The MediShoe (Promedics Orthopaedics Ltd, Glasgow) is a specific post-operative foot orthosis used by post-operative foot and ankle patients designed to protect fixations, wounds and maximise comfort. The use of rigid-soled shoes has been said to alter joint loading within the knee and with the popular use of the MediShoe at our centre in post operative foot and ankle surgery patients, it is important to ascertain whether this is also true. An analysis of the knee gait
One of the main concerns about the currently available simulators is that the TKA is driven in a “passive way” for assessment. For the simulators for the wear assessment, the tibio-femoral relative motion is automatically made by using the knee kinematics and loading profile of a normal gait. As for the simulators for the kinematics and
We have developed a novel knee simulator that reproduces the active knee motion to evaluate kinematics and joint reaction forces of TKA. There have been developed many kinds of knee simulators; Most of them are to predict TKA component wear and the others are to evaluate the kinematics and/or
Introduction. A deep squat (DS) is a challenging motion at the level of the hip joint generating substantial reaction forces (HJRF). As a closed chain exercise, it has great value in rehabilitation and muscle strengthening of hip and knee. During DS, the hip flexion angle approximates the functional range of hip motion risking femoroacetabular impingement in some morphologies. In-vivo HJRF measurements have been limited to instrumented implants in a limited number of older patients performing incomplete squats (< 50° hip flexion and < 80° knee flexion). On the other hand, total hip arthroplasty is being increasingly performed in a younger and higher demanding patient population. These patients clearly have a different kinetical profile with hip and knee flexion ranges going well over 100 degrees. Since measurements of HJRF with instrumented prostheses in healthy subjects would be ethically unfeasible, this study aims to report a personalised numerical solution based on inverse dynamics to calculate realistic in-silico HJRF values during DS. Material and methods. Thirty-five healthy males (18–25 years old) were prospectively recruited for motion and morphological analysis. DS motion capture (MoCap) acquisitions and MRI scans with gait lab marker positions were obtained. The AnyBody Modelling System (v6.1.1) was used to implement a novel personalisation workflow of the AnyMoCap template model. Bone geometries, semi-automatically segmented from MRI, and corresponding markers were incorporated into the template human model by an automated procedure. A state of-the-art TLEM 2.0 dataset, included in the Anybody Managed Model Repository (v2.0), was used in the template model. The subject-specific MoCap trials were processed to compute kinematics of DS, muscle and joint reaction forces in the entire body. Resulting hip joint loads were compared with in-vivo data from OrthoLoad dataset. Additionally, hip and knee joint angles were computed. Results. An average HJRF of 274%BW (251.5 – 297.9%BW; 95% confidence interval) was calculated at the peak of DS. The HJRF on the pelvis was directed superior, medial and posterior throughout the DS. Peak knee and hip flexion angles were 112° (108.1° – 116.5°) and 107° (104.6° – 109.4°) on average. Discussion and conclusions. A comprehensive approach to construct an accurate personalised musculoskeletal model from subject-specific MoCap data, bone geometries, and palpatory landmarks was presented. Consistently higher HJR forces during DS in young adults were demonstrated as opposed to the Orthoload dataset. Similarly, knee and hip flexion angles were much higher, which could cause the increase in HJRF. It can be concluded that DS
Multiple video fluoroscopic analyses have been performed to determine the in vivo kinematic patterns of total knee arthroplasty (TKA) and non implanted knees. Unfortunately, many of these studies were not correlated with bearing surface forces and possible failure modes that could be detected with a sound sensor. Therefore, the objective of the present study was to conduct a comparative analysis of the kinematic data derived for all subjects having a TKA who were analyzed over the past seventeen years at our laboratory and to determine how these patterns correlate with bearing surface forces and joint sound. Initially, femorotibial contact positions and axial rotation magnitudes were derived for subjects having either a non implanted or implanted knee. Non implanted knees consisted of normal and anterior cruciate ligament (ACL) deficient knees (ACLD). Implanted knees consisted of posterior stabilized (PS) fixed (PSF) and mobile (PSM) bearing, posterior cruciate ligament retaining (PCR) fixed (PCRF) and mobile (PCRM) bearing, posterior cruciate sacrificing mobile (PCSM) bearing and ACL retaining fixed (ACRF) bearing TKA. Each subject, while under fluoroscopic surveillance, performed a weight-bearing deep knee bend and/or normal gait. Using a three-dimensional (3D) model fitting approach, the relative pose of knee implant components were determined in 3D from a single-perspective fluoroscopic image by manipulating a CAD model in three-dimensional space. Anterior/posterior (A/P) contact positions for both the medial and lateral condyles and axial rotation of the femoral component relative to the tibial component were assessed. Then, a subset of these subjects were further analyzed to determine their in vivo bearing surface forces and joint sound using a more recently derived protocol for analyzing audible signals.INTRODUCTION
METHODS
This study evaluates the impact of radii-related differences in posterior cruciate ligament retaining (PCR) primary total knee arthroplasty (TKA) prosthetic designs on knee biomechanics during level walking 1-year after surgery. The multi-radius (MR) design creates at least two instantaneous flexion axes by changing the radius of curvature of the femoral component throughout the arc of knee motion. The femoral component of the single-radius (SR) design has only one radius and therefore a fixed axis. Subjects scheduled for computer-navigated TKA (n = 37: SR n = 20 [9M, 11F], MR n = 17 [8M, 9F]; 69.8 ± 7.1 years, 87.6 ± 20.8 kg, 1.68 ± 0.09 m), and demographic-matched controls without knee pathology n = 23 [13M, 10F], provided informed consent under the Banner IRB (Sun Health panel). All surgical subjects received similar pre-, peri-, and post-operative care under the direction of three surgeons from a single orthopedic practice. Position and force data were collected using 28 reflective markers (modified Helen Hayes [Kadaba et al 1990]) tracked by ten digital IR cameras (120 Hz) (Motion Analysis Corp., Santa Rosa, CA) and four force platforms (1200 Hz) (AMTI, Watertown, MA) embedded in an 8m walkway. Data were recorded and smoothed (Butterworth filter, 6 Hz) using EVaRT 5.0.4 software (Motion Analysis Corp.). Gait cycle parameters were calculated using the ‘Functional Hip Center’ and ‘Original Knee Axis’ models in Orthotrak 6.6.1 (Motion Analysis Corp.). Data from each group were height and weight normalized and ensemble averaged by affected limb (right limb for controls) using custom code written in Labview (National Instruments Corp, Austin, TX). Descriptive statistics for the maximum and minimum knee kinematic, kinetic, and temporal spatial values in the stance and swing phases of the gait cycle were generated for each group. Between-group comparisons were made using an ANOVA with post hoc testing as appropriate (SPSS 14.0 (SPSS Inc, Chicago, IL)).Introduction:
Methods:
INTRODUCTION. While computational models have been used for many years to contribute to pre-clinical, design phase iterations of total knee replacement implants, the analysis time required has limited the real-time use as required for other applications, such as in patient-specific surgical alignment in the operating room. In this environment, the impact of variation in ligament balance and implant alignment on estimated joint mechanics must be available instantaneously. As neural networks (NN) have shown the ability to appropriately represent dynamic systems, the objective of this preliminary study was to evaluate deep learning to represent the joint level kinetic and kinematic results from a validated finite element lower limb model with varied surgical alignment. METHODS. External hip and ankle boundary conditions were created for a previously-developed finite element lower limb model [1] for step down (SD), deep knee bend (DKB) and gait to best reproduce in-vivo loading conditions as measured on patients with the Innex knee (. orthoload.com. ) (Figure1). These boundary conditions were subsequently used as inputs for the model with a current fixed-bearing total knee replacement to estimate implant-specific
Individuals with multi-compartment knee osteoarthritis (KOA) frequently experience challenges in activities of daily living (ADL) such as stair ambulation. The Levitation “Tri-Compartment Offloader” (TCO) knee brace was designed to reduce pain in individuals with multicompartment KOA. This brace uses novel spring technology to reduce tibiofemoral and patellofemoral forces via reduced quadriceps forces. Information on brace utility during stair ambulation is limited. This study evaluated the effect of the TCO during stair descent in patients with multicompartment KOA by assessing knee flexion moments (KFM), quadriceps activity and pain. Nine participants (6 male, age 61.4±8.1 yrs; BMI 30.4±4.0 kg/m2) were tested following informed consent. Participants had medial tibiofemoral and patellofemoral OA (Kellgren-Lawrence grades two to four) diagnosed by an orthopaedic surgeon. Joint
Purpose. The purpose of this study was to clarify the relationship between the laxity of surrounding soft tissue and artificial joint
Introduction. Bicruciate-retaining (BiCR) total knee replacements (TKRs) were designed to improve implant performance; however, functional advantages during daily activity have yet to be demonstrated. Although level walking is a common way to analyze functionality, it has been shown to be a weak test for identifying gait abnormalities related to ACL pathologies. The goal of this study is to set up a functional motion analysis test that will examine the effects of the ACL in TKR patients by comparing knee kinematics,
Introduction. Total hip arthroplasty (THA) is the most effective treatment modality for severe arthritis of the hip. Patients report excellent clinical and functional outcomes following THA, including subjective improvement in gait mechanics. However, few studies in the literature have outlined the impact of THA, as well as surgical approach, on gait
Total hip arthroplasty (THA) is the most effective treatment modality for severe arthritis of the hip. Patients report excellent clinical and functional outcomes following THA, including subjective improvement in gait mechanics. However, few studies in the literature have outlined the impact of surgical approach on gait
With the growing number of individuals with asymptomatic cam-type deformities, elevated alpha angles alone do not always explain clinical signs of femoroacetabular impingement (FAI). Differences in additional anatomical parameters may affect hip joint mechanics, altering the pathomechanical process resulting in symptomatic FAI. The purpose was to examine the association between anatomical hip joint parameters and kinematics and
Meniscus tears in adult patients do not heal spontaneously and represent a risk factor for OA development. PDGF is well known as an enhancer of meniscal cell biosynthetic activity and also has chemotactic activity for mesenchymal cells. PDGF incorporation into scaffolds should be efficient for recruitment of cells to initiate repair in the injured meniscus. We recently developed decellularized meniscus sheet for use in the treatment of meniscus tears. The aim of this study is to examine the potential of PDGF-coated decellularized meniscus scaffold in mediating integrative healing by endogenous cell migration. Fresh bovine meniscus was chemically decellularized. Round sheets were made from the decellularized tissue. Heparin was covalently conjugated with decellularized meniscus scaffold (DMS). PDGF-BB was immobilized by binding to the heparin-conjugated DMS. In vitro, PDGF release
The vast majority of total hip replacements (THR) implanted today enable modularity by means of a tapered junction; based on the Morse taper design introduced for cutting tools in the 19. th. Century . 1. Morse-type tapers at the head-stem junction provide many benefits, key for a successful surgical outcome such as wider component selection and restoration of better biomechanics . 2. However, moving from mono-block to modular designs has not been without its issues. Fluid ingress and motion at the interface has led to a complex multifactorial degradation mechanism better known as fretting-corrosion . 3. Fretting-corrosion products created at the junction are commonly associated with adverse local tissue reactions . 4. . There is a wide variation in the taper junction of THR differing quite significantly from Morse's original design. Performance of the taper junction has been found to vary with different designs . 5,6. However, there is still a lack of common understanding of what design inputs makes a ‘good’ modular taper interface. The aim of this study was to better understand the links between implant design and fretting-corrosion initially focussing on the role of angular mismatch between male and female taper. A combination of experimental approaches with the aid of computational models to assist understanding has been adopted. A more descriptive understanding between taper design, engagement, motion and fretting-corrosion will be developed. Three different sample designs were created to represent the maximum range of possible angular mismatches seen in clinically available THR modular tapers (Matched: 0.020 ±0.002 °, Proximal: 0.127 ±0.016 °, Distal: −0.090 ±0.002 °). Head-stem components were assembled at 2 kN. Motion and fretting-corrosion at the interface was simulated under incremental uniaxial sinusoidal loading between 0.5–4 kN at 8 intervals of 600 cycles. The different types of motions at the interface was measured using a developed inductance circuit composed of four sensing coils, digital inductance converter chip (LDC1614, Texas Instruments, US) and microcontroller (myRIO, National Instruments, US). Fretting-corrosion was measured using potentiostatic electrochemical techniques with an over potential of +100 mV vs OCP (Ivium, NL). Complimentary finite element (FE) models were created in Ansys (Ansys 19.2, US). Under uniaxial loading, the ‘matched’ modular taper assemblies corroded most and allowed the greatest pistoning motion due to a seating action. ‘Distal’ and ‘proximal’ engaged modular tapers showed reduced corrosion and seating when compare to the ‘matched’ components. However the
Thigh-calf contact force is the force acting on posterior side of the thigh and calf during deep knee flexion. It has been reported the force is important to analyze the
Introduction. Optimal knee joint function obviously requires a delicate balance between the osseous anatomy and the surrounding soft tissues, which is distorted in the case of joint line elevation (JLE). Although several studies have found no correlation between JLE and outcome, others have linked JLE to inferior results. The purpose of this in vitro investigation was to evaluate the effect of JLE on tibiofemoral kinematics and collateral ligament strains. Materials and Methods. Six cadaver knees were equipped with reflective markers on femur and tibia and CT scans were made. A total knee arthroplasty (TKA) was performed preserving the native joint level. The knees were then tested in passive flexion-extension and squatting in a knee kinematics simulator while marker positions were recorded with an optical system. During squatting quadriceps forces were measured as well as tibio-femoral contact pressures. Finally, a revision TKA was performed with JLE by 4 mm. The femoral component was downsized and a thicker insert was used. The knees were again tested as before. Based on the bony landmarks identified in the CT scans and the measured trajectories of the markers, relative tibiofemoral kinematics could be calculated as well as distance changes between insertions of the collateral ligaments. Statistical tests were carried out to detect significant differences in kinematic patterns, ligaments elongation, tibiofemoral contact pressures and quadriceps forces between the primary TKA and after JLE. Results. Tibiofemoral kinematics are shown in Figure 1. For both passive flexion and squatting, tibial external rotation and adduction were similar before and after JLE. In passive flexion, JLE decreased the posterior translation of the femoral medial and lateral condyle centres, especially beyond 40 degrees of flexion. A slight 5% anterior shift of both centres was noted after JLE during squatting, but this was not significant. Strains in the collateral ligaments are shown in Figure 2. The collateral ligament lengths remained constant during passive flexion and were unaffected by elevation of the joint line. During squatting, the sMCL stretched with flexion after primary TKA and this behaviour stayed constant when the joint line was elevated. The LCL showed a similar loosening trend in both TKA configurations. Also tibiofemoral joint
Aim. The demonstration of the in vivo bactericidal efficacy of a new bone cement with rifampicin contained in microcapsules and its intra-articular release profile. Method. Fifteen New Zealand White rabbits were employed to reproduce periprosthetic infection by intra-articular inoculation of 10. 5. CFU/mL of Staphylococcus aureus ATCC® 29213 using as a target implant a 3D printed stainless steel tibial insert. 7 days after inoculation, the first stage of the two stage exchange was carried out and at this time the animals were divided into two study groups: group C (7 rabbits) that received a spacer with gentamicin and group R (8 rabbits) that received a spacer with gentamicin and rifampicin microcapsules. Response to infection was monitored by clinical (weight and temperature), hematological (leukocyte, lymphocyte and platelet counts) and biochemical (erythrocyte sedimentation rate) analyses at the time of inoculation, at the first stage of exchange, 4 days after first stage and weekly until the fourth week when animals were euthanized. Microbiological counts were performed at the first stage of exchange and at the end of the study. Results. 14/15 animals (93.3%) developed a PJI 1 week after the inoculation. A statistically significant elevation of the leukocyte and platelet count and a decrease in the percentage of lymphocytes (p=0.0001) was found and positive microbiological cultures. Four weeks after the placement of the spacer, no bacterial growth was found in the soft tissue or bone samples of the group with rifampicin microcapsules (group R), being these differences statistically significant with p=0.01 and 0.03 respectively. The rifampicin intra-articular release
Power production in the terminal stance phase is essential for propelling the body forward during walking and is generated primarily by ankle plantarflexion. Osteoarthritis (OA) of the ankle restricts joint range of motion and is expected to reduce power production at that ankle. This loss of power may be compensated for by unaffected joints on both the ipsilateral and contralateral limbs resulting in overloading of the asymptomatic joints. Total ankle arthroplasty (TAA) has been shown to reduce pain and has the potential to restore range of motion and therefore increase ankle joint power, which could reduce overloading of the unaffected joints and increase walking speed. The purpose of this study was to test the hypothesis that ankle OA causes a loss of power in the affected ankle, compensatory power changes in unaffected lower limb joints, and that TAA will increase ankle power in the repaired ankle and reduce compensatory changes in other joints. One hundred and eighty-three patients (86 men, 97 women with average ages 64.1 and 62.4 years respectively) requiring surgical intervention for ankle OA were prospectively enrolled. Implant selection of either a fixed (INBONE or Salto Talaris) or mobile (STAR) bearing implant was based on surgeon preference. Three-dimensional kinematics and
Aim. Cutibacterium acnes (CA) is one of the crucial actors in spine instrumentation or shoulder prosthesis. Its population is subdivided into 6 major phylotypes: IA1, IA2, IB, IC, II and III. Recent methods for discriminating subpopulations within CA phylotypes highlight the predominance of SLST types H1 to 6 or K1 to 20 in bone and joint infection (BJI). The impact of their ability to produce a biofilm during the development of the infection (with resistance / tolerance to antibiotics used for treatment) remains little studied. Method. The purpose of this study was to determine whether the ability to establish a biofilm varied according to the different subtypes of clinical strains of CA previously characterized and involved in BJI (hip, knee and shoulder prosthesis). The BioFilm ring test (BioFilm Control®) method with index determination, called BFI (BioFilm Index) inversely proportional to the level of biofilm production was used (BFI = 0.00 indicates a high production of biofilm versus BFI = 20.00 indicates zero production). The BFI was determined after 3 h (T3) and 6 h (T6) incubation. The strains used came from patients, 5 belonging to the IA1 phylotype (SLST A1 and D1 types) and 4 to different phylotypes (IA2, IB, II and III). Results. The results show that the