Three-Dimensional Tibiofemoral Articular Contact Kinematics of a Cruciate-Retaining Total Knee Arthroplasty

Li, Guoan; Suggs, Jeremy F.; Hanson, George R.; Durbhakula, Sridhar M.; Johnson, Todd; Freiberg, Andrew A.

doi:10.2106/jbjs.d.03028

Cited by 57 publications

(41 citation statements)

References 21 publications

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“…When we averaged the five model results, the medial and lateral compartment contact points throughout the lunge maneuver resulted in means that fell within one SD of the means of the nine subjects of Li et al [11] for all angles except at full extension (Fig. 4).…”

Section: Resultsmentioning

confidence: 81%

“…We used a virtual knee simulator (LifeMOD TM /Knee-SIM; LifeModeler, Inc, San Clemente, CA, USA), based on multibody dynamics, to simulate a lunge in a manner similar to the in vivo lunge maneuver reported in fluoroscopic studies of TKA kinematics [9][10][11][12]19]. The model included tibiofemoral and patellofemoral contact, passive soft tissue (medial and lateral collateral ligaments, PCL, and capsular tissues), and active muscle elements (quadriceps and hamstrings).…”

Section: Methodsmentioning

confidence: 99%

“…We compared the data from Li et al [11] to the five simulated models with varying implant orientations by averaging the model results at every 15°of flexion and comparing model mean results to mean results of all nine patients evaluated. In addition, we compared the five simulated cases to five of the nine patients from the study whose clinical rotation magnitude and direction at full extension, as assessed from the starting relative AP fluoroscopic contact positions, were most similar to the direction and magnitude of malalignment in the model.…”

Section: Methodsmentioning

confidence: 99%

“…We performed a linear regression analysis of the relative medial and lateral fluoroscopic contact positions of Li et al [11] on the relative calculated contact positions for the five model implant orientations.…”

Section: Methodsmentioning

confidence: 99%

“…While these studies provide insight into TKA kinematics, they also reveal wide variations from patient to patient [9-11, 14, 19]. For example, Li et al [11] found AP translations in the medial and lateral compartments varied considerably between subjects (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

How Does TKA Kinematics Vary With Transverse Plane Alignment Changes in a Contemporary Implant?

Mihalko

Conner

Benner

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Assessment of patient function after TKA often focuses on implant alignment and daily activity capabilities, but the functional results and kinematics of the TKA are not easily predicted by some of these parameters during surgery. Questions/purposes We asked whether differences in implant alignment in the transverse plane may affect fluorokinematics and be one of the many variables that help explain the discrepancies in fluorokinematic results. Methods We utilized a computer model (LifeMOD TM / KneeSIM; LifeModeler, Inc, San Clemente, CA, USA) to show variability in polyethylene contact patterns. We imported components of a cruciate-retaining TKA into the model and subjected the systems to a simulated lunge. We modeled five different combinations of implant positioning in the transverse plane of both the femoral and tibial components in internal or external rotation and compared the resulting changes in joint rotations and displacements of these five variations to those for published fluorokinematic observations using the same modeled lunge-type maneuver for five patients. Results We observed variations in AP translation of the lateral and medial femoral condyles resembling several of those in the literature for individual patients with the same cruciate-retaining knee implant. The largest AP translational changes were seen with the tibia internally rotated 5°. Using the five different implant transverse plane alignment scenarios resulted in a coefficient of determination of 0.6 for the linear regression when compared to five subjects from a published fluorokinematic study. Conclusions Variations in implant positioning may be responsible for variations in fluorokinematics reported for individual subjects with the same implant design. Clinical Relevance If validated computer modeling can aid surgeons to predict the effects of individual implant alignment variations in TKA kinematics, a more personalized approach to implant positioning during TKA can be implemented.

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Section: Resultsmentioning

confidence: 81%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

How Does TKA Kinematics Vary With Transverse Plane Alignment Changes in a Contemporary Implant?

Mihalko

Conner

Benner

et al. 2012

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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In vivo anterior tibial post contact after posterior stabilizing total knee arthroplasty

Hanson

Suggs

Kwon

et al. 2007

Journal Orthopaedic Research

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Anterior polyethylene post failure in posterior stabilizing total knee arthroplasty (TKA) has been reported in recent patient follow-up studies. However, no data have been reported on the biomechanic interaction between the anterior tibial post and femoral component in posterior stabilizing TKA patients under physiological conditions. The objective of this study was to measure the in vivo anterior tibial post contact area at full knee extension using a dual-orthogonal fluoroscopic imaging technique. Eleven osteoarthritic patients were investigated after posterior stabilizing TKA to measure the contact between the femoral component box and anterior aspect of the tibial post. Anterior tibial post contact, ranging between 0.5 and 80.9 mm 2 , was detected in 63% of the healthy patients (seven out of the eleven patients) at weight-bearing full extension of the knee. The patients with anterior tibial post contact had significantly higher hyperextension angles (À8.4 AE 4.38) than those without contact (1.4 AE 7.28). A statistically significant difference was also detected in the femoral component flexion with respect to the femoral shaft between the patients with anterior post contact (2.7 AE 2.78) and

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Sensitivity of knee replacement contact calculations to kinematic measurement errors

Fregly

Banks

D’Lima

et al. 2008

Journal Orthopaedic Research

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The ability to measure in vivo knee kinematics accurately makes it tempting to calculate in vivo contact forces, pressures, and areas directly from kinematic data. However, the sensitivity of contact calculations to kinematic measurement errors has not been adequately investigated. To address this issue, we developed a series of sensitivity analyses derived from a validated in vivo computational simulation of gait. The simulation used an elastic foundation contact model to reproduce in vivo contact force, center of pressure, and fluoroscopic motion data collected from an instrumented knee replacement. Treating each degree of freedom (DOF) in the simulation as motion controlled, we first quantified how errors in measured relative pose of the implant components affected contact calculations. Pose variations of AE0.1 mm or degree over the entire gait cycle changed maximum contact force, pressure, and area by 204, 100, and 117%, respectively. Larger variations of AE0.5 mm or degree changed these same quantities by 1157, 108, and 578%, respectively. In both cases, the largest sensitivities were to errors in superior-inferior translation and varus-valgus rotation, with loss of contact occurring on one or both sides. We then quantified how switching the sensitive DOFs from motion to load control affected the sensitivity results. Pose variations of AE0.5 mm or degree in the remaining DOFs changed maximum contact quantities by at most 3%. These results suggest that accuracy on the order of microns and milliradians is needed to estimate contact forces, pressures, and areas directly from in vivo kinematic measurements, and that use of load rather than motion control for the sensitive DOFs may improve the accuracy of in vivo contact calculations. Keywords: in vivo knee kinematics; elastic contact model; computational simulation; total knee arthroplasty Technological advances allow measurement of in vivo knee kinematics with submillimeter accuracy. Such measurements are useful for investigating how changes in knee kinematics (e.g., following anterior cruciate ligament (ACL) injury) may contribute to the development of osteoarthritis and how differences in knee replacement design may affect wear performance. Various methods exist for performing these in vivo measurements, including single-plane fluoroscopy with modelbased shape matching or implanted markers, 1-7 biplane X-ray with model-based shape-matching or implanted markers, [8][9][10][11] cortical bone pins with external marker triads, 12 and point cluster methods with redundant surface markers.13,14 For X-ray-based methods, the accuracy of the translations and rotations representing the pose of the femur with respect to the tibia are on the order of AE0.5 mm/degreee for single-plane methods of these measurements and AE0.1 mm/degree for biplane methods. 8-11The high accuracy of these measurements makes it tempting to use them directly to estimate contact forces, pressures, and areas on the medial and lateral condyles and to determine contact status (i.e., in or...

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Three-Dimensional Tibiofemoral Articular Contact Kinematics of a Cruciate-Retaining Total Knee Arthroplasty

Cited by 57 publications

References 21 publications

How Does TKA Kinematics Vary With Transverse Plane Alignment Changes in a Contemporary Implant?

How Does TKA Kinematics Vary With Transverse Plane Alignment Changes in a Contemporary Implant?

In vivo anterior tibial post contact after posterior stabilizing total knee arthroplasty

Sensitivity of knee replacement contact calculations to kinematic measurement errors

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