 11 bd Marie et Pierre Curie, BP 30179 - 86962 Futuroscope, France
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129
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Load Distribution at the Patellofemoral Joint During Walking. Ann Biomed Eng 2020; 48:2821-2835. [DOI: 10.1007/s10439-020-02672-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
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130
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Esrafilian A, Stenroth L, Mononen ME, Tanska P, Van Rossom S, Lloyd DG, Jonkers I, Korhonen RK. 12 Degrees of Freedom Muscle Force Driven Fibril-Reinforced Poroviscoelastic Finite Element Model of the Knee Joint. IEEE Trans Neural Syst Rehabil Eng 2020; 29:123-133. [PMID: 33175682 DOI: 10.1109/tnsre.2020.3037411] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Accurate knowledge of the joint kinematics, kinetics, and soft tissue mechanical responses is essential in the evaluation of musculoskeletal (MS) disorders. Since in vivo measurement of these quantities requires invasive methods, musculoskeletal finite element (MSFE) models are widely used for simulations. There are, however, limitations in the current approaches. Sequentially linked MSFE models benefit from complex MS and FE models; however, MS model's outputs are independent of the FE model calculations. On the other hand, due to the computational burden, embedded (concurrent) MSFE models are limited to simple material models and cannot estimate detailed responses of the soft tissue. Thus, first we developed a MSFE model of the knee with a subject-specific MS model utilizing an embedded 12 degrees of freedom (DoFs) knee joint with elastic cartilages in which included both secondary kinematic and soft tissue deformations in the muscle force estimation (inverse dynamics). Then, a muscle-force-driven FE model with fibril-reinforced poroviscoelastic cartilages and fibril-reinforced poroelastic menisci was used in series to calculate detailed tissue mechanical responses (forward dynamics). Second, to demonstrate that our workflow improves the simulation results, outputs were compared to results from the same FE models which were driven by conventional MS models with a 1 DoF knee, with and without electromyography (EMG) assistance. The FE model driven by both the embedded and the EMG-assisted MS models estimated similar results and consistent with experiments from literature, compared to the results estimated by the FE model driven by the MS model with 1 DoF knee without EMG assistance.
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131
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Dumas R, Moissenet F, Cheze L. Fluoroscopy-based subject-specific knee joint constraints for the estimation of prosthesis kinematics and contact velocities during gait. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1812170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- R. Dumas
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon, France
| | - F. Moissenet
- Kinesiology Laboratory, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - L. Cheze
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, Lyon, France
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132
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Norman-Gerum V, McPhee J. Comprehensive description of sit-to-stand motions using force and angle data. J Biomech 2020; 112:110046. [DOI: 10.1016/j.jbiomech.2020.110046] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 08/11/2020] [Accepted: 09/07/2020] [Indexed: 01/09/2023]
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133
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Serrancolí G, Kinney AL, Fregly BJ. Influence of musculoskeletal model parameter values on prediction of accurate knee contact forces during walking. Med Eng Phys 2020; 85:35-47. [DOI: 10.1016/j.medengphy.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/29/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
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134
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In Silico-Enhanced Treatment and Rehabilitation Planning for Patients with Musculoskeletal Disorders: Can Musculoskeletal Modelling and Dynamic Simulations Really Impact Current Clinical Practice? APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10207255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past decades, the use of computational physics-based models representative of the musculoskeletal (MSK) system has become increasingly popular in many fields of clinically driven research, locomotor rehabilitation in particular. These models have been applied to various functional impairments given their ability to estimate parameters which cannot be readily measured in vivo but are of interest to clinicians. The use of MSK modelling and simulations allows analysis of relevant MSK biomarkers such as muscle and joint contact loading at a number of different stages in the clinical treatment pathway in order to benefit patient functional outcome. Applications of these methods include optimisation of rehabilitation programs, patient stratification, disease characterisation, surgical pre-planning, and assistive device and exoskeleton design and optimisation. This review provides an overview of current approaches, the components of standard MSK models, applications, limitations, and assumptions of these modelling and simulation methods, and finally proposes a future direction.
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135
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Erdemir A, Mulugeta L, Ku JP, Drach A, Horner M, Morrison TM, Peng GCY, Vadigepalli R, Lytton WW, Myers JG. Credible practice of modeling and simulation in healthcare: ten rules from a multidisciplinary perspective. J Transl Med 2020; 18:369. [PMID: 32993675 PMCID: PMC7526418 DOI: 10.1186/s12967-020-02540-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
The complexities of modern biomedicine are rapidly increasing. Thus, modeling and simulation have become increasingly important as a strategy to understand and predict the trajectory of pathophysiology, disease genesis, and disease spread in support of clinical and policy decisions. In such cases, inappropriate or ill-placed trust in the model and simulation outcomes may result in negative outcomes, and hence illustrate the need to formalize the execution and communication of modeling and simulation practices. Although verification and validation have been generally accepted as significant components of a model’s credibility, they cannot be assumed to equate to a holistic credible practice, which includes activities that can impact comprehension and in-depth examination inherent in the development and reuse of the models. For the past several years, the Committee on Credible Practice of Modeling and Simulation in Healthcare, an interdisciplinary group seeded from a U.S. interagency initiative, has worked to codify best practices. Here, we provide Ten Rules for credible practice of modeling and simulation in healthcare developed from a comparative analysis by the Committee’s multidisciplinary membership, followed by a large stakeholder community survey. These rules establish a unified conceptual framework for modeling and simulation design, implementation, evaluation, dissemination and usage across the modeling and simulation life-cycle. While biomedical science and clinical care domains have somewhat different requirements and expectations for credible practice, our study converged on rules that would be useful across a broad swath of model types. In brief, the rules are: (1) Define context clearly. (2) Use contextually appropriate data. (3) Evaluate within context. (4) List limitations explicitly. (5) Use version control. (6) Document appropriately. (7) Disseminate broadly. (8) Get independent reviews. (9) Test competing implementations. (10) Conform to standards. Although some of these are common sense guidelines, we have found that many are often missed or misconstrued, even by seasoned practitioners. Computational models are already widely used in basic science to generate new biomedical knowledge. As they penetrate clinical care and healthcare policy, contributing to personalized and precision medicine, clinical safety will require established guidelines for the credible practice of modeling and simulation in healthcare.
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Affiliation(s)
- Ahmet Erdemir
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue (ND20), Cleveland, OH, 44195, USA.,Committee on Credible Practice of Modeling, & Simulation in Healthcare, Interagency Modeling and Analysis Group and Multiscale Modeling Consortium, Bethesda, MD, USA
| | - Lealem Mulugeta
- InSilico Labs LLC, 2617 Bissonnet St. Suite 435, Houston, TX, 77005, USA.,Committee on Credible Practice of Modeling, & Simulation in Healthcare, Interagency Modeling and Analysis Group and Multiscale Modeling Consortium, Bethesda, MD, USA
| | - Joy P Ku
- Department of Bioengineering, Clark Center, Stanford University, 318 Campus Drive, Stanford, CA, 94305-5448, USA.,Committee on Credible Practice of Modeling, & Simulation in Healthcare, Interagency Modeling and Analysis Group and Multiscale Modeling Consortium, Bethesda, MD, USA
| | - Andrew Drach
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, 201 E. 24th st, Austin, TX, 78712, USA.,Committee on Credible Practice of Modeling, & Simulation in Healthcare, Interagency Modeling and Analysis Group and Multiscale Modeling Consortium, Bethesda, MD, USA
| | - Marc Horner
- ANSYS, Inc, 1007 Church Street, Suite 250, Evanston, IL, 60201, USA.,Committee on Credible Practice of Modeling, & Simulation in Healthcare, Interagency Modeling and Analysis Group and Multiscale Modeling Consortium, Bethesda, MD, USA
| | - Tina M Morrison
- Division of Applied Mechanics, United States Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA.,Committee on Credible Practice of Modeling, & Simulation in Healthcare, Interagency Modeling and Analysis Group and Multiscale Modeling Consortium, Bethesda, MD, USA
| | - Grace C Y Peng
- National Institute of Biomedical Imaging & Bioengineering, Suite 200, MSC 6707 Democracy Blvd5469, Bethesda, MD, 20892, USA.,Committee on Credible Practice of Modeling, & Simulation in Healthcare, Interagency Modeling and Analysis Group and Multiscale Modeling Consortium, Bethesda, MD, USA
| | - Rajanikanth Vadigepalli
- Department of Pathology, Anatomy and Cell Biology, Daniel Baugh Institute for Functional Genomics/Computational Biology, Thomas Jefferson University, 1020 Locust St, Philadelphia, PA, 19107, USA.,Committee on Credible Practice of Modeling, & Simulation in Healthcare, Interagency Modeling and Analysis Group and Multiscale Modeling Consortium, Bethesda, MD, USA
| | - William W Lytton
- State University of New York, Kings County Hospital, 450 Clarkson Ave., MSC 31, Brooklyn, NY, 11203, USA.,Committee on Credible Practice of Modeling, & Simulation in Healthcare, Interagency Modeling and Analysis Group and Multiscale Modeling Consortium, Bethesda, MD, USA
| | - Jerry G Myers
- Human Research Program, Cross-Cutting Computational Modeling Project, National Aeronautics and Space Administration - John H. Glenn Research Center, 21000 Brookpark Road, Cleveland, OH, 44135, USA. .,Committee on Credible Practice of Modeling, & Simulation in Healthcare, Interagency Modeling and Analysis Group and Multiscale Modeling Consortium, Bethesda, MD, USA.
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136
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van Drongelen S, Wesseling M, Holder J, Meurer A, Stief F. Knee Load Distribution in Hip Osteoarthritis Patients After Total Hip Replacement. Front Bioeng Biotechnol 2020; 8:578030. [PMID: 33072728 PMCID: PMC7534409 DOI: 10.3389/fbioe.2020.578030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/28/2020] [Indexed: 11/22/2022] Open
Abstract
Reduced external knee adduction moments in the second half of stance after total hip replacement have been reported in hip osteoarthritis patients. This reduction is thought to shift the load from the medial to the lateral knee compartment and as such increase the risk for knee osteoarthritis. The knee adduction moment is a surrogate for the load distribution between the medial and lateral compartments of the knee and not a valid measure for the tibiofemoral contact forces which are the result of externally applied forces and muscle forces. The purpose of this study was to investigate whether the distribution of the tibiofemoral contact forces over the knee compartments in unilateral hip osteoarthritis patients 1 year after receiving a primary total hip replacement differs from healthy controls. Musculoskeletal modeling on gait was performed in OpenSim using the detailed knee model of Lerner et al. (2015) for 19 patients as well as for 15 healthy controls of similar age. Knee adduction moments were calculated by the inverse dynamics analysis, medial and lateral tibiofemoral contact forces with the joint reaction force analysis. Moments and contact forces of patients and controls were compared using Statistical Parametric Mapping two-sample t-tests. Knee adduction moments and medial tibiofemoral contact forces of both the ipsi- and contralateral leg were not significantly different compared to healthy controls. The contralateral leg showed 14% higher medial tibiofemoral contact forces compared to the ipsilateral (operated) leg during the second half of stance. During the first half of stance, the lateral tibiofemoral contact force of the contralateral leg was 39% lower and the ratio 32% lower compared to healthy controls. In contrast, during the second half of stance the forces were significantly higher (39 and 26%, respectively) compared to healthy controls. The higher ratio indicates a changed distribution whereas the increased lateral tibiofemoral contact forces indicate a higher lateral knee joint loading in the contralateral leg in OA patients after total hip replacement (THR). Musculoskeletal modeling using a detailed knee model can be useful to detect differences in the load distribution between the medial and lateral knee compartment which cannot be verified with the knee adduction moment.
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Affiliation(s)
- Stefan van Drongelen
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Orthopaedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany
| | - Mariska Wesseling
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Jana Holder
- Orthopaedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany
| | - Andrea Meurer
- Orthopaedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany
| | - Felix Stief
- Orthopaedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany
- Goethe University Frankfurt, Frankfurt, Germany
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137
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Wang L, Wang CJ. Influence of tibial bearing curvatures of a customised total knee implant on squatting motion and loads. Comput Methods Biomech Biomed Engin 2020; 24:43-55. [PMID: 32840135 DOI: 10.1080/10255842.2020.1808970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A range of preliminary designs of customised total knee implants (CTKIs) was created by resurfacing the distal femur and applying different tibial bearing surface curvatures. These were then compared with a scaled off-the-shelf symmetric total knee implant (STKI). To evaluate the biomechanical performance, a dynamic knee simulation model was created with patient-specific muscle and ankle joint loads calculated from an OpenSim musculoskeletal model. Simulation results showed the transverse curvatures of the tibial bearing surface influenced femoral mediolateral translation, while its longitudinal curvatures affected femoral adduction. Compared to the STKI, the CTKIs could restore patient knee function.
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Affiliation(s)
- Linjie Wang
- Department of Engineering and Design, University of Sussex, Falmer, Brighton, UK
| | - Chang Jiang Wang
- Department of Engineering and Design, University of Sussex, Falmer, Brighton, UK
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138
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Conconi M, Sancisi N, Parenti-Castelli V. Prediction of Individual Knee Kinematics From an MRI Representation of the Articular Surfaces. IEEE Trans Biomed Eng 2020; 68:1084-1092. [PMID: 32816671 DOI: 10.1109/tbme.2020.3018113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The knowledge of individual joint motion may help to understand the articular physiology and to design better treatments and medical devices. Measurements of in-vivo individual motion are nowadays invasive/ionizing (fluoroscopy) or imprecise (skin markers). We propose a new approach to derive the individual knee natural motion from a three-dimensional representation of articular surfaces. METHODS We hypothesize that tissue adaptation shapes articular surfaces to optimize load distribution. Thus, the knee natural motion is obtained as the envelope of tibiofemoral positions and orientations that minimize peak contact pressure, i.e. that maximize joint congruence. We investigated four in-vitro and one in-vivo knees. Articular surfaces were reconstructed from a reference MRI. Natural motion was computed by congruence maximization and results were validated versus experimental data, acquired through bone implanted markers, in-vitro, and single-plane fluoroscopy, in-vivo. RESULTS In two cases, one of which in-vivo, maximum mean absolute error stays below 2.2° and 2.7 mm for rotations and translations, respectively. The remaining knees showed differences in joint internal rotation between the reference MRI and experimental motion at 0° flexion, possibly due to some laxity. The same difference is found in the model predictions, which, however, still replicate the individual knee motion. CONCLUSION The proposed approach allows the prediction of individual joint motion based on non-ionizing MRI data. SIGNIFICANCE This method may help to characterize healthy and, by comparison, pathological knee behavior. Moreover, it may provide an individual reference motion for the personalization of musculoskeletal models, opening the way to their clinical application.
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139
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Zhang Q, Chen Z, Zhang Z, Jin Z, Muratoglu OK, Varadarajan KM. Leveraging subject-specific musculoskeletal modeling to assess effect of anterior cruciate ligament retaining total knee arthroplasty during walking gait. Proc Inst Mech Eng H 2020; 234:1445-1456. [DOI: 10.1177/0954411920947204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Bi-cruciate retaining total knee arthroplasty has several potential advantages including improved anteroposterior knee stability compared to contemporary posterior cruciate-retaining total knee arthroplasty. However, few studies have explored whether there is significant differences of knee biomechanics following bi-cruciate retaining total knee arthroplasty compared to posterior cruciate-retaining total knee arthroplasty. In the present study, subject-specific lower extremity musculoskeletal multi-body dynamics models for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty were developed based on the musculoskeletal modeling framework using force-dependent kinematics method and validated against in vivo telemetric data. The experiment data of two subjects who underwent total knee arthroplasty were obtained for the SimTK “Grand Challenge Competition” repository, and integrated into the musculoskeletal model. Five walking gait trials for each subject were used as partial inputs for the model to predict the knee biomechanics for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty. The results revealed significantly greater range of anterior/posterior tibiofemoral translation, and significantly more posterior tibial location during the early phase of gait and more anterior tibial location during the late phase of gait were found in bi-cruciate retaining total knee arthroplasty without anterior cruciate ligament when compared to the bi-cruciate retaining total knee arthroplasty. No significant differences in tibiofemoral contact forces, rotations, translations, and ligament forces between bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty during normal walking gait, albeit slight differences in range of tibiofemoral internal/external rotation and anterior/posterior translation were observed. The present study revealed that anterior cruciate ligament retention has a positive effect on restoring normal knee kinematics in bi-cruciate retaining total knee arthroplasty. Preservation of anterior cruciate ligament in total knee arthroplasty and knee implant designs interplay each other and both contribute to restoring normal knee kinematics in different types of total knee arthroplasty. Further evaluation of more demanding activities and subject data from patients with bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty via musculoskeletal modeling may better highlight the role of the anterior cruciate ligament and its stabilizing influence.
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Affiliation(s)
- Qida Zhang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang’an University, Xi’an, China
| | - Zhifeng Zhang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Orhun K Muratoglu
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kartik M Varadarajan
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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140
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van Veen BC, Mazza C, Viceconti M. The Uncontrolled Manifold Theory Could Explain Part of the Inter-Trial Variability of Knee Contact Force During Level Walking. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1800-1807. [DOI: 10.1109/tnsre.2020.3003559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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141
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Wang L, Wang CJ. Influence of patellar implantation on the patellofemoral joint of an anatomic customised total knee replacement implant: A case study. Proc Inst Mech Eng H 2020; 234:1370-1383. [PMID: 32723134 PMCID: PMC7675768 DOI: 10.1177/0954411920941400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Few studies have been conducted to investigate kinematics and kinetics of the patellofemoral joint under physiological muscle forces and ankle joint loads. In this study, a preliminary design of a customised total knee implant was proposed and created. To compare the influences of different patella treatment scenarios, a dynamic knee simulation model was created with patient-specific muscle forces and ankle joint loads that are calculated from an OpenSim musculoskeletal model. The goal is to improve patellar implant-bone connection and restore patellofemoral joint mobility. Identical dynamic boundary conditions were applied on an unresurfaced patella and three different dome-shaped patellar implants. It was found that the unresurfaced patella and patellar implants resulted in different motions of patellar internal rotation and medial tilt. The size of the dome-shaped patellar implant affected the motion and loading of the patellofemoral joint. When the exposed patella bone was not fully covered by the patellar implant, the patella bone then contacted the femoral component during knee flexion. This would most likely lead to anterior knee pain and subsequent revision.
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Affiliation(s)
- Linjie Wang
- Department of Engineering and Design, University of Sussex, Brighton, UK
| | - Chang Jiang Wang
- Department of Engineering and Design, University of Sussex, Brighton, UK
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142
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Kim W, Araujo D, Kohles SS, Kim SG, Alvarez Sanchez HH. Affordance-Based Surgical Design Methods Considering Biomechanical Artifacts. ECOLOGICAL PSYCHOLOGY 2020; 33:57-71. [PMID: 37123457 PMCID: PMC10134908 DOI: 10.1080/10407413.2020.1792782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Surgical design in personalized medicine is often based on native anatomy, which may not accurately reflect the interaction between native musculoskeletal tissues and biomechanical artifacts. To overcome this problem, researchers have developed alternative methods based on affordance-based design. The design process can be viewed in terms of action possibilities provided by the (biological) environment. Here, we use the affordance-based approach to address possibilities for action offered by biomechanical artifacts. In anterior crucial ligament (ACL) reconstruction, the design goal is to avoid ligament impingement while optimizing the placement of the tibial tunnel. Although in the current rationale for tibial tunnel placement roof impingement is minimized to avoid a negative affordance, we show that tibial tunnel placement can rather aim to constrain the target bounds with respect to a positive affordance. We describe the steps for identifying the measurable invariants and provide a mathematical framework for the surgery affordances within the knee.
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Affiliation(s)
- Wangdo Kim
- Mechanical Engineering, University of Engineering & Technology (Ingeniería Mecánica, Universidad de Ingenieria y Tecnologia – UTEC)
| | - Duarte Araujo
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa
| | - Sean S. Kohles
- Kohles Bioengineering; Biomaterials & Biomechanics, School of Dentistry, and Emergency Medicine, School of Medicine, Oregon Health & Science University
| | | | - Helard Henry Alvarez Sanchez
- Mechanical Engineering, University of Engineering & Technology (Ingeniería Mecánica, Universidad de Ingenieria y Tecnologia – UTEC)
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143
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Machine learning methods to support personalized neuromusculoskeletal modelling. Biomech Model Mechanobiol 2020; 19:1169-1185. [DOI: 10.1007/s10237-020-01367-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 12/19/2022]
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144
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Gu W, Pandy MG. Direct Validation of Human Knee-Joint Contact Mechanics Derived From Subject-Specific Finite-Element Models of the Tibiofemoral and Patellofemoral Joints. J Biomech Eng 2020; 142:071001. [PMID: 31802099 DOI: 10.1115/1.4045594] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Indexed: 11/08/2022]
Abstract
The primary aim of this study was to validate predictions of human knee-joint contact mechanics (specifically, contact pressure, contact area, and contact force) derived from finite-element models of the tibiofemoral and patellofemoral joints against corresponding measurements obtained in vitro during simulated weight-bearing activity. A secondary aim was to perform sensitivity analyses of the model calculations to identify those parameters that most significantly affect model predictions of joint contact pressure, area, and force. Joint pressures in the medial and lateral compartments of the tibiofemoral and patellofemoral joints were measured in vitro during two simulated weight-bearing activities: stair descent and squatting. Model-predicted joint contact pressure distribution maps were consistent with those obtained from experiment. Normalized root-mean-square errors between the measured and calculated contact variables were on the order of 15%. Pearson correlations between the time histories of model-predicted and measured contact variables were generally above 0.8. Mean errors in the calculated center-of-pressure locations were 3.1 mm for the tibiofemoral joint and 2.1 mm for the patellofemoral joint. Model predictions of joint contact mechanics were most sensitive to changes in the material properties and geometry of the meniscus and cartilage, particularly estimates of peak contact pressure. The validated finite element modeling framework offers a useful tool for noninvasive determination of knee-joint contact mechanics during dynamic activity under physiological loading conditions.
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Affiliation(s)
- Wei Gu
- Department of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia
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Enhanced In-Silico Polyethylene Wear Simulation of Total Knee Replacements During Daily Activities. Ann Biomed Eng 2020; 49:322-333. [PMID: 32607843 DOI: 10.1007/s10439-020-02555-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
Abstract
A computational wear simulator is an efficient tool for evaluating the wear of artificial knee joints. The classical Archard's wear law-based simulator has questionable accuracy and is focused on walking. In this study, an in silico polyethylene wear simulation of total knee replacements was developed considering the various highly demanding daily activities. A good predicted accuracy (error = 8.1%) was found through comparison of the experimental results. A relatively larger averaged wear loss was found under the loading condition (1.53 mg/mc) of daily activities compared with the walking condition (1.32 mg/mc). The squatting movement (2.57 mg/mc) produces the highest overall wear rate. In addition, a relatively larger amount of wear was found on the medial side knee prosthesis than that on the lateral side. The enhanced in silico polyethylene wear simulator provides an accurate and comprehensive tool for wear prediction in preclinical wear testing.
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146
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Obrębska P, Skubich J, Piszczatowski S. Gender differences in the knee joint loadings during gait. Gait Posture 2020; 79:195-202. [PMID: 32438266 DOI: 10.1016/j.gaitpost.2020.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The differences in anatomical structure between men and women are widely known. Unfortunately, the influence of gender on the biomechanics of a healthy knee joint during gait is still poorly understood. RESEARCH QUESTION The aim of the presented study was to determine loads acting in the knee joint during gait, based on the observation of a large group of healthy young adults, in particular to determine the influence of gender on values of forces and moments and their time characteristics during gait cycle. METHODS Time-spatial gait parameters and ground reaction force were registered for 86 persons (43 females and 43 males) using a motion capture system and force plates. The numerical simulation with the AnyBody system was used to estimate loadings acting in the knee joint. Differences between women and men were tested using the unpaired Student's t-test with a Bonferroni correction. RESULTS The maximum values of loadings acting in the knee joint were: 411.1 %BW (body weight) for resultant force, 390.6 %BW for proximo-distal force, 110.8 %BW for antero-posterior force, 77.0 %BW for medio-lateral force, 2.63 %BWh (body weight times height) for flexion/extension moment, 0.97 %BWh for internal/external rotation moment and 5.7 %BWh for abduction/adduction moment. In general, the normalised forces were greater in the male group, while the normalised external moments acting on the knee were greater in the female group. Local extrema of forces during the stance phase were observed earlier for women. SIGNIFICANCE Knowledge about gender differences in loadings acting in the knee joint can be of great importance in the case of detecting the early stages of gait abnormalities and treatment planning.
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Affiliation(s)
- Paulina Obrębska
- Institute of Biomedical Engineering, Faculty of Mechanical Engineering, Bialystok University of Technology, Bialystok, Poland.
| | - Justyna Skubich
- Institute of Biomedical Engineering, Faculty of Mechanical Engineering, Bialystok University of Technology, Bialystok, Poland.
| | - Szczepan Piszczatowski
- Institute of Biomedical Engineering, Faculty of Mechanical Engineering, Bialystok University of Technology, Bialystok, Poland.
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147
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Dejtiar DL, Dzialo CM, Pedersen PH, Jensen KK, Fleron MK, Andersen MS. Development and Evaluation of a Subject-Specific Lower Limb Model With an Eleven-Degrees-of-Freedom Natural Knee Model Using Magnetic Resonance and Biplanar X-Ray Imaging During a Quasi-Static Lunge. J Biomech Eng 2020; 142:061001. [PMID: 31314894 DOI: 10.1115/1.4044245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 12/31/2022]
Abstract
Musculoskeletal (MS) models can be used to study the muscle, ligament, and joint mechanics of natural knees. However, models that both capture subject-specific geometry and contain a detailed joint model do not currently exist. This study aims to first develop magnetic resonance image (MRI)-based subject-specific models with a detailed natural knee joint capable of simultaneously estimating in vivo ligament, muscle, tibiofemoral (TF), and patellofemoral (PF) joint contact forces and secondary joint kinematics. Then, to evaluate the models, the predicted secondary joint kinematics were compared to in vivo joint kinematics extracted from biplanar X-ray images (acquired using slot scanning technology) during a quasi-static lunge. To construct the models, bone, ligament, and cartilage structures were segmented from MRI scans of four subjects. The models were then used to simulate lunges based on motion capture and force place data. Accurate estimates of TF secondary joint kinematics and PF translations were found: translations were predicted with a mean difference (MD) and standard error (SE) of 2.13 ± 0.22 mm between all trials and measures, while rotations had a MD ± SE of 8.57 ± 0.63 deg. Ligament and contact forces were also reported. The presented modeling workflow and the resulting knee joint model have potential to aid in the understanding of subject-specific biomechanics and simulating the effects of surgical treatment and/or external devices on functional knee mechanics on an individual level.
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Affiliation(s)
- David Leandro Dejtiar
- Department of Materials and Production, Aalborg University, Fibigestræde 16, Aalborg DK-9220, Denmark
| | - Christine Mary Dzialo
- Department of Materials and Production, Aalborg University, Fibigestræde 16, Aalborg DK-9220, Denmark; Anybody Technology A/S, Niels Jernes Vej 10, Aalborg DK-9220, Denmark
| | - Peter Heide Pedersen
- Department of Orthopedic Surgery, Aalborg University Hospital, Hobrovej 18-22, Aalborg DK-9000, Denmark
| | - Kenneth Krogh Jensen
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg DK-9000, Denmark
| | - Martin Kokholm Fleron
- Department of Health Science and Technology, Aalborg University, Frederik Bajers Vej 7, Aalborg DK-9220, Denmark
| | - Michael Skipper Andersen
- Department of Materials and Production, Aalborg University, Fibigestræde 16, Aalborg DK-9220, Denmark
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148
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Musculoskeletal Multibody Simulation Analysis on the Impact of Patellar Component Design and Positioning on Joint Dynamics after Unconstrained Total Knee Arthroplasty. MATERIALS 2020; 13:ma13102365. [PMID: 32455672 PMCID: PMC7287668 DOI: 10.3390/ma13102365] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/07/2020] [Accepted: 05/16/2020] [Indexed: 12/16/2022]
Abstract
Patellofemoral (PF) disorders are considered a major clinical complication after total knee replacement (TKR). Malpositioning and design of the patellar component impacts knee joint dynamics, implant fixation and wear propagation. However, only a limited number of studies have addressed the biomechanical impact of the patellar component on PF dynamics and their results have been discussed controversially. To address these issues, we implemented a musculoskeletal multibody simulation (MMBS) study for the systematical analysis of the patellar component’s thickness and positioning on PF contact forces and kinematics during dynamic squat motion with virtually implanted unconstrained cruciate-retaining (CR)-TKR. The patellar button thickness clearly increased the contact forces in the PF joint (up to 27%). Similarly, the PF contact forces were affected by superior–inferior positioning (up to 16%) and mediolateral positioning (up to 8%) of the patellar button. PF kinematics was mostly affected by the mediolateral positioning and the thickness of the patellar component. A medialization of 3 mm caused a lateral patellar shift by up to 2.7 mm and lateral patellar tilt by up to 1.6°. However, deviations in the rotational positioning of the patellar button had minor effects on PF dynamics. Aiming at an optimal intraoperative patellar component alignment, the orthopedic surgeon should pay close attention to the patellar component thickness in combination with its mediolateral and superior–inferior positioning on the retropatellar surface. Our generated MMBS model provides systematic and reproducible insight into the effects of patellar component positioning and design on PF dynamics and has the potential to serve as a preoperative analysis tool.
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149
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van der Straaten R, Wesseling M, Jonkers I, Vanwanseele B, Bruijnes AKBD, Malcorps J, Bellemans J, Truijen J, De Baets L, Timmermans A. Functional movement assessment by means of inertial sensor technology to discriminate between movement behaviour of healthy controls and persons with knee osteoarthritis. J Neuroeng Rehabil 2020; 17:65. [PMID: 32430036 PMCID: PMC7236325 DOI: 10.1186/s12984-020-00694-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/07/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Apart from biomechanical alterations in movement patterns, it is known that movement limitations in persons with knee osteoarthritis (PwKOA) are related to an individual's perception and belief regarding pain and disability. To gain more insights into the functional movement behaviour of PwKOA in a clinical setting, inertial sensor technology can be applied. This study first aims to evaluate the ability of inertial sensors to discriminate between healthy controls (HC) and PwKOA. Secondly, this study aims to determine the relationship between movement behaviour, pain-related factors and disability scores. METHODS Twelve HC and 19 PwKOA were included. Five repetitions of six functional movement tasks (walking, forward lunge, sideward lunge, ascent and descent stairs, single leg squat and sit-to-stand) were simultaneously recorded by the inertial sensor system and a camera-based motion analysis system. Statistically significant differences in angular waveforms of the trunk, pelvis and lower limb joints between HC and PwKOA were determined using one-dimensional statistical parametric mapping (SPM1D). The Knee injury and Osteoarthritis Outcome Score and TAMPA scale for Kinesiophobia were used to evaluate the relationship between discriminating joint motion, pain-related factors and disability using spearman's correlation coefficients. RESULTS PwKOA had significantly less trunk rotation, internal pelvis rotation and knee flexion ROM during walking. Additionally, the reduced knee flexion (i.e. at the end of the stance phase and swing phase) was related to increased level of perceived pain. During the sideward lunge, PwKOA had significantly less knee flexion, ankle plantarflexion and hip abduction. This decreased hip abduction (i.e. during stance) was related to higher fear of movement. Finally, PwKOA had significantly less knee flexion during the forward lunge, single leg squat and during ascent and descent stairs. No significant correlations were observed with disability. CONCLUSIONS Inertial sensors were able to discriminate between movement characteristics of PwKOA and HC. Additionally, significant relationships were found between joint motion, perceived pain and fear of movement. Since inertial sensors can be used outside the laboratory setting, these results are promising as they indicate the ability to evaluate movement deviations. Further research is required to enable measurements of small movement deviations in clinically relevant tasks.
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Affiliation(s)
| | - Mariska Wesseling
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - Benedicte Vanwanseele
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | | | - Jan Malcorps
- Department of Orthopaedic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Johan Bellemans
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jan Truijen
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Liesbet De Baets
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
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150
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van der Straaten R, Wesseling M, Jonkers I, Vanwanseele B, Bruijnes AKBD, Malcorps J, Bellemans J, Truijen J, De Baets L, Timmermans A. Discriminant validity of 3D joint kinematics and centre of mass displacement measured by inertial sensor technology during the unipodal stance task. PLoS One 2020; 15:e0232513. [PMID: 32407415 PMCID: PMC7224481 DOI: 10.1371/journal.pone.0232513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 04/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background The unipodal stance task is a clinical task that quantifies postural stability and alignment of the lower limb joints, while weight bearing on one leg. As persons with knee osteoarthritis (KOA) have poor postural and knee joint stability, objective assessment of this task might be useful. Objective To investigate the discriminant validity of three-dimensional joint kinematics and centre of mass displacement (COM) between healthy controls and persons with knee KOA, during unipodal stance using inertial sensors. Additionally, the reliability, agreement and construct validity are assessed to determine the reproducibility and accuracy of the discriminating parameters. Methods Twenty healthy controls and 19 persons with unilateral severe KOA were included. Five repetitions of the unipodal stance task were simultaneously recorded by an inertial sensor system and a camera-based system (gold standard). Statistical significant differences in kinematic waveforms between healthy controls and persons with severe knee KOA were determined using one-dimensional statistical parametric mapping (SPM1D). Results Persons with severe knee KOA had more lateral trunk lean towards the contralateral leg, more hip flexion throughout the performance of the unipodal stance task, more pelvic obliquity and COM displacement towards the contralateral side. However, for the latter two parameters the minimum detectable change was greater than the difference between healthy controls and persons with severe knee KOA. The construct validity was good (coefficient of multiple correlation 0.75, 0.83 respectively) and the root mean squared error (RMSE) was low (RMSE <1.5°) for the discriminant parameters. Conclusion Inertial sensor based movement analysis can discriminate between healthy controls and persons with severe knee KOA for lateral trunk lean and hip flexion, but unfortunately not for the knee angles. Further research is required to improve the reproducibility and accuracy of the inertial sensor measurements before they can be used to assess differences in tasks with a small range of motion.
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Affiliation(s)
- R. van der Straaten
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- * E-mail:
| | - M. Wesseling
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - I. Jonkers
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - B. Vanwanseele
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | | | - J. Malcorps
- Department of Orthopaedic Surgery, Jessa Hospital, Hasselt, Belgium
| | - J. Bellemans
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - J. Truijen
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - L. De Baets
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - A. Timmermans
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
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