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Simplified Theoretical Model for Temperature Evaluation in Tissue–Implant–Bone Systems during Ultrasound Diathermy. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10041306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Deep heating procedures are helpful in treating joint contractures that frequently occur with fractures and joint diseases involving surgical implants and artificial joint prostheses. This study uses a one-dimensional composite medium model consisting of parallel slabs as a simplified approach to shed light on the influences of implants during ultrasound diathermy. Analytical solutions for the one-dimensional transient heat generation and conduction problem were derived using the orthogonal expansion technique and a Green’s function approach. The analytical solutions provided deep insight into the temperature profile by therapeutic ultrasound heating in the composite system. The effects of the implant material type, tissue thickness, and ultrasound operation frequency on temperature distribution were studied for clinical application. In addition, sensitivity analyses were carried out to investigate the influences of material properties on the temperature distribution during ultrasound diathermy. Based on the derived analytical solutions, the numerical simulations indicate that materials with high density, high specific heat, and low thermal conductivity may be optimal implant materials. Among available implant materials, a tantalum implant, which can achieve a lower temperature rise within the tissue (hydrogel) and bone layers during ultrasound diathermy, is a better choice thanks to its thermodynamics.
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Glogaza A, Schröder C, Woiczinski M, Müller P, Jansson V, Steinbrück A. Medial stabilized and posterior stabilized TKA affect patellofemoral kinematics and retropatellar pressure distribution differently. Knee Surg Sports Traumatol Arthrosc 2018; 26:1743-1750. [PMID: 29124287 DOI: 10.1007/s00167-017-4772-7] [Citation(s) in RCA: 9] [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: 08/07/2017] [Accepted: 10/30/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Patellofemoral kinematics and retropatellar pressure distribution change after total knee arthroplasty (TKA). It was hypothesized that different TKA designs will show altered retropatellar pressure distribution patterns and different patellofemoral kinematics according to their design characteristics. METHODS Twelve fresh-frozen knee specimens were tested dynamically in a knee rig. Each specimen was measured native, after TKA with a posterior stabilized design (PS) and after TKA with a medial stabilized design (MS). Retropatellar pressure distribution was measured using a pressure sensitive foil which was subdivided into three areas (lateral and medial facet and patellar ridge). Patellofemoral kinematics were measured by an ultrasonic-based three-dimensional motion system (Zebris CMS20, Isny Germany). RESULTS Significant changes in patellofemoral kinematics and retropatellar pressure distribution were found in both TKA types when compared to the native situation. Mean retropatellar contact areas were significantly smaller after TKA (native: 241.1 ± 75.6 mm2, MS: 197.7 ± 74.5 mm2, PS: 181.2 ± 56.7 mm2, native vs. MS p < 0.001; native vs. PS p < 0.001). The mean peak pressures were significantly higher after TKA. The increased peak pressures were however seen in different areas: medial and lateral facet in the PS-design (p < 0.001), ridge in the MS design (p < 0.001). Different patellofemoral kinematics were found in both TKA designs when compared to the native knee during flexion and extension with a more medial patella tracking. CONCLUSION Patellofemoral kinematics and retropatellar pressure change after TKA in different manner depending on the type of TKA used. Surgeons should be aware of influencing the risks of patellofermoral complications by the choice of the prosthesis design.
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Affiliation(s)
- Alexander Glogaza
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Peter Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital Munich, Campus Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
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Steinbrück A, Schröder C, Woiczinski M, Glogaza A, Müller PE, Jansson V, Fottner A. A lateral retinacular release during total knee arthroplasty changes femorotibial kinematics: an in vitro study. Arch Orthop Trauma Surg 2018; 138:401-407. [PMID: 29188420 DOI: 10.1007/s00402-017-2843-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lateral retinacular release (LRR) is a common procedure during total knee arthroplasty (TKA), especially if patellar maltracking is observed intraoperatively. The impact of LRR on patellofemoral kinematics is well-examined, but the influence on femorotibial kinematics requires more elucidation. Therefore, the aim of this study was to evaluate the effects of LRR on femorotibial kinematics in vitro. MATERIALS AND METHODS A fixed bearing TKA was implanted in six human knee specimens. Femorotibial kinematics were measured dynamically through the use of a custom-constructed knee rig which flexes the knee from 20° to 120° under weight bearing conditions. Measurements were performed before and after LRR. LRR was performed completely including transection of synovium, retinaculum and tractus fibers. For the registration of tibiofemoral kinematics a 3-dimensional-ultrasound-based motion analysis system was used. RESULTS LRR revealed a significant reduction of femoral rollback at the lateral compartment (9.4 ± 5.0 vs 7.8 ± 9.4 mm; p < 0.01), whereas the present decrease of femoral rollback at the medial compartment was not significant (3.4 ± 4.7 vs 2.3 ± 5.9 mm; p = 0.34). Accordingly, LRR significantly reduced internal rotation of the tibia (0.8°; p < 0.01). CONCLUSION The results suggest that LRR significantly decreases lateral femoral rollback as well as internal rotation of the tibia, probably by changing the tension of the iliotibial band. When performing a LRR in clinical routine, surgeons should be aware of altering not only patellofemoral kinematics but also the femorotibial kinematics.
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Affiliation(s)
- Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Glogaza
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
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Steinbrück A, Schröder C, Woiczinski M, Schmidutz F, Müller PE, Jansson V, Fottner A. Mediolateral femoral component position in TKA significantly alters patella shift and femoral roll-back. Knee Surg Sports Traumatol Arthrosc 2017; 25:3561-3568. [PMID: 28681088 DOI: 10.1007/s00167-017-4633-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/30/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Increased retropatellar pressure and altered kinematics are associated with anterior knee pain and unsatisfied patients after total knee arthroplasty (TKA). Since malposition of the implant is believed to contribute to postoperative pain, we performed this in vitro study to evaluate the influence of mediolateral femoral component position on retropatellar pressure as well as tibio-femoral and patella kinematics. METHODS For the test, a fixed-bearing TKA was implanted in eight fresh frozen cadaver specimens. To determine the impact of mediolateral (ML) position, three variants of femoral components (3-mm medialization, neutral position and 3-mm lateralization) were produced using rapid prototyping replicas. In a knee rig, a loaded squat from 20° to 120° of flexion was applied. Retropatellar pressure distribution was measured with a pressure-sensitive film. Additionally, an ultrasonic-based three-dimensional motion analysis system was used to register patello- and tibio-femoral kinematics. RESULTS ML translation of the femoral component by 3 mm did not lead to a significant alteration in retropatellar peak pressure (medial 6.5 ± 2.5 MPa vs. lateral 6.0 ± 2.4 MPa). Following the ML translation of the femoral component, the patella was significantly shifted and tilted in the same directions. Varying the ML femoral component position also led to a significant alteration in femoral roll-back. CONCLUSION In day-by-day use, ML position should be chosen with care since there is a significant influence on patella shift and femoral roll-back. Retropatellar pressure is not significantly altered, so there is no clear evidence of an impact on anterior knee pain.
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Affiliation(s)
- Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Florian Schmidutz
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany.,BG Trauma Center, Eberhard Karls University Tübingen, Schnarrenbergstrasse 95, 72076, Tübingen, Germany
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
| | - Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany
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Komnik I, Peters M, Funken J, David S, Weiss S, Potthast W. Non-Sagittal Knee Joint Kinematics and Kinetics during Gait on Level and Sloped Grounds with Unicompartmental and Total Knee Arthroplasty Patients. PLoS One 2016; 11:e0168566. [PMID: 28002437 PMCID: PMC5176302 DOI: 10.1371/journal.pone.0168566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/04/2016] [Indexed: 11/19/2022] Open
Abstract
After knee arthroplasty (KA) surgery, patients experience abnormal kinematics and kinetics during numerous activities of daily living. Biomechanical investigations have focused primarily on level walking, whereas walking on sloped surfaces, which is stated to affect knee kinematics and kinetics considerably, has been neglected to this day. This study aimed to analyze over-ground walking on level and sloped surfaces with a special focus on transverse and frontal plane knee kinematics and kinetics in patients with KA. A three-dimensional (3D) motion analysis was performed by means of optoelectronic stereophogrammetry 1.8 ± 0.4 years following total knee arthroplasty (TKA) and unicompartmental arthroplasty surgery (UKA). AnyBody™ Modeling System was used to conduct inverse dynamics. The TKA group negotiated the decline walking task with reduced peak knee internal rotation angles compared with a healthy control group (CG). First-peak knee adduction moments were diminished by 27% (TKA group) and 22% (UKA group) compared with the CG during decline walking. No significant differences were detected between the TKA and UKA groups, regardless of the locomotion task. Decline walking exposed apparently more abnormal knee frontal and transverse plane adjustments in KA patients than level walking compared with the CG. Hence, walking on sloped surfaces should be included in further motion analysis studies investigating KA patients in order to detect potential deficits that might be not obvious during level walking.
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Affiliation(s)
- Igor Komnik
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Markus Peters
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Johannes Funken
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Sina David
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Stefan Weiss
- ARCUS Clinics Pforzheim, Pforzheim, Baden-Württemberg, Germany
| | - Wolfgang Potthast
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
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Verjans M, Asseln M, Radermacher K. Rapid prototyping of replica knee implants for in vitro testing. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2016. [DOI: 10.1515/cdbme-2016-0122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The understanding of the complex biomechanics of the knee is a key for an optimal implant design. To easily investigate the influence of prosthetic designs on knee biomechanics a rapid prototyping workflow for knee implants has been developed and evaluated. Therefore, different manufacturing technologies and post-treatment methods have been examined and overall seven different replica knee implants were manufactured. For evaluation, the manufacturing properties such as surface accuracy and roughness were determined and kinematic behaviour was investigated in a novel knee testing rig. It was carried out that PolyJet-Modelling with a sanded surface resulted in changed kinematic patterns compared to a usual CoCr-UHMWPE implant. However, fused deposition modelling using ABS and subsequent surface smoothening with acetone vapor showed the lowest roughness of the manufactured implants and only minor kinematic differences. For this reason this method constitutes a promising approach towards an optimal implant design for improved patient-satisfaction and long lifetime of the implant. Finally the workflow is not only limited to the knee.
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Affiliation(s)
- Mark Verjans
- Chair of Medical Engineering at Helmholtz-Institute for Biomedical Engineering of the RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany
| | - Malte Asseln
- Chair of Medical Engineering at Helmholtz-Institute for Biomedical Engineering of the RWTH Aachen University, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering at Helmholtz-Institute for Biomedical Engineering of the RWTH Aachen University, Germany
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Woiczinski M, Steinbrück A, Weber P, Müller PE, Jansson V, Schröder C. Development and validation of a weight-bearing finite element model for total knee replacement. Comput Methods Biomech Biomed Engin 2015; 19:1033-45. [PMID: 26618541 DOI: 10.1080/10255842.2015.1089534] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Total knee arthroplasty (TKA) is a successful procedure for osteoarthritis. However, some patients (19%) do have pain after surgery. A finite element model was developed based on boundary conditions of a knee rig. A 3D-model of an anatomical full leg was generated from magnetic resonance image data and a total knee prosthesis was implanted without patella resurfacing. In the finite element model, a restarting procedure was programmed in order to hold the ground reaction force constant with an adapted quadriceps muscle force during a squat from 20° to 105° of flexion. Knee rig experimental data were used to validate the numerical model in the patellofemoral and femorotibial joint. Furthermore, sensitivity analyses of Young's modulus of the patella cartilage, posterior cruciate ligament (PCL) stiffness, and patella tendon origin were performed. Pearson's correlations for retropatellar contact area, pressure, patella flexion, and femorotibial ap-movement were near to 1. Lowest root mean square error for retropatellar pressure, patella flexion, and femorotibial ap-movement were found for the baseline model setup with Young's modulus of 5 MPa for patella cartilage, a downscaled PCL stiffness of 25% compared to the literature given value and an anatomical origin of the patella tendon. The results of the conducted finite element model are comparable with the experimental results. Therefore, the finite element model developed in this study can be used for further clinical investigations and will help to better understand the clinical aspects after TKA with an unresurfaced patella.
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Affiliation(s)
- M Woiczinski
- a Department of Orthopedic Surgery, Physical Medicine and Rehabilitation , University Hospital of Munich (LMU) , Munich , Germany
| | - A Steinbrück
- a Department of Orthopedic Surgery, Physical Medicine and Rehabilitation , University Hospital of Munich (LMU) , Munich , Germany
| | - P Weber
- a Department of Orthopedic Surgery, Physical Medicine and Rehabilitation , University Hospital of Munich (LMU) , Munich , Germany
| | - P E Müller
- a Department of Orthopedic Surgery, Physical Medicine and Rehabilitation , University Hospital of Munich (LMU) , Munich , Germany
| | - V Jansson
- a Department of Orthopedic Surgery, Physical Medicine and Rehabilitation , University Hospital of Munich (LMU) , Munich , Germany
| | - Ch Schröder
- a Department of Orthopedic Surgery, Physical Medicine and Rehabilitation , University Hospital of Munich (LMU) , Munich , Germany
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