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Bennett HJ, Estler K, Valenzuela K, Weinhandl JT. Predicting Knee Joint Contact Forces During Normal Walking Using Kinematic Inputs With a Long-Short Term Neural Network. J Biomech Eng 2024; 146:081004. [PMID: 38270972 DOI: 10.1115/1.4064550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/19/2024] [Indexed: 01/26/2024]
Abstract
Knee joint contact forces are commonly estimated via surrogate measures (i.e., external knee adduction moments or musculoskeletal modeling). Despite its capabilities, modeling is not optimal for clinicians or persons with limited experience. The purpose of this study was to design a novel prediction method for knee joint contact forces that is simplistic in terms of required inputs. This study included marker trajectories and instrumented knee forces during normal walking from the "Grand Challenge" (n = 6) and "CAMS" (n = 2) datasets. Inverse kinematics were used to derive stance phase hip (sagittal, frontal, transverse), knee (sagittal, frontal), ankle (sagittal), and trunk (frontal) kinematics. A long-short term memory network (LSTM) was created using matlab to predict medial and lateral knee force waveforms using combinations of the kinematics. The Grand Challenge and CAMS datasets trained and tested the network, respectively. Musculoskeletal modeling forces were derived using static optimization and joint reaction tools in OpenSim. Waveform accuracy was determined as the proportion of variance and root-mean-square error between network predictions and in vivo data. The LSTM network was highly accurate for medial forces (R2 = 0.77, RMSE = 0.27 BW) and required only frontal hip and knee and sagittal hip and ankle kinematics. Modeled medial force predictions were excellent (R2 = 0.77, RMSE = 0.33 BW). Lateral force predictions were poor for both methods (LSTM R2 = 0.18, RMSE = 0.08 BW; modeling R2 = 0.21, RMSE = 0.54 BW). The designed LSTM network outperformed most reports of musculoskeletal modeling, including those reached in this study, revealing knee joint forces can accurately be predicted by using only kinematic input variables.
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Affiliation(s)
- Hunter J Bennett
- Neuromechanics Laboratory, Old Dominion University, 1007 Student Recreation Center, Norfolk, VA 23529
| | - Kaileigh Estler
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN 37996
- University of Tennessee at Knoxville
| | - Kevin Valenzuela
- Department of Kinesiology, California State University, Long Beach, CA 90840
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation, and Sport Studies, The University of Tennessee, Knoxville, TN 37996
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2
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Guo N, Smith CR, Schütz P, Trepczynski A, Moewis P, Damm P, Maas A, Grupp TM, Taylor WR, Hosseini Nasab SH. Posterior tibial slope influences joint mechanics and soft tissue loading after total knee arthroplasty. Front Bioeng Biotechnol 2024; 12:1352794. [PMID: 38686117 PMCID: PMC11056792 DOI: 10.3389/fbioe.2024.1352794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
As a solution to restore knee function and reduce pain, the demand for Total Knee Arthroplasty (TKA) has dramatically increased in recent decades. The high rates of dissatisfaction and revision makes it crucially important to understand the relationships between surgical factors and post-surgery knee performance. Tibial implant alignment in the sagittal plane (i.e., posterior tibia slope, PTS) is thought to play a key role in quadriceps muscle forces and contact conditions of the joint, but the underlying mechanisms and potential consequences are poorly understood. To address this biomechanical challenge, we developed a subject-specific musculoskeletal model based on the bone anatomy and precise implantation data provided within the CAMS-Knee datasets. Using the novel COMAK algorithm that concurrently optimizes joint kinematics, together with contact mechanics, and muscle and ligament forces, enabled highly accurate estimations of the knee joint biomechanics (RMSE <0.16 BW of joint contact force) throughout level walking and squatting. Once confirmed for accuracy, this baseline modelling framework was then used to systematically explore the influence of PTS on knee joint biomechanics. Our results indicate that PTS can greatly influence tibio-femoral translations (mainly in the anterior-posterior direction), while also suggesting an elevated risk of patellar mal-tracking and instability. Importantly, however, an increased PTS was found to reduce the maximum tibio-femoral contact force and improve efficiency of the quadriceps muscles, while also reducing the patellofemoral contact force (by approximately 1.5% for each additional degree of PTS during walking). This study presents valuable findings regarding the impact of PTS variations on the biomechanics of the TKA joint and thereby provides potential guidance for surgically optimizing implant alignment in the sagittal plane, tailored to the implant design and the individual deficits of each patient.
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Affiliation(s)
- Ning Guo
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Colin R. Smith
- Department of Biomedical Engineering, Steadman Philippon Research Institute, Vail, CO, United States
| | - Pascal Schütz
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Adam Trepczynski
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Philippe Moewis
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Allan Maas
- Aesculap AG, Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Munich, Germany
| | - Thomas M. Grupp
- Aesculap AG, Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Munich, Germany
| | - William R. Taylor
- Institute for Biomechanics, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
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Dreyer MJ, Weisse B, Contreras Raggio JI, Zboray R, Taylor WR, Preiss S, Horn N. The influence of implant design and limb alignment on in vivo wear rates of fixed-bearing and rotating-platform knee implant retrievals. J Orthop Res 2024; 42:777-787. [PMID: 37975250 DOI: 10.1002/jor.25734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/11/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Analysis of polyethylene (PE) wear in knee implants is crucial for understanding the factors leading to revision in total knee arthroplasty. Importantly, current experimental and computational methods for predicting insert wear can only be validated against true in vivo measurements from retrievals. This study quantitatively investigated in vivo PE wear rates in fixed-bearing (FB) (n = 21) and rotating-platform (n = 53) implant retrievals. 3D surface geometry of the retrievals was measured using a structured light scanner. Then, a reference surface that included the deformation, but not the wear that the retrievals had experienced in vivo, was constructed using a fully automatic surface reconstruction algorithm. Finally, wear volume was calculated from the deviation between the worn and reconstructed surfaces. The measurement and analysis techniques were validated and the algorithm was found to produce errors of only 0.2% relative to the component volumes. In addition to quantifying cohort-level wear rates, the effect of mechanical axis limb alignment on mediolateral wear distribution was examined for a subset of the retrievals (n = 14 + 26). Our results show that FB implants produce significantly (p = 0.04) higher topside wear rates (24.6 ± 10.1 mm3/year) than rotating-platform implants (15.3 ± 8.0 mm3/year). This effect was larger than that of limb alignment, which had a smaller and nonsignificant influence on overall wear rates (+4.5 ± 11.6 mm3/year, p = 0.43). However, increased varus alignment was associated significantly with greater medial compartment wear in both the FB and rotating-platform designs (+1.7 ± 1.3%/° and +1.8 ± 1.6%/°). Our findings emphasize the importance of implant design and limb alignment on wear outcomes, providing reference data for improving implant performance and longevity.
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Affiliation(s)
- Michael J Dreyer
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - Bernhard Weisse
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - José Ignacio Contreras Raggio
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibáñez, Viña del Mar, Chile
| | - Robert Zboray
- Center for X-ray Analytics, Empa, Dübendorf, Switzerland
| | - William R Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Stefan Preiss
- Department of Lower Extremities, Schulthess Clinic, Zürich, Switzerland
| | - Nils Horn
- Department of Lower Extremities, Schulthess Clinic, Zürich, Switzerland
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4
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Apostolopoulos V, Boháč P, Marcián P, Nachtnebl L, Mahdal M, Pazourek L, Tomáš T. Biomechanical comparison of all-polyethylene total knee replacement and its metal-backed equivalent on periprosthetic tibia using the finite element method. J Orthop Surg Res 2024; 19:153. [PMID: 38396020 PMCID: PMC10893603 DOI: 10.1186/s13018-024-04631-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) with all-polyethylene tibial (APT) components has shown comparable survivorship and clinical outcomes to that with metal-backed tibial (MBT). Although MBT is more frequently implanted, APT equivalents are considered a low-cost variant for elderly patients. A biomechanical analysis was assumed to be suitable to compare the response of the periprosthetic tibia after implantation of TKA NexGen APT and MBT equivalent. METHODS A standardised load model was used representing the highest load achieved during level walking. The geometry and material models were created using computed tomography data. In the analysis, a material model was created that represents a patient with osteopenia. RESULTS The equivalent strain distribution in the models of cancellous bone with an APT component showed values above 1000 με in the area below the medial tibial section, with MBT component were primarily localised in the stem tip area. For APT variants, the microstrain values in more than 80% of the volume were in the range from 300 to 1500 με, MBT only in less than 64% of the volume. CONCLUSION The effect of APT implantation on the periprosthetic tibia was shown as equal or even superior to that of MBT despite maximum strain values occurring in different locations. On the basis of the strain distribution, the state of the bone tissue was analysed to determine whether bone tissue remodelling or remodelling would occur. Following clinical validation, outcomes could eventually modify the implant selection criteria and lead to more frequent implantation of APT components.
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Affiliation(s)
- Vasileios Apostolopoulos
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Boháč
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Petr Marcián
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Luboš Nachtnebl
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Mahdal
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukáš Pazourek
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomáš Tomáš
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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5
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Glenday JD, Vigdorchik JM, Sculco PK, Kahlenberg CA, Mayman DJ, Debbi EM, Lipman JD, Wright TM, González FJQ. A novel computational workflow to holistically assess total knee arthroplasty biomechanics identifies subject-specific effects of joint mechanics on implant fixation. J Biomech 2024; 164:111973. [PMID: 38325192 DOI: 10.1016/j.jbiomech.2024.111973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
Computational studies of total knee arthroplasty (TKA) often focus on either joint mechanics (kinematics and forces) or implant fixation mechanics. However, such disconnect between joint and fixation mechanics hinders our understanding of overall TKA biomechanical function by preventing identification of key relationships between these two levels of TKA mechanics. We developed a computational workflow to holistically assess TKA biomechanics by integrating musculoskeletal and finite element (FE) models. For our initial study using the workflow, we investigated how tibiofemoral contact mechanics affected the risk of failure due to debonding at the implant-cement interface using the four available subjects from the Grand Challenge Competitions to Predict In Vivo Knee Loads. We used a musculoskeletal model with a 12 degrees-of-freedom knee joint to simulate the stance phase of gait for each subject. The computed tibiofemoral joint forces at each node in contact were direct inputs to FE simulations of the same subjects. We found that the peak risk of failure did not coincide with the peak joint forces or the extreme tibiofemoral contact positions. Moreover, despite the consistency of joint forces across subjects, we observed important variability in the profile of the risk of failure during gait. Thus, by a combined evaluation of the joint and implant fixation mechanics of TKA, we could identify subject-specific effects of joint kinematics and forces on implant fixation that would otherwise have gone unnoticed. We intend to apply our workflow to evaluate the impact of implant alignment and design on TKA biomechanics.
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Affiliation(s)
- Jonathan D Glenday
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
| | | | - Peter K Sculco
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
| | | | - David J Mayman
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
| | - Eytan M Debbi
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
| | - Joseph D Lipman
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
| | - Timothy M Wright
- Hospital for Special Surgery, 535 East 71st Street, New York 10021, NY, USA
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6
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Zhang Q, Li Z, Chen Z, Peng Y, Jin Z, Qin L. Prediction of knee biomechanics with different tibial component malrotations after total knee arthroplasty: conventional machine learning vs. deep learning. Front Bioeng Biotechnol 2024; 11:1255625. [PMID: 38260731 PMCID: PMC10800660 DOI: 10.3389/fbioe.2023.1255625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
The precise alignment of tibiofemoral components in total knee arthroplasty is a crucial factor in enhancing the longevity and functionality of the knee. However, it is a substantial challenge to quickly predict the biomechanical response to malrotation of tibiofemoral components after total knee arthroplasty using musculoskeletal multibody dynamics models. The objective of the present study was to conduct a comparative analysis between a deep learning method and four conventional machine learning methods for predicting knee biomechanics with different tibial component malrotation during a walking gait after total knee arthroplasty. First, the knee contact forces and kinematics with different tibial component malrotation in the range of ±5° in the three directions of anterior/posterior slope, internal/external rotation, and varus/valgus rotation during a walking gait after total knee arthroplasty were calculated based on the developed musculoskeletal multibody dynamics model. Subsequently, deep learning and four conventional machine learning methods were developed using the above 343 sets of biomechanical data as the dataset. Finally, the results predicted by the deep learning method were compared to the results predicted by four conventional machine learning methods. The findings indicated that the deep learning method was more accurate than four conventional machine learning methods in predicting knee contact forces and kinematics with different tibial component malrotation during a walking gait after total knee arthroplasty. The deep learning method developed in this study enabled quickly determine the biomechanical response with different tibial component malrotation during a walking gait after total knee arthroplasty. The proposed method offered surgeons and surgical robots the ability to establish a calibration safety zone, which was essential for achieving precise alignment in both preoperative surgical planning and intraoperative robotic-assisted surgical navigation.
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Affiliation(s)
- Qida Zhang
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Zhuhuan Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang’an University, Xi’an, China
| | - Yinghu Peng
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, China
| | - Zhongmin Jin
- 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, United Kingdom
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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7
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Febrer-Nafría M, Dreyer MJ, Maas A, Taylor WR, Smith CR, Hosseini Nasab SH. Knee kinematics are primarily determined by implant alignment but knee kinetics are mainly influenced by muscle coordination strategy. J Biomech 2023; 161:111851. [PMID: 37907050 DOI: 10.1016/j.jbiomech.2023.111851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023]
Abstract
Implant malalignment has been reported to be a primary reason for revision total knee arthroplasty (TKA). In addition, altered muscle coordination patterns are commonly observed in TKA patients, which is thought to alter knee contact loads. A comprehensive understanding of the influence of surgical implantation and muscle recruitment strategies on joint contact mechanics is crucial to improve surgical techniques, increase implant longevity, and inform rehabilitation protocols. In this study, a detailed musculoskeletal model with a 12 degrees of freedom knee was developed to represent a TKA subject from the CAMS-Knee datasets. Using motion capture and ground reaction force data, a level walking cycle was simulated and the joint movement and loading patterns were estimated using a novel technique for concurrent optimization of muscle activations and joint kinematics. In addition, over 12'000 Monte Carlo simulations were performed to predict knee contact mechanics during walking, considering numerous combinations of implant alignment and muscle activation scenarios. Validation of our baseline simulation showed good agreement between the model kinematics and loading patterns against the in vivo data. Our analyses reveal a considerable impact of implant alignment on the joint kinematics, while variation in muscle activation strategies mainly affects knee contact loading. Moreover, our results indicate that high knee compressive forces do not necessarily originate from extreme kinematics and vice versa. This study provides an improved understanding of the complex inter-relationships between loading and movement patterns resulting from different surgical implantation and muscle coordination strategies and presents a validated framework towards population-based modelling in TKA.
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Affiliation(s)
- Míriam Febrer-Nafría
- Institute for Biomechanics, ETH Zürich, Switzerland; Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Spain
| | - Michael J Dreyer
- Institute for Biomechanics, ETH Zürich, Switzerland; Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - Allan Maas
- Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany; Research and Development, Aesculap AG, Tuttlingen, Germany
| | | | - Colin R Smith
- Institute for Biomechanics, ETH Zürich, Switzerland; Steadman Philippon Research Institute, Vail, USA
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8
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Donno L, Galluzzo A, Pascale V, Sansone V, Frigo CA. Walking with a Posterior Cruciate Ligament Injury: A Musculoskeletal Model Study. Bioengineering (Basel) 2023; 10:1178. [PMID: 37892908 PMCID: PMC10604140 DOI: 10.3390/bioengineering10101178] [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: 09/02/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
The understanding of the changes induced in the knee's kinematics by a Posterior Cruciate Ligament (PCL) injury is still rather incomplete. This computational study aimed to analyze how the internal loads are redistributed among the remaining ligaments when the PCL is lesioned at different degrees and to understand if there is a possibility to compensate for a PCL lesion by changing the hamstring's contraction in the second half of the swing phase. A musculoskeletal model of the knee joint was used for simulating a progressive PCL injury by gradually reducing the ligament stiffness. Then, in the model with a PCL residual stiffness at 15%, further dynamic simulations of walking were performed by progressively reducing the hamstring's force. In each condition, the ligaments tension, contact force and knee kinematics were analyzed. In the simulated PCL-injured knee, the Medial Collateral Ligament (MCL) became the main passive stabilizer of the tibial posterior translation, with synergistic recruitment of the Lateral Collateral Ligament. This resulted in an enhancement of the tibial-femoral contact force with respect to the intact knee. The reduction in the hamstring's force limited the tibial posterior sliding and, consequently, the tension of the ligaments compensating for PCL injury decreased, as did the tibiofemoral contact force. This study does not pretend to represent any specific population, since our musculoskeletal model represents a single subject. However, the implemented model could allow the non-invasive estimation of load redistribution in cases of PCL injury. Understanding the changes in the knee joint biomechanics could help clinicians to restore patients' joint stability and prevent joint degeneration.
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Affiliation(s)
- Lucia Donno
- Movement Biomechanics and Motor Control Lab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, I-20133 Milan, Italy;
| | - Alessandro Galluzzo
- IRCCS Istituto Ortopedico Galeazzi, I-20161 Milan, Italy; (A.G.); (V.P.); (V.S.)
- Residency Program in Orthopaedics and Traumatology, University of Milan, I-20122 Milan, Italy
| | - Valerio Pascale
- IRCCS Istituto Ortopedico Galeazzi, I-20161 Milan, Italy; (A.G.); (V.P.); (V.S.)
- Department of Biomedical Sciences for Health, University of Milan, I-20122 Milan, Italy
| | - Valerio Sansone
- IRCCS Istituto Ortopedico Galeazzi, I-20161 Milan, Italy; (A.G.); (V.P.); (V.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, I-20122 Milan, Italy
| | - Carlo Albino Frigo
- Movement Biomechanics and Motor Control Lab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, I-20133 Milan, Italy;
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9
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Hafez MA, Halloran JP. Polynomial chaos expansion based sensitivity analysis of predicted knee reactions-assessing the influence of the primary ligaments in distraction based models. Comput Methods Biomech Biomed Engin 2023; 26:1678-1690. [PMID: 36222456 DOI: 10.1080/10255842.2022.2131401] [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: 04/06/2022] [Revised: 08/11/2022] [Accepted: 09/21/2022] [Indexed: 11/03/2022]
Abstract
Computational knee models have shown that predicted condylar reactions are sensitive to the utilized ligament mechanical parameters. These models, however, are computationally expensive with multiple sources of uncertainty. Traditional uncertainty analysis using Monte-Carlo (MC) inspired methods are costly to perform. The purpose of this study was to use two example calibrated knee models to compare quasi-MC versus polynomial chaos expansion (PCE) sensitivity analyses of predicted condylar reactions that included uncertainty in the mechanical parameters of the ligaments. PCE was practically identical versus quasi-MC with 95% and 98% reductions in model evaluations for analyses with 10 and 6 uncertain variables, respectively.
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Affiliation(s)
- Mhd Ammar Hafez
- Department of Civil and Environmental Engineering, Cleveland State University, Cleveland, OH, USA
| | - Jason P Halloran
- Applied Sciences Laboratory, Institute for Shock Physics, Washington State University, Spokane, WA, USA
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10
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Zhang Q, Peng Y, Chen Z, Jin Z, Qin L. Conformity design can change the effect of tibial component malrotation on knee biomechanics after total knee arthroplasty. Clin Biomech (Bristol, Avon) 2023; 105:105985. [PMID: 37182435 DOI: 10.1016/j.clinbiomech.2023.105985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Component alignment is essential to improve knee function and survival in total knee arthroplasty. However, it is still unclear whether the conformity design of tibiofemoral component can mitigate abnormal knee biomechanics caused by component malrotation. The purpose of this study was to investigate whether the sagittal/coronal conformity design of the tibial component could change the effect of the tibial component malrotation on knee biomechanics in total knee arthroplasty. METHODS A developed patient-specific musculoskeletal multi-body dynamics model of total knee arthroplasty was used to investigate the effects of the sagittal/coronal conformity of the tibial component on knee contact forces and kinematics caused by tibial component malrotation during the walking gait. FINDINGS Medial and lateral contact forces, internal-external rotation, and anterior-posterior translation were significantly affected by tibial component malrotation after total knee arthroplasty during the walking gait. The lower sagittal conformity of the tibial component can mitigate the abnormal internal-external rotation caused by tibial component malrotation in total knee arthroplasty, the higher coronal conformity of the tibial component can mitigate the abnormal medial-lateral translation caused by tibial component malrotation in total knee arthroplasty. INTERPRETATION This study highlights the importance of the tibiofemoral conformity designs on knee biomechanics caused by component malrotation in total knee arthroplasty. The optimization of the tibiofemoral conformity designs should be thoroughly considered in the design of new implants and in the planning of surgical procedures.
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Affiliation(s)
- Qida Zhang
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Yinghu Peng
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology Chinese Academy of Sciences, Shenzhen, China
| | - 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
- 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
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
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11
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Di Raimondo G, Willems M, Killen BA, Havashinezhadian S, Turcot K, Vanwanseele B, Jonkers I. Peak Tibiofemoral Contact Forces Estimated Using IMU-Based Approaches Are Not Significantly Different from Motion Capture-Based Estimations in Patients with Knee Osteoarthritis. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094484. [PMID: 37177688 PMCID: PMC10181595 DOI: 10.3390/s23094484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Altered tibiofemoral contact forces represent a risk factor for osteoarthritis onset and progression, making optimization of the knee force distribution a target of treatment strategies. Musculoskeletal model-based simulations are a state-of-the-art method to estimate joint contact forces, but they typically require laboratory-based input and skilled operators. To overcome these limitations, ambulatory methods, relying on inertial measurement units, have been proposed to estimated ground reaction forces and, consequently, knee contact forces out-of-the-lab. This study proposes the use of a full inertial-capture-based musculoskeletal modelling workflow with an underlying probabilistic principal component analysis model trained on 1787 gait cycles in patients with knee osteoarthritis. As validation, five patients with knee osteoarthritis were instrumented with 17 inertial measurement units and 76 opto-reflective markers. Participants performed multiple overground walking trials while motion and inertial capture methods were synchronously recorded. Moderate to strong correlations were found for the inertial capture-based knee contact forces compared to motion capture with root mean square error between 0.15 and 0.40 of body weight. The results show that our workflow can inform and potentially assist clinical practitioners to monitor knee joint loading in physical therapy sessions and eventually assess long-term therapeutic effects in a clinical context.
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Affiliation(s)
- Giacomo Di Raimondo
- Department of Movement Sciences, Katholieke Universiteit Leuven, 3001 Heverlee, Belgium
| | - Miel Willems
- Department of Movement Sciences, Katholieke Universiteit Leuven, 3001 Heverlee, Belgium
| | - Bryce Adrian Killen
- Department of Movement Sciences, Katholieke Universiteit Leuven, 3001 Heverlee, Belgium
| | | | - Katia Turcot
- Department of Kinesiology, Université Laval, Québec, QC G1V 0A6, Canada
| | - Benedicte Vanwanseele
- Department of Movement Sciences, Katholieke Universiteit Leuven, 3001 Heverlee, Belgium
| | - Ilse Jonkers
- Department of Movement Sciences, Katholieke Universiteit Leuven, 3001 Heverlee, Belgium
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12
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Dreyer MJ, Kneifel P, Hosseini Nasab SH, Weisse B, Taylor WR. A novel method to accurately recreate in vivo loads and kinematics in computational models of the knee. Comput Methods Biomech Biomed Engin 2023:1-7. [PMID: 37128680 DOI: 10.1080/10255842.2023.2206934] [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: 05/03/2023]
Abstract
Despite availability of in vivo knee loads and kinematics data, conventional load- and displacement-controlled configurations still can't accurately predict tibiofemoral loads from kinematics or vice versa. We propose a combined load- and displacement-control method for joint-level simulations of the knee to reliably reproduce in vivo contact mechanics. Prediction errors of the new approach were compared to those of conventional purely load- or displacement-controlled models using in vivo implant loads and kinematics for multiple subjects and activities (CAMS-Knee dataset). Our method reproduced both loads and kinematics more closely than conventional models and thus demonstrates clear advantages for investigating tibiofemoral contact or wear.
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Affiliation(s)
- Michael J Dreyer
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zurich, Switzerland
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - Paul Kneifel
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | | | - Bernhard Weisse
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - William R Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zurich, Switzerland
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13
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Tischer T, Geier A, Lutter C, Enz A, Bader R, Kebbach M. Patella height influences patellofemoral contact and kinematics following cruciate-retaining total knee replacement. J Orthop Res 2023; 41:793-802. [PMID: 35949157 DOI: 10.1002/jor.25425] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/02/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
The role of patella height is discussed controversially in total knee arthroplasty (TKA). Therefore, this computational study aims to systematically analyze the biomechanical effect of different patella heights on patellofemoral (PF) forces and kinematics after cruciate-retaining (CR) TKA. We implemented a CR bicondylar TKA with a dome patellar button in a validated dynamic musculoskeletal multibody model of a male human knee joint. Retropatellar dynamics (contact force [N], shear force [N], patellar shift [mm], tilt [°], and rotation [°]) were evaluated during dual-limb squat motion (flexion from 0° to 90°) with simulated active muscle forces and the effects of different patella heights (Blackburne-Peel [BP] ratio of 0.39, 0.49, 0.65, 0.85, 1.01, and 1.1 were systematically examined). As active knee flexion increased, PF contact force also increased. Patella alta (BP = 1.1) resulted in higher PF contact forces compared to normal patella height (BP = 0.65) by up to 16%. Contrarily, patella baja was associated with decreased PF forces by 7%. Compared to patella baja (BP = 0.39), patella alta (BP = 1.1) considerably increased the contact force by up to 25%. Different patellar heights mainly affected PF shear forces during early knee flexion. Concerning PF kinematics, patella alta (BP = 1.1) yielded a greater lateral tilt of more than 4° and higher patellar rotation by up to 3° during deep knee flexion, compared to normal patella height (BP = 0.65). Our computational study indicates that patella alta is associated with the highest PF contact and shear force after the implantation of a CR bicondylar TKA. This should be considered in PF disorders following TKA.
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Affiliation(s)
- Thomas Tischer
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Andreas Geier
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christoph Lutter
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Andreas Enz
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
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14
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Chen Y, Gong T, Jiang N, Zhao A, Wang T, Wang X, Han W. Dynamics analysis of the anterior cruciate ligament reconstruction surgery based on magnetic resonance imaging. Biotechnol Genet Eng Rev 2023:1-13. [PMID: 36877599 DOI: 10.1080/02648725.2023.2186324] [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: 01/10/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
In clinical practice, anterior cruciate ligament (ACL) rupture is always repaired by the single-beam reconstruction method. Before the surgery, the surgeon made the diagnosis based on medical images, such as CT (computerized tomography) and MR (magnetic resonance) images. However, little is known about how biomechanics governs the biological nature for femoral tunnel position. In the present study, three volunteers' motion trails were captured by six cameras when they were doing squat movement. The medical image can reconstruct the structure of the ligaments and bones and a left knee model was reconstructed by MIMICS by MRI data of DICOM format. Finally, the effects of different femoral tunnel positions on ACL biomechanics were characterized by the inverse dynamic analysis method. The results showed that there were significant differences in the direct mechanical effects of the anterior cruciate ligament at different locations of the femoral tunnel (p < 0.05), the peak stress of ACL in the low tension area was 1097.24 ± 25.55 N, and the peak stress of ACL in the distal femur was 356.81 ± 15.39 N, both of which were much higher than that in the direct fiber area (118.78 ± 20.68 N).
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Affiliation(s)
- Yadong Chen
- School of Electrical Engineering, Shenyang University of Technology, Shenyang, China
| | - Tianxing Gong
- School of Electrical Engineering, Shenyang University of Technology, Shenyang, China
| | - Nan Jiang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Aoxiang Zhao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Tongyu Wang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Xiangdong Wang
- Sports Science Research Institute of the State Sports General Administration, China Institute of Sport Science, Beijing, China
| | - Wenfeng Han
- Sports Science Research Institute of the State Sports General Administration, General Hospital of northern theater command, Shenyang, China
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15
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Effect of total knee arthroplasty for valgus knee correction on clinical outcome and patellar position. INTERNATIONAL ORTHOPAEDICS 2023; 47:735-743. [PMID: 36645475 PMCID: PMC9931837 DOI: 10.1007/s00264-023-05689-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/01/2023] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose was to investigate the effect of different degrees of valgus deformity correction on patellar position and clinical outcome in patients with valgus knees after total knee arthroplasty (TKA). METHODS We retrospectively analyzed and followed 118 patients with valgus knees. Based on the post-operative hip-knee-ankle (HKA), patients were divided into three groups: neutral (±3°), mild (3-6°), and severe (> 6°). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), and Knee Society Score (KSS) were used to evaluate post-operative clinical efficacy. Also, the patellar tilt angle (ε-angle), congruence angle (θ-angle), and Insall-Salvati index (ISI) were used to represent the patellar position. Post-operative observation indicators included HKA, angle of the femur (α-angle), tibial angle (β-angle), femoral component flexion angle (γ-angle), and tibial component posterior slope angle (δ-angle). RESULTS All patients showed significant improvements in HKA, ROM, WOMAC, and KSS after operation (P < 0.001). Regarding patellar position, the ISI values decreased to varying degrees (P < 0.05). The patellar tilt angle was significantly increased in the severe valgus group compared to that in the mild valgus and neutral groups (P < 0.001). Univariate analysis showed that the degree of post-operative residual valgus was significantly affected by WOMAC, KSS, α-, ε-, and θ-angles. CONCLUSION Minor valgus undercorrection did not affect the short-term outcome after TKA; however, when the residual valgus angle was > 6°, the post-operative scores were significantly reduced. Inadequate valgus correction does not result in significant changes in patellar height but may increase the risk of poor patellar tracking.
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16
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Yang H, Bayoglu R, Clary CW, Rullkoetter PJ. Impact of patient, surgical, and implant design factors on predicted tray-bone interface micromotions in cementless total knee arthroplasty. J Orthop Res 2023; 41:115-129. [PMID: 35437819 DOI: 10.1002/jor.25344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/14/2022] [Accepted: 04/16/2022] [Indexed: 02/04/2023]
Abstract
Micromotion magnitudes exceeding 150 µm may prevent bone formation and limit fixation after cementless total knee arthroplasty (TKA). Many factors influence the tray-bone interface micromotion but the critical parameters and sensitivities are less clear. In this study, we assessed the impacts of surgical (tray alignment, tibial coverage, and resection surface preparation), patient (bone properties and tibiofemoral kinematics), and implant design (tray feature and surface friction) factors on tray-bone interface micromotions during a series of activities of daily living. Micromotion was estimated via three previously validated implant-bone finite element models and tested under gait, deep knee bending, and stair descent loads. Overall, the average micromotion across the tray-bone cementless contact interface ranged from 9.3 to 111.4 µm, and peak micromotion was consistently found along the anterior tray edge. Maximizing tibial coverage above a properly sized tibial tray (an average of 12.3% additional area) had minimal impact on micromotion. A 1 mm anterior tray alignment change reduced the average micromotion by an average of 16.1%. Two-degree tibial angular resection errors reduced the area for bone ingrowth up to 48.1%. Differences on average micromotion from ±25% changes in bone moduli were up to 75.5%. A more posterior tibiofemoral contact due to additional 100 N posterior force resulted in an average of 79.3% increase on average micromotion. Overall, careful surgical technique, patient selection, and controlling kinematics through articular design all contribute meaningfully to minimizing micromotion in cementless TKA, with centralizing the load transfer to minimize the resulting moment at the anterior tray perimeter a consistent theme.
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Affiliation(s)
- Huizhou Yang
- Center for Orthopaedic Biomechanics, University of Denver, Denver, Colorado, USA
| | - Riza Bayoglu
- Center for Orthopaedic Biomechanics, University of Denver, Denver, Colorado, USA
| | - Chadd W Clary
- Center for Orthopaedic Biomechanics, University of Denver, Denver, Colorado, USA
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Denver, Colorado, USA
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17
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Amiri P, Bull AMJ. Prediction of in vivo hip contact forces during common activities of daily living using a segment-based musculoskeletal model. Front Bioeng Biotechnol 2022; 10:995279. [PMID: 36588939 PMCID: PMC9797521 DOI: 10.3389/fbioe.2022.995279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Quantifying in vivo hip muscle and contact forces during activities of daily living (ADL) provides valuable information for diagnosis and treatment of hip-related disorders. The objective of this study was to utilize Freebody, a segment-based musculoskeletal model, for the prediction of hip contact forces using a novel objective function during seven common ADLs and validate its performance against the publicly available HIP98 dataset. Methods: Marker data, ground reaction forces, and hip contact forces during slow, normal, and fast walking, stair ascent and descent, and standing up and sitting down were extracted for 3 subjects from the HIP98 dataset. A musculoskeletal anatomical dataset was scaled to match the dimensions of each subject, and muscle and hip contact forces were estimated by minimizing a novel objective function, which was the summation of the muscle stresses squared and body weight-normalised hip contact force. The accuracy of predictions were quantified using several metrics, and muscle forces were qualitatively compared to experimental EMGs in the literature. Results: FreeBody predicted the hip contact forces during the ADLs with encouraging accuracy: The root mean squared error of predictions were 44.0 ± 8.5, 47.4 ± 6.5, and 59.8 ± 7.1% BW during slow, normal, and fast walking, 44.2 ± 16.8% and 53.3 ± 12.2% BW for stair ascent and descent, and 31.8 ± 8.2% and 17.1 ± 5.0% BW for standing up and sitting down, respectively. The error in prediction of peak hip contact forces were 14-18%, 24-28%, 17-35% for slow, normal, and fast walking, 7-25% and 15-32% in stair ascent and descent, and around 10% for standing up and sitting down. The coefficient of determination was larger than 0.90 in all activities except in standing up (0.86 ± 0.08). Conclusion: This study has implemented a novel objective function in a segment-based musculoskeletal model, FreeBody, for the prediction of hip contact forces during a large range of ADLs. The model outputs compare favourably for all ADLs and are the best in standing up and sitting down, while muscle activation patterns are consistent with experimental EMGs from literature. This new objective function addresses one of the major limitations associated with musculoskeletal models in the literature, namely the high non-physiological predicted hip joint contact forces.
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18
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Ogawa H, Sengoku M, Shimokawa T, Nakamura Y, Ohnishi K, Matsumoto K, Akiyama H. Extra-articular factors of the femur and tibia affecting knee balance in mechanically aligned total knee arthroplasty. Orthop Traumatol Surg Res 2022; 108:103297. [PMID: 35508294 DOI: 10.1016/j.otsr.2022.103297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/22/2022] [Accepted: 03/21/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Although the joint gap distance and compartment loading of the knee are different parameters for obtaining balanced knees in patients with total knee arthroplasty (TKA), the extent to which a balanced knee is achieved in patients with mechanically aligned TKA (MA-TKA) is unclear. This study aimed to investigate the anatomical factors that affect the ligament balancing in MA-TKA according to a gap balancing technique by measured resection technique. METHODS The relationship between compartment loading, gap distance, and lower limb alignment was analysed in forty-three patients who underwent navigation-assisted MA-TKA with the minimum soft-tissue release. Radiographic parameters included hip-knee-ankle (HKA) angle, femorotibial angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, posterior tibial slope, varus and valgus joint line convergence angle, femoral valgus angle, femoral shaft curve, and tibial shaft curve (TSC). RESULTS The postoperative HKA angle was 0.4±1.5°, with one coronal alignment outlier (2.3%). The gap distance showed four unbalanced knees for extension (9.3%) and flexion (9.3%), whereas the compartment loading identified 17 unbalanced knees (39.5%) at extension, 8 (18.6%) at 45° flexion, 7 (16.2%) at 90° flexion, and 10 (23.2%) at full flexion in MA-TKA. Mediolateral differentials of compartment loading correlated with femoral valgus angle (0°, 45°, and 90° flexion), mLDFA (45° and 90° flexion), and TSC (45° and 90° flexion). Femoral valgus angle and TSC were risk factors of the mediolateral differentials of compartment loading. CONCLUSION Extra-articular factors of femoral valgus angle, mLDFA, and TSC were associated with the mediolateral imbalance of compartmental loading, suggesting there is a limit to obtaining balanced knees in MA-TKA due to these unadjustable extra-articular factors. LEVEL OF EVIDENCE IV, therapeutic case series.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan; Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan.
| | - Masaya Sengoku
- Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Tetsuya Shimokawa
- Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Yutaka Nakamura
- Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Kazuichiro Ohnishi
- Department of Orthopaedic Surgery, Ogaki-Tokushukai Hospital, Hayashi-machi 6-85-1, 503-0015 Ogaki, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan
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19
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Bartsoen L, Faes MGR, Wirix-Speetjens R, Moens D, Jonkers I, Sloten JV. Probabilistic planning for ligament-balanced TKA-Identification of critical ligament properties. Front Bioeng Biotechnol 2022; 10:930724. [PMID: 36466330 PMCID: PMC9713239 DOI: 10.3389/fbioe.2022.930724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/30/2022] [Indexed: 04/04/2024] Open
Abstract
Total knee arthroplasty (TKA) failures are often attributed to unbalanced knee ligament loading. The current study aims to develop a probabilistic planning process to optimize implant component positioning that achieves a ligament-balanced TKA. This planning process accounts for both subject-specific uncertainty, in terms of ligament material properties and attachment sites, and surgical precision related to the TKA process typically used in clinical practice. The consequent uncertainty in the implant position parameters is quantified by means of a surrogate model in combination with a Monte Carlo simulation. The samples for the Monte Carlo simulation are generated through Bayesian parameter estimation on the native knee model in such a way that each sample is physiologically relevant. In this way, a subject-specific uncertainty is accounted for. A sensitivity analysis, using the delta-moment-independent sensitivity measure, is performed to identify the most critical ligament parameters. The designed process is capable of estimating the precision with which the targeted ligament-balanced TKA can be realized and converting this into a success probability. This study shows that without additional subject-specific information (e.g., knee kinematic measurements), a global success probability of only 12% is estimated. Furthermore, accurate measurement of reference strains and attachment sites critically improves the success probability of the pre-operative planning process. To allow more precise planning, more accurate identification of these ligament properties is required. This study underlines the relevance of investigating in vivo or intraoperative measurement techniques to minimize uncertainty in ligament-balanced pre-operative planning results, particularly prioritizing the measurement of ligament reference strains and attachment sites.
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Affiliation(s)
- Laura Bartsoen
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | | | | | - David Moens
- Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Movement Science Department, KU Leuven, Leuven, Belgium
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20
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Clinical outcomes in TKA are enhanced by both robotic assistance and patient specific alignment: a comparative trial in 120 patients. Arch Orthop Trauma Surg 2022; 143:3391-3399. [PMID: 36192660 DOI: 10.1007/s00402-022-04636-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 09/18/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Robotically assisted surgery was introduced in total knee arthroplasty (TKA) to increase the precision of implant positioning and optimize clinical outcomes. However, the target implant position or alignment is debated. The aim of this study was twofold: to compare clinical outcomes of conventional TKA vs. robotically assisted TKA in an adjusted mechanically aligned (MA) TKA series, and to analyze the clinical effects of introducing patient-specific alignment (inverse kinematic alignment, iKA) in a robotically assisted TKA cohort. MATERIALS AND METHODS A total of 120 patients with end stage osteoarthritis of the knee were enrolled. The first group (n = 40) received conventional adjusted MA TKA. The second group (n = 40) received robotically assisted adjusted MA TKA. The third group (n = 40) received robotically assisted iKA TKA. All patients received cruciate retaining Triathlon TKA with a uniform surgery protocol. The three groups were matched for age, sex, BMI and preoperative osteoarthritis. Preoperative and 1-year postoperative clinical outcomes were documented with the Oxford Knee Score (OKS). RESULTS Comparison of OKS between the MA groups indicated no significant difference (p = 0.223) between the conventional TKA (group 1; 40.2 ± 5.9) and robotically assisted TKA (group 2; 42.2 ± 6.3) 1 year postoperatively. Comparison of OKS between the robotically assisted groups indicated no significant difference (p = 0.078) between the MA TKA (group 2; 42.2 ± 6.3) and iKA TKA (group 3; 44.8 ± 3.5). Comparison of conventional MA TKA (group 1; 40.3 ± 6.0) with robotically assisted iKA TKA (group 3; 44.8 ± 3.5) indicated a significant difference (p < 0.001). CONCLUSIONS The results of this study suggest that the introduction of both patient-specific alignment and robotically assisted surgery improve clinical outcomes in TKA surgery. When access to robotic assistance is available, performing patient-specific alignment should be the objective.
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Raju V, Koorata PK. Influence of material heterogeneity on the mechanical response of articulated cartilages in a knee joint. Proc Inst Mech Eng H 2022; 236:1340-1348. [DOI: 10.1177/09544119221116263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Structurally, the articular cartilages are heterogeneous owing to nonuniform distribution and orientation of its constituents. The oversimplification of this soft tissue as a homogeneous material is generally considered in the simulation domain to estimate contact pressure along with other physical responses. Hence, there is a need for investigating knee cartilages for their actual response to external stimuli. In this article, impact of material and geometrical heterogeneity of the cartilage is resolved using well known material models. The findings are compared with conventional homogeneous models. The results indicate vital differences in contact pressure distribution and tissue deformation. Further, this study paves way for standardizing material models to extract maximum information possible for investigating knee mechanics with variable geometry and case specific parameters.
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Affiliation(s)
- Vaishakh Raju
- Applied Solid Mechanics Laboratory, Department of Mechanical Engineering, National Institute of Technology Karnataka, Surathkal, Karnataka, India
| | - Poornesh Kumar Koorata
- Applied Solid Mechanics Laboratory, Department of Mechanical Engineering, National Institute of Technology Karnataka, Surathkal, Karnataka, India
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22
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Winnock de Grave P, Kellens J, Luyckx T, Tampere T, Lacaze F, Claeys K. Inverse Kinematic Alignment for Total Knee Arthroplasty. Orthop Traumatol Surg Res 2022; 108:103305. [PMID: 35513224 DOI: 10.1016/j.otsr.2022.103305] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
Patient specific alignment might improve clinical outcomes in total knee arthroplasty (TKA). Different alignment concepts are described, each providing specific features with theoretical benefits or possible disadvantages. Inverse kinematic alignment (iKA) is a new patient specific alignment concept with excellent reported clinical outcome and patient satisfaction at short-term follow-up. iKA is a tibia-first, gap balancing technique restoring the native tibial joint line obliquity (JLO). In each patient, within boundaries, equal medial and lateral tibial resections are performed, compensating for cartilage and bone loss. We describe the surgical technique of iKA using a robotic assisted system (Mako, Stryker, Kalamazoo, USA). A case series of 100 consecutive iKA cases is assessed and the bony resections and resection angles are reported. Both in the coronal plane and axial plane, iKA might offer advantages over existing alignment strategies, possibly providing optimal clinical outcome and durable long-term survival, regardless of the alignment is varus, neutral or valgus.
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Affiliation(s)
- Philip Winnock de Grave
- AZ Delta Roeselare, Department Orthopaedic Surgery, Roeselare, Belgium; KU Leuven, Department Rehabilitation Sciences, Brugge, Belgium.
| | - Jonas Kellens
- UZ Leuven, Department Orthopaedic Surgery, Leuven, Belgium
| | - Thomas Luyckx
- AZ Delta Roeselare, Department Orthopaedic Surgery, Roeselare, Belgium; UZ Leuven, Department Orthopaedic Surgery, Leuven, Belgium
| | - Thomas Tampere
- AZ Delta Roeselare, Department Orthopaedic Surgery, Roeselare, Belgium; UZ Gent, Department Orthopaedic Surgery, Gent, Belgium
| | - Franck Lacaze
- Orthosud, Clinic Saint Jean de France, Saint Jean de Vedas, France
| | - Kurt Claeys
- KU Leuven, Department Rehabilitation Sciences, Brugge, Belgium
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23
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陈 瑱, 张 志, 高 永, 张 静, 郭 磊, 靳 忠. [Musculoskeletal multibody dynamics investigation of posterior-stabilized total knee prosthesis]. SHENG WU YI XUE GONG CHENG XUE ZA ZHI = JOURNAL OF BIOMEDICAL ENGINEERING = SHENGWU YIXUE GONGCHENGXUE ZAZHI 2022; 39:651-659. [PMID: 36008328 PMCID: PMC10957355 DOI: 10.7507/1001-5515.202203023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/24/2022] [Indexed: 06/15/2023]
Abstract
Posterior-stabilized total knee prostheses have been widely used in orthopedic clinical treatment of knee osteoarthritis, but the patients and surgeons are still troubled by the complications, for example severe wear and fracture of the post, as well as prosthetic loosening. Understanding the in vivo biomechanics of knee prostheses will aid in the decrease of postoperative prosthetic revision and patient dissatisfaction. Therefore, six different designs of posterior-stabilized total knee prostheses were used to establish the musculoskeletal multibody dynamics models of total knee arthroplasty respectively, and the biomechanical differences of six posterior-stabilized total knee prostheses were investigated under three simulated physiological activities: walking, right turn and squatting. The results showed that the post contact forces of PFC Sigma and Scorpio NGR prostheses were larger during walking, turning right, and squatting, which may increase the risk of the fracture and wear as well as the early loosening. The post design of Gemini SL prosthesis was more conductive to the knee internal-external rotation and avoided the edge contact and wear. The lower conformity design in sagittal plane and the later post-cam engagement resulted in the larger anterior-posterior translation. This study provides a theoretical support for guiding surgeon selection, improving posterior-stabilized prosthetic design and reducing the prosthetic failure.
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Affiliation(s)
- 瑱贤 陈
- 长安大学 工程机械学院(西安 710064)School of Construction Machinery, Chang'an University, Xi’an 710064, P. R. China
| | - 志峰 张
- 长安大学 工程机械学院(西安 710064)School of Construction Machinery, Chang'an University, Xi’an 710064, P. R. China
| | - 永昌 高
- 长安大学 工程机械学院(西安 710064)School of Construction Machinery, Chang'an University, Xi’an 710064, P. R. China
| | - 静 张
- 长安大学 工程机械学院(西安 710064)School of Construction Machinery, Chang'an University, Xi’an 710064, P. R. China
| | - 磊 郭
- 长安大学 工程机械学院(西安 710064)School of Construction Machinery, Chang'an University, Xi’an 710064, P. R. China
| | - 忠民 靳
- 长安大学 工程机械学院(西安 710064)School of Construction Machinery, Chang'an University, Xi’an 710064, P. R. China
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Ro J, Ro DH, Kang Y, Han HS, Shin CS. Biomechanical Effect of Coronal Alignment and Ligament Laxity in Total Knee Arthroplasty: A Simulation Study. Front Bioeng Biotechnol 2022; 10:851495. [PMID: 35480980 PMCID: PMC9035799 DOI: 10.3389/fbioe.2022.851495] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
The purposes of this study were to develop a cruciate-retaining total knee arthroplasty musculoskeletal model, which enables the adjustment of ligament length and implant alignment; validate the model; and evaluate the effects of varus/valgus alignment adjustment and unbalanced medial/lateral ligament laxity during gait. A cruciate-retaining total knee arthroplasty musculoskeletal model was constructed and validated against the in vivo contact forces. This model was transformed to 2° varus/valgus alignment of femoral or tibial replacement models and 2° medial/lateral laxity models. The contact forces and ligament tensions of the adjusted models were calculated. The contact forces in the model showed good agreement with the in vivo contact forces. Valgus replacement alignment with balanced ligament models showed a lower contact force at the medial compartment than at the neutral alignment model, whereas the varus replacement alignment with balanced ligament models showed a greater contact force at the medial compartment and medial/posterior cruciate ligament tension. The medial laxity with neutral alignment model showed a similar contact force with decreased medial ligament tension compared to the balanced neutral alignment model, whereas the lateral laxity with the neutral alignment model showed a greater contact force and decreased lateral ligament tension. The cruciate-retaining total knee arthroplasty model was validated using in vivo contact forces (r = 0.939) Two degrees of valgus alignment adjustment with balanced ligament or neutral alignment with 2° of medial laxity can be safe without increasing contact force or ligament tension compared to neutral alignment with a balanced extension gap. However, 2° of varus alignment adjustment with balanced ligament or neutral alignment with 2° of lateral laxity may be unfavorable due to the overloading of the joints and knee ligaments.
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Affiliation(s)
- Jaehun Ro
- Central R&D Center, Corentec Co., Ltd., Seoul, Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- CONNECTEVE Co., Ltd, Seoul, Korea
| | - Yeokyung Kang
- Central R&D Center, Corentec Co., Ltd., Seoul, Korea
- Department of Biomedical Engineering, Yonsei University, Seoul, Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- *Correspondence: Hyuk-Soo Han, ; Choongsoo S. Shin,
| | - Choongsoo S. Shin
- Department of Mechanical Engineering, Sogang University, Seoul, Korea
- *Correspondence: Hyuk-Soo Han, ; Choongsoo S. Shin,
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Glenday JD, Wright TM, Lipman JD, Sculco PK, Mayman DJ, Vigdorchik JM, Quevedo-Gonzalez FJ. Effect of varus alignment on the bone-implant interaction of a cementless tibial baseplate during gait. J Orthop Res 2022; 40:816-825. [PMID: 34231249 DOI: 10.1002/jor.25129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/01/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
Component alignment in total knee arthroplasty is a determining factor for implant longevity. Mechanical alignment, which provides balanced load transfer, is the most common alignment strategy. However, a retrospective review found that varus alignment, which could lead to unbalanced loading, can happen in up to 18% of tibial baseplates. This may be particularly burdensome for cementless tibial baseplates, which require low bone-implant micromotion and avoidance of bone overload to obtain bone ingrowth. Our aim was to assess the effect of varus alignment on the bone-implant interaction of cementless baseplates. We virtually implanted 11 patients with knee OA with a modern cementless tibial baseplate in mechanical alignment and in 2° of tibial varus alignment. We performed finite element simulations throughout gait, with loading conditions derived from literature. Throughout the stance phase, varus alignment had greater micromotion and percentage of bone volume at risk of failure than mechanical alignment. At mid-stance, when the most critical conditions occurred, the average increase in peak micromotion and amount of bone at risk of failure due to varus alignment were 79% and 59%, respectively. Varus alignment also resulted in the decrease of the surface area with micromotion compatible with bone ingrowth. However, for both alignments, this surface area was larger than the average area of ingrowth reported for well-fixed implants retrieved post-mortem. Our findings suggest that small varus deviations from mechanical alignment can adversely impact the biomechanics of the bone-implant interaction for cementless tibial baseplates during gait; however, the clinical implications of such changes remain unclear.
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Influence of Articular Geometry and Tibial Tubercle Location on Patellofemoral Kinematics and Contact Mechanics. J Appl Biomech 2022; 38:58-66. [PMID: 35045394 DOI: 10.1123/jab.2021-0162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/03/2021] [Accepted: 12/08/2021] [Indexed: 11/18/2022]
Abstract
Trochlear groove geometry and the location of the tibial tubercle, where the patellar tendon inserts, have both been associated with patellofemoral instability and can be modified surgically. Although their effects on patellofemoral biomechanics have been investigated individually, the interaction between the two is unclear. The authors' aim was to use statistical shape modeling and musculoskeletal simulation to examine the effect of patellofemoral geometry on the relationship between tibial tubercle location and patellofemoral function. A statistical shape model was used to generate new knee geometries with trochlear grooves ranging from shallow to deep. A Monte Carlo approach was used to create 750 knee models by randomly selecting a geometry and randomly translating the tibial tubercle medially/laterally and anteriorly. Each knee model was incorporated into a musculoskeletal model, and an overground walking trial was simulated. Knees with shallow trochlear geometry were more sensitive to tubercle medialization with greater changes in lateral patella position (-3.0 mm/cm medialization shallow vs -0.6 mm/cm deep) and cartilage contact pressure (-0.51 MPa/cm medialization shallow vs 0.04 MPa/cm deep). However, knees with deep trochlear geometry experienced greater increases in medial cartilage contact pressure with medialization. This modeling framework has the potential to aid in surgical decision making.
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Daszkiewicz K, Łuczkiewicz P. Biomechanics of the medial meniscus in the osteoarthritic knee joint. PeerJ 2021; 9:e12509. [PMID: 34900428 PMCID: PMC8627128 DOI: 10.7717/peerj.12509] [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: 05/27/2021] [Accepted: 10/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background Increased mechanical loading and pathological response of joint tissue to the abnormal mechanical stress can cause degradation of cartilage characteristic of knee osteoarthritis (OA). Despite osteoarthritis is risk factor for the development of meniscal lesions the mechanism of degenerative meniscal lesions is still unclear. Therefore, the aim of the study is to investigate the influence of medial compartment knee OA on the stress state and deformation of the medial meniscus. Methods The finite element method was used to simulate the stance phase of the gait cycle. An intact knee model was prepared based on magnetic resonance scans of the left knee joint of a healthy volunteer. Degenerative changes in the medial knee OA model were simulated by nonuniform reduction in articular cartilage thickness in specific areas and by a decrease in the material parameters of cartilage and menisci. Two additional models were created to separately evaluate the effect of alterations in articular cartilage geometry and material parameters of the soft tissues on the results. A nonlinear dynamic analysis was performed for standardized knee loads applied to the tibia bone. Results The maximum von Mises stress of 26.8 MPa was observed in the posterior part of the medial meniscus body in the OA model. The maximal hoop stress for the first peak of total force was 83% greater in the posterior horn and only 11% greater in the anterior horn of the medial meniscus in the OA model than in the intact model. The reduction in cartilage thickness caused an increase of 57% in medial translation of the medial meniscus body. A decrease in the compressive modulus of menisci resulted in a 2.5-fold greater reduction in the meniscal body width compared to the intact model. Conclusions Higher hoop stress levels on the inner edge of the posterior part of the medial meniscus in the OA model than in the intact model are associated with a greater medial translation of the meniscus body and a greater reduction in its width. The considerable increase in hoop stresses shows that medial knee OA may contribute to the initiation of meniscal radial tears.
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Affiliation(s)
- Karol Daszkiewicz
- Department of Mechanics of Materials and Structures, Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk, Poland
| | - Piotr Łuczkiewicz
- II Department of Orthopaedics and Kinetic Organ Traumatology, Medical University of Gdańsk, Gdańsk, Poland
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Kainz H, Schwartz MH. The importance of a consistent workflow to estimate muscle-tendon lengths based on joint angles from the conventional gait model. Gait Posture 2021; 88:1-9. [PMID: 33933913 DOI: 10.1016/j.gaitpost.2021.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Musculoskeletal models enable us to estimate muscle-tendon length, which has been shown to improve clinical decision-making and outcomes in children with cerebral palsy. Most clinical gait analysis services, however, do not include muscle-tendon length estimation in their clinical routine. This is due, in part, to a lack of knowledge and trust in the musculoskeletal models, and to the complexity involved in the workflow to obtain the muscle-tendon length. RESEARCH QUESTION Can the joint angles obtained with the conventional gait model (CGM) be used to generate accurate muscle-tendon length estimates? METHODS Three-dimensional motion capture data of 15 children with cerebral palsy and 15 typically developing children were retrospectively analyzed and used to estimate muscle-tendon length with the following four modelling frameworks: (1) 2392-OSM-IK-angles: standard OpenSim workflow including scaling, inverse kinematics and muscle analysis; (2) 2392-OSM-CGM-angle: generic 2392-OpenSim model driven with joint angles from the CGM; (3) modif-OSM-IK-angles: standard OpenSim workflow including inverse kinematics and a modified model with segment coordinate systems and joint degrees-of-freedom similar to the CGM; (4) modif-OSM-CGM-angles: modified model driven with joint angles from the CGM. Joint kinematics and muscle-tendon length were compared between the different modelling frameworks. RESULTS Large differences in hip joint kinematics were observed between the CGM and the 2392-OpenSim model. The modif-OSM showed similar kinematics as the CGM. Muscle-tendon length obtained with modif-OSM-IK-angles and modif-OSM-CGM-angles were similar, whereas large differences in some muscle-tendon length were observed between 2392-OSM-IK-angles and 2392-OSM-CGM-angles. SIGNIFICANCE The modif-OSM-CGM-angles framework enabled us to estimate muscle-tendon lengths without the need for scaling a musculoskeletal model and running inverse kinematics. Hence, muscle-tendon length estimates can be obtained simply, without the need for the complexity, knowledge and time required for musculoskeletal modeling and associated software. An instruction showing how the framework can be used in a clinical setting is provided on https://github.com/HansUniVie/MuscleLength.
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Affiliation(s)
- Hans Kainz
- Centre for Sport Science and University Sports, Department of Biomechanics, Kinesiology and Computer Science in Sport, Neuromechanics Research Group, University of Vienna, Vienna, Austria.
| | - Michael H Schwartz
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St Paul, MN, USA; Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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Bartsoen L, Faes MGR, Wesseling M, Wirix-Speetjens R, Moens D, Jonkers I, Sloten JV. Computationally Efficient Optimization Method to Quantify the Required Surgical Accuracy for a Ligament Balanced TKA. IEEE Trans Biomed Eng 2021; 68:3273-3280. [PMID: 33780331 DOI: 10.1109/tbme.2021.3069330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study proposes a computationally efficient method to quantify the effect of surgical inaccuracies on ligament strain in total knee arthroplasty (TKA). More specifically, this study describes a framework to determine the implant position and required surgical accuracy that results in a ligament balanced post-operative outcome with a probability of 90%. METHODS The response surface method is used to translate uncertainty in the implant position parameters to uncertainty in the ligament strain. The designed uncertainty quantification technique allows for an optimization with feasible computational cost towards the planned implant position and the tolerated surgical error for each of the twelve degrees of freedom of the implant position. RESULTS It is shown that the error does not allow for a ligament balanced TKA with a probability of 90% using preoperative planning. Six critical implant position parameters can be identified, namely AP translation, PD translation, VV rotation, IE rotation for the femoral component and PD translation, VV rotation for the tibial component. CONCLUSION We introduced an optimization process that allows for the computation of the required surgical accuracy for a ligament balanced postoperative outcome using preoperative planning with feasible computational cost. SIGNIFICANCE Towards the research society, the proposed method allows for a computationally efficient uncertainty quantification on a complex model. Towards surgical technique developers, six critical implant position parameters were identified, which should be the focus when refining surgical accuracy of TKA, leveraging better patient satisfaction.
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Lahkar BK, Rohan PY, Pillet H, Thoreux P, Skalli W. Development and evaluation of a new procedure for subject-specific tensioning of finite element knee ligaments. Comput Methods Biomech Biomed Engin 2021; 24:1195-1205. [PMID: 33427509 DOI: 10.1080/10255842.2020.1870220] [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: 10/22/2022]
Abstract
Subject-specific tensioning of ligaments is essential for the stability of the knee joint and represents a challenging aspect in the development of finite element models. We aimed to introduce and evaluate a new procedure for the quantification of ligament prestrains from biplanar X-ray and CT data. Subject-specific model evaluation was performed by comparing predicted femorotibial kinematics with the in vitro response of six cadaveric specimens. The differences obtained using personalized models were comparable to those reported in similar studies in the literature. This study is the first step toward the use of simplified, personalized knee FE models in clinical context such as ligament balancing.
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Affiliation(s)
- Bhrigu K Lahkar
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Helene Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Patricia Thoreux
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France.,Université Sorbonne Paris Nord, Bobigny, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
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Holder J, Trinler U, Meurer A, Stief F. A Systematic Review of the Associations Between Inverse Dynamics and Musculoskeletal Modeling to Investigate Joint Loading in a Clinical Environment. Front Bioeng Biotechnol 2020; 8:603907. [PMID: 33365306 PMCID: PMC7750503 DOI: 10.3389/fbioe.2020.603907] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022] Open
Abstract
The assessment of knee or hip joint loading by external joint moments is mainly used to draw conclusions on clinical decision making. However, the correlation between internal and external loads has not been systematically analyzed. This systematic review aims, therefore, to clarify the relationship between external and internal joint loading measures during gait. A systematic database search was performed to identify appropriate studies for inclusion. In total, 4,554 articles were identified, while 17 articles were finally included in data extraction. External joint loading parameters were calculated using the inverse dynamics approach and internal joint loading parameters by musculoskeletal modeling or instrumented prosthesis. It was found that the medial and total knee joint contact forces as well as hip joint contact forces in the first half of stance can be well predicted using external joint moments in the frontal plane, which is further improved by including the sagittal joint moment. Worse correlations were found for the peak in the second half of stance as well as for internal lateral knee joint contact forces. The estimation of external joint moments is useful for a general statement about the peak in the first half of stance or for the maximal loading. Nevertheless, when investigating diseases as valgus malalignment, the estimation of lateral knee joint contact forces is necessary for clinical decision making because external joint moments could not predict the lateral knee joint loading sufficient enough. Dependent on the clinical question, either estimating the external joint moments by inverse dynamics or internal joint contact forces by musculoskeletal modeling should be used.
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Affiliation(s)
- Jana Holder
- Faculty of Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany.,Movement Analysis Laboratory, Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt am Main, Germany
| | - Ursula Trinler
- Laboratory for Movement Analysis, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Andrea Meurer
- Department of Special Orthopedics, Orthopedic University Hospital Friedrichsheim gGmbH, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Stief
- Faculty of Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany.,Movement Analysis Laboratory, Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt am Main, Germany
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Vignos MF, Smith CR, Roth JD, Kaiser JM, Baer GS, Kijowski R, Thelen DG. Anterior Cruciate Ligament Graft Tunnel Placement and Graft Angle Are Primary Determinants of Internal Knee Mechanics After Reconstructive Surgery. Am J Sports Med 2020; 48:3503-3514. [PMID: 33175559 PMCID: PMC8374934 DOI: 10.1177/0363546520966721] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Graft placement is a modifiable and often discussed surgical factor in anterior cruciate ligament (ACL) reconstruction (ACLR). However, the sensitivity of functional knee mechanics to variability in graft placement is not well understood. PURPOSE To (1) investigate the relationship of ACL graft tunnel location and graft angle with tibiofemoral kinematics in patients with ACLR, (2) compare experimentally measured relationships with those observed with a computational model to assess the predictive capabilities of the model, and (3) use the computational model to determine the effect of varying ACL graft tunnel placement on tibiofemoral joint mechanics during walking. STUDY DESIGN Controlled laboratory study. METHODS Eighteen participants who had undergone ACLR were tested. Bilateral ACL footprint location and graft angle were assessed using magnetic resonance imaging (MRI). Bilateral knee laxity was assessed at the completion of rehabilitation. Dynamic MRI was used to measure tibiofemoral kinematics and cartilage contact during active knee flexion-extension. Additionally, a total of 500 virtual ACLR models were created from a nominal computational knee model by varying ACL footprint locations, graft stiffness, and initial tension. Laxity tests, active knee extension, and walking were simulated with each virtual ACLR model. Linear regressions were performed between internal knee mechanics and ACL graft tunnel locations and angles for the patients with ACLR and the virtual ACLR models. RESULTS Static and dynamic MRI revealed that a more vertical graft in the sagittal plane was significantly related (P < .05) to a greater laxity compliance index (R2 = 0.40) and greater anterior tibial translation and internal tibial rotation during active knee extension (R2 = 0.22 and 0.23, respectively). Similarly, knee extension simulations with the virtual ACLR models revealed that a more vertical graft led to greater laxity compliance index, anterior translation, and internal rotation (R2 = 0.56, 0.26, and 0.13). These effects extended to simulations of walking, with a more vertical ACL graft inducing greater anterior tibial translation, ACL loading, and posterior migration of contact on the tibial plateaus. CONCLUSION This study provides clinical evidence from patients who underwent ACLR and from complementary modeling that functional postoperative knee mechanics are sensitive to graft tunnel locations and graft angle. Of the factors studied, the sagittal angle of the ACL was particularly influential on knee mechanics. CLINICAL RELEVANCE Early-onset osteoarthritis from altered cartilage loading after ACLR is common. This study shows that postoperative cartilage loading is sensitive to graft angle. Therefore, variability in graft tunnel placement resulting in small deviations from the anatomic ACL angle might contribute to the elevated risk of osteoarthritis after ACLR.
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Affiliation(s)
- Michael F. Vignos
- Department of Mechanical Engineering, University of Wisconsin – Madison 1513 University Avenue, Madison, WI, USA 53706
| | - Colin R. Smith
- Department of Mechanical Engineering, University of Wisconsin – Madison 1513 University Avenue, Madison, WI, USA 53706
| | - Joshua D. Roth
- Department of Mechanical Engineering, University of Wisconsin – Madison1513 University Avenue, Madison, WI, USA 53706
| | - Jarred M. Kaiser
- Department of Mechanical Engineering, University of Wisconsin – Madison 1513 University Avenue, Madison, WI, USA 53706
| | - Geoffrey S. Baer
- Department of Orthopedics and Rehabilitation, University of Wisconsin - Madison, 1685 Highland Avenue, Madison, WI, USA 53705
| | - Richard Kijowski
- Department of Radiology, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI 53792
| | - Darryl G. Thelen
- Department of Mechanical Engineering, University of Wisconsin – Madison 1513 University Avenue, Madison, WI, USA 53706
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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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Khasian M, Meccia BA, LaCour MT, Komistek RD. A Validated Forward Solution Dynamics Mathematical Model of the Knee Joint: Can It Be an Effective Alternative for Implant Evaluation? J Arthroplasty 2020; 35:3289-3299. [PMID: 32631725 DOI: 10.1016/j.arth.2020.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mathematical modeling is among the most common computational tools for assessing total knee arthroplasty (TKA) mechanics of different implant designs and surgical alignments. The main objective of this study is to describe and validate a forward solution mathematical of the knee joint to investigate the effects of TKA design and surgical conditions on TKA outcomes. METHODS A 12-degree of freedom mathematical model of the human knee was developed. This model includes the whole lower extremity of the human body and comprises major muscles and ligaments at the knee joint. The muscle forces are computed using a proportional-integral-derivative controller, and the joint forces are calculated using a contact detection algorithm. The model was validated using telemetric implants and fluoroscopy, and the sensitivity analyses were performed to determine how sensitive the model is to both implant design, which was analyzed by varying medial conformity of the polyethylene, and surgical alignment, which was analyzed by varying the posterior tibial tilt. RESULTS The model predicted the tibiofemoral joint forces with an average accuracy of 0.14× body weight (BW), 0.13× BW, and 0.17× BW root-mean-square errors for lateral, medial, and total tibiofemoral contact forces. With fluoroscopy, the kinematics were validated with an average accuracy of 0.44 mm, 0.62 mm, and 0.77 root-mean-square errors for lateral anteroposterior position, medial anteroposterior position, and axial rotation, respectively. Increasing medial conformity resulted in reducing the paradoxical anterior sliding midflexion. Furthermore, increasing posterior tibial slopes shifted the femoral contact point more posterior on the bearing and reduced the tension in the posterior cruciate ligament. CONCLUSION A forward solution dynamics model of the knee joint was developed and validated using telemetry devices and fluoroscopy data. The results of this study suggest that a validated mathematical model can be used to predict the effects of component design and surgical conditions on TKA outcomes.
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Affiliation(s)
- Milad Khasian
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Bradley A Meccia
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Michael T LaCour
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Richard D Komistek
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
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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: 15] [Impact Index Per Article: 3.8] [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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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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Hosseini Nasab SH, Smith C, Schütz P, Postolka B, Ferguson S, Taylor WR, List R. Elongation Patterns of the Posterior Cruciate Ligament after Total Knee Arthroplasty. J Clin Med 2020; 9:E2078. [PMID: 32630654 PMCID: PMC7408829 DOI: 10.3390/jcm9072078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022] Open
Abstract
This study aimed to understand the ability of fixed-bearing posterior cruciate ligament (PCL)-retaining implants to maintain functionality of the PCL in vivo. To achieve this, elongation of the PCL was examined in six subjects with good clinical and functional outcomes using 3D kinematics reconstructed from video-fluoroscopy, together with multibody modelling of the knee. Here, length-change patterns of the ligament bundles were tracked throughout complete cycles of level walking and stair descent. Throughout both activities, elongation of the anterolateral bundle exhibited a flexion-dependent pattern with more stretching during swing than stance phase (e.g., at 40° flexion, anterolateral bundle experienced 3.9% strain during stance and 9.1% during swing phase of stair descent). The posteromedial bundle remained shorter than its reference length (defined at heel strike of the level gait cycle) during both activities. Compared with loading patterns of the healthy ligament, postoperative elongation patterns indicate a slackening of the ligament at early flexion followed by peak ligament lengths at considerably smaller flexion angles. The reported data provide a novel insight into in vivo PCL function during activities of daily living that has not been captured previously. The findings support previous investigations reporting difficulties in achieving a balanced tension in the retained PCL.
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Affiliation(s)
- Seyyed Hamed Hosseini Nasab
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - Colin Smith
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - Pascal Schütz
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - Barbara Postolka
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - Stephen Ferguson
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - William R. Taylor
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
| | - Renate List
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland; (S.H.H.N.); (C.S.); (P.S.); (B.P.); (S.F.); (R.L.)
- Human Performance Lab, Schulthess Clinic, 8008 Zurich, Switzerland
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Maniar N, Schache AG, Pizzolato C, Opar DA. Muscle contributions to tibiofemoral shear forces and valgus and rotational joint moments during single leg drop landing. Scand J Med Sci Sports 2020; 30:1664-1674. [DOI: 10.1111/sms.13711] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/14/2020] [Accepted: 05/07/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Nirav Maniar
- School of Behavioural and Health Australian Catholic University Melbourne Vic Australia
| | - Anthony G. Schache
- La Trobe Sports and Exercise Medicine Research Centre La Trobe University Melbourne Vic Australia
| | - Claudio Pizzolato
- School of Allied Health Sciences Griffith University Gold Coast QLD Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE) Menzies Health Institute Queensland Griffith University Gold Coast QLD Australia
| | - David A. Opar
- School of Behavioural and Health Australian Catholic University Melbourne Vic Australia
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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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Ettinger M, Tücking LR, Savov P. [Kinematic alignment in total knee arthroplasty with image-based and image-independent robotic support]. DER ORTHOPADE 2020; 49:604-610. [PMID: 32447404 DOI: 10.1007/s00132-020-03924-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Ettinger
- Klinik für Orthopädie im Annastift, Medizinische Hochschule Hannover, Anna-von-Borries-Straße 1, 30625, Hannover, Deutschland.
| | - L-R Tücking
- Klinik für Orthopädie im Annastift, Medizinische Hochschule Hannover, Anna-von-Borries-Straße 1, 30625, Hannover, Deutschland
| | - P Savov
- Klinik für Orthopädie im Annastift, Medizinische Hochschule Hannover, Anna-von-Borries-Straße 1, 30625, Hannover, Deutschland
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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: 19] [Impact Index Per Article: 4.8] [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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Esrafilian A, Stenroth L, Mononen ME, Tanska P, Avela J, Korhonen RK. EMG-Assisted Muscle Force Driven Finite Element Model of the Knee Joint with Fibril-Reinforced Poroelastic Cartilages and Menisci. Sci Rep 2020; 10:3026. [PMID: 32080233 PMCID: PMC7033219 DOI: 10.1038/s41598-020-59602-2 10.1109/tnsre.2022.3159685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Abnormal mechanical loading is essential in the onset and progression of knee osteoarthritis. Combined musculoskeletal (MS) and finite element (FE) modeling is a typical method to estimate load distribution and tissue responses in the knee joint. However, earlier combined models mostly utilize static-optimization based MS models and muscle force driven FE models typically use elastic materials for soft tissues or analyze specific time points of gait. Therefore, here we develop an electromyography-assisted muscle force driven FE model with fibril-reinforced poro(visco)elastic cartilages and menisci to analyze knee joint loading during the stance phase of gait. Moreover, since ligament pre-strains are one of the important uncertainties in joint modeling, we conducted a sensitivity analysis on the pre-strains of anterior and posterior cruciate ligaments (ACL and PCL) as well as medial and lateral collateral ligaments (MCL and LCL). The model produced kinematics and kinetics consistent with previous experimental data. Joint contact forces and contact areas were highly sensitive to ACL and PCL pre-strains, while those changed less cartilage stresses, fibril strains, and fluid pressures. The presented workflow could be used in a wide range of applications related to the aetiology of cartilage degeneration, optimization of rehabilitation exercises, and simulation of knee surgeries.
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Affiliation(s)
- A Esrafilian
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - L Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - M E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - P Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J Avela
- NeuroMuscular Research Center, Unit of Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Esrafilian A, Stenroth L, Mononen ME, Tanska P, Avela J, Korhonen RK. EMG-Assisted Muscle Force Driven Finite Element Model of the Knee Joint with Fibril-Reinforced Poroelastic Cartilages and Menisci. Sci Rep 2020; 10:3026. [PMID: 32080233 PMCID: PMC7033219 DOI: 10.1038/s41598-020-59602-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/31/2020] [Indexed: 11/12/2022] Open
Abstract
Abnormal mechanical loading is essential in the onset and progression of knee osteoarthritis. Combined musculoskeletal (MS) and finite element (FE) modeling is a typical method to estimate load distribution and tissue responses in the knee joint. However, earlier combined models mostly utilize static-optimization based MS models and muscle force driven FE models typically use elastic materials for soft tissues or analyze specific time points of gait. Therefore, here we develop an electromyography-assisted muscle force driven FE model with fibril-reinforced poro(visco)elastic cartilages and menisci to analyze knee joint loading during the stance phase of gait. Moreover, since ligament pre-strains are one of the important uncertainties in joint modeling, we conducted a sensitivity analysis on the pre-strains of anterior and posterior cruciate ligaments (ACL and PCL) as well as medial and lateral collateral ligaments (MCL and LCL). The model produced kinematics and kinetics consistent with previous experimental data. Joint contact forces and contact areas were highly sensitive to ACL and PCL pre-strains, while those changed less cartilage stresses, fibril strains, and fluid pressures. The presented workflow could be used in a wide range of applications related to the aetiology of cartilage degeneration, optimization of rehabilitation exercises, and simulation of knee surgeries.
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Affiliation(s)
- A Esrafilian
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - L Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - M E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - P Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J Avela
- NeuroMuscular Research Center, Unit of Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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Giorgini A, Zambianchi F, Lombardi M, Francioni E, Marcovigi A, Catani F. Mechanical alignment changes during flexion in total knee arthroplasty without affecting clinical outcomes. Clin Biomech (Bristol, Avon) 2020; 72:63-68. [PMID: 31838212 DOI: 10.1016/j.clinbiomech.2019.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 11/22/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Primary aim of this study is to investigate if Hip-Knee-Ankle angle, measured in the coronal plane, changes with knee flexion after total knee arthroplasty. The secondary aim is to assess the relationship between Hip-Knee-Ankle during knee flexion and clinical outcome at mid-term follow up. METHODS 334 computer assisted total knee arthroplasties were retrospectively evaluated. A total of 233 patients were available for assessment of clinical outcomes at last follow up (mean 35 months). Hip-Knee-Ankle angle at different degrees of knee flexion and components' alignment were recorded intraoperatively. FINDINGS Patients were stratified based on the preoperative alignment: 202 varus knees, 99 neutral knees, and 33 valgus knees. In the varus knee group, 146 patients (89%) maintained a neutral overall limb alignment when flexed to 20°, 118 (72%) remained neutrally aligned at 45° and 92 (54%) at 90°. In valgus knee group, 26 (90%) remained neutrally aligned at 20°, 22 (75%) at 45° and 16 (55%) at 90°. In neutrally-aligned knee group, 88 (96%) remained neutrally aligned at 20°, 73 (79%) at 45° and 61 (66%) at 90°. Femoral component external rotation was correlated with varus alignment in flexion. Good outcomes were reported in 181 (78%) cases, fair results in 28 (12%) cases, poor results in 24 (10%) of cases. Poor results were not correlated to Hip-Knee-Ankle angle at different knee flexion angles. INTERPRETATION This study demonstrates that intraoperative Hip-Knee-Ankle angle changes as the knee moves into deeper flexion. However, neutral Hip-Knee-Ankle through the range of motion does not correlate with superior outcomes.
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Affiliation(s)
- Andrea Giorgini
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy.
| | - Francesco Zambianchi
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Martina Lombardi
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Elena Francioni
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Andrea Marcovigi
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Fabio Catani
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy.
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Hosseini Nasab SH, Smith CR, Schütz P, Postolka B, List R, Taylor WR. Elongation Patterns of the Collateral Ligaments After Total Knee Arthroplasty Are Dominated by the Knee Flexion Angle. Front Bioeng Biotechnol 2019; 7:323. [PMID: 31799245 PMCID: PMC6861521 DOI: 10.3389/fbioe.2019.00323] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 10/28/2019] [Indexed: 11/13/2022] Open
Abstract
The primary aim of this study was to assess the effects of total knee arthroplasty (TKA) implant design on collateral ligament elongation patterns that occur during level walking, downhill walking, and stair descent. Using a moving fluoroscope, tibiofemoral kinematics were captured in three groups of patients with different TKA implant designs, including posterior stabilized, medial stabilized, and ultra-congruent. The 3D in vivo joint kinematics were then fed into multibody models of the replaced knees and elongation patterns of virtual bundles connecting origin and insertion points of the medial and lateral collateral ligaments (MCL and LCL) were determined throughout complete cycles of all activities. Regardless of the implant design and activity type, non-isometric behavior of the collateral ligaments was observed. The LCL shortened with increasing knee flexion, while the MCL elongation demonstrated regional variability, ranging from lengthening of the anterior bundle to slackening of the posterior bundle. The implant component design did not demonstrate statistically significant effects on the collateral elongation patterns and this was consistent between the studied activities. This study revealed that post-TKA collateral ligament elongation is primarily determined by the knee flexion angle. The different anterior translation and internal rotation that were induced by three distinctive implant designs had minimal impact on the length change patterns of the collateral ligaments.
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Affiliation(s)
| | - Colin R Smith
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Pascal Schütz
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Barbara Postolka
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Renate List
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - William R Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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Clouthier A, Borschneck D, Thelen DG, Deluzio K, Rainbow MJ. Relationship Between Lateral Patellar Stability Following Tibial Tubercle Osteotomy for Varying Patellofemoral Geometries. J Biomech Eng 2019; 141:1065796. [PMID: 31628469 DOI: 10.1115/1.4045231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Indexed: 01/17/2023]
Abstract
The geometry of the patellofemoral joint affects function and pathology. However, the impact of trochlear groove depth on treatments for patellar instability and pain is not clear. Tibial tubercle osteotomy is a common surgical intervention for patellar instability where the tibial insertion of the patellar tendon is translated to align the extensor mechanism and stabilize the joint. The aim of this work was to investigate the interaction between trochlear groove depth and patellar tendon insertion and their effect on patellar stability. Patellofemoral geometry was modified based on a statistical shape model to create knees with a range of trochlear groove depths. A Monte Carlo approach was used and 750 instances of a musculoskeletal model were generated with varying geometry and anterior and medial transfer of the patellar tendon. Stability was assessed by applying a lateral perturbation force to the patella during simulation of overground walking. In knees with deep trochlear grooves, a medialized patellar tendon increased stability. However, in knees with shallow trochlear grooves, stability was maximized for tendon insertion ~1 mm medial to its neutral location. This patellar tendon insertion also corresponded to the best alignment of the patella in the trochlear groove in these knees, indicating that good alignment may be important to maximizing stability. Anterior patellar tendon transfer had minimal effect on stability for all geometries. A better understanding of the effects of articular geometry and tubercle location on stability may aid clinicians in patient-specific surgical planning.
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Affiliation(s)
- Allison Clouthier
- School of Human Kinetics, University of Ottawa, 75 Laurier Ave. E, Ottawa, Ontario, K1N 6N5, Canada
| | - Daniel Borschneck
- Department of Surgery, Kingston General Hospital, 76 Stuart St., Kingston, Ontario, K7L 2V7, Canada
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave., Madison, Wisconsin, 53706, USA
| | - Kevin Deluzio
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., Kingston, Ontario, K7L 3N6, Canada
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., Kingston, Ontario, K7L 3N6, Canada
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Calliess T, Ettinger M, Savov P, Karkosch R, Windhagen H. Individualized alignment in total knee arthroplasty using image-based robotic assistance : Video article. DER ORTHOPADE 2019; 47:871-879. [PMID: 30218354 PMCID: PMC6182501 DOI: 10.1007/s00132-018-3637-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Introduction Over the past decades many innovations were introduced in total knee arthroplasty (TKA) focusing on implant longevity and higher procedural precision; however, there are still a high number of dissatisfied patients. It was reported that better anatomical alignment may result in improved patient outcome; however, current technologies have limitations to achieve this. The aim of this video article is to describe the technique of individualized alignment in TKA with the use of image-based robotic assistance. Methods The technology is based on an individual patient knee model computed from segmented computed tomography (CT) scans. A preoperative planning of prosthesis position is conducted following the principle of kinematic alignment. Intraoperatively the soft tissue envelope is recorded and the computer predicts the gap balance based on the virtual planning. The prosthesis position is then adapted to achieve balanced gaps and to avoid soft tissue release. This technique is shown in a cadaver operation and clinical examples of two patients are described. Results With the combination of anatomically oriented prosthesis positioning and minor adaptations with respect to the soft tissue, an individualized alignment is achieved with reduced need of soft tissue release. The robotic-assisted surgery guarantees a precise implementation of the planning. The initial experience showed a promising outcome in short-term follow-up. Video online The online version of this article (10.1007/s00132-018-3637-1) contains a video on patient individualized alignment in total knee arthroplasty. The article and video are available in the electronic full text archive at SpringerMedizin.de under http://www.springermedizin.de/der-orthopaede. The video can be found at the end of the article as supplementary material.
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Affiliation(s)
- Tilman Calliess
- Department for Orthopedic Surgery at Annastift Hospital, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
| | - Max Ettinger
- Department for Orthopedic Surgery at Annastift Hospital, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Peter Savov
- Department for Orthopedic Surgery at Annastift Hospital, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Roman Karkosch
- Department for Orthopedic Surgery at Annastift Hospital, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Henning Windhagen
- Department for Orthopedic Surgery at Annastift Hospital, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
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Abstract
BACKGROUND There are still a high number of dissatisfied knee arthroplasty patients. This situation has not changed much for decades, despite many innovations focusing on implant longevity and higher procedural precision. In this context, there is a growing discussion on possible systematic errors made in knee arthroplasty, especially regarding the alignment philosophy of the implants. OBJECTIVE It was reported that a more anatomical alignment might result in improved patient outcome. However, current technologies have severe limitations to achieving optimized and individual alignment. In this context, the aim of this manuscript was to assess whether image-based robot-guided knee arthroplasty might represent an opportunity for achieving individualized alignment. METHODS The literature on this subject was evaluated and analyzed. Furthermore, research projects and expert recommendations were discussed. RESULTS The precision of preoperative planning is higher with robotic techniques than with other computer-assisted or manual technologies. In addition, the individual soft tissue situation of the patient is taken into account and the prosthesis position is optimized. This ensures optimum soft tissue balancing and stability of the prosthesis. CONCLUSION Modern robot-assisted systems are the mechanical bridge between imaging and patient. This technique provides objective control over the results produced with alternative alignments. This applies to both the prosthesis position itself and the resulting soft tissue balancing.
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Patients With Medial Knee Osteoarthritis Reduce Medial Knee Contact Forces by Altering Trunk Kinematics, Progression Speed, and Stepping Strategy During Stair Ascent and Descent: A Pilot Study. J Appl Biomech 2019; 35:280-289. [PMID: 31141436 DOI: 10.1123/jab.2017-0159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Medial knee loading during stair negotiation in individuals with medial knee osteoarthritis, has only been reported in terms of joint moments, which may underestimate the knee loading. This study assessed knee contact forces (KCF) and contact pressures during different stair negotiation strategies. Motion analysis was performed in five individuals with medial knee osteoarthritis (52.8±11.0 years) and eight healthy subjects (51.0±13.4 years) while ascending and descending a staircase. KCF and contact pressures were calculated using a multi-body knee model while performing step-over-step at controlled and self-selected speed, and step-by-step strategies. At controlled speed, individuals with osteoarthritis showed decreased peak KCF during stair ascent but not during stair descent. Osteoarthritis patients showed higher trunk rotations in frontal and sagittal planes than controls. At lower self-selected speed, patients also presented reduced medial KCF during stair descent. While performing step-by-step, medial contact pressures decreased in osteoarthritis patients during stair descent. Osteoarthritis patients reduced their speed and increased trunk flexion and lean angles to reduce KCF during stair ascent. These trunk changes were less safe during stair descent where a reduced speed was more effective. Individuals should be recommended to use step-over-step during stair ascent and step-by-step during stair descent to reduce medial KCF.
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Zaylor W, Stulberg BN, Halloran JP. Use of distraction loading to estimate subject-specific knee ligament slack lengths. J Biomech 2019; 92:1-5. [DOI: 10.1016/j.jbiomech.2019.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
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