Introduction

The patella experiences large forces and variable kinematic patterns throughout flexion which could influence function and patient satisfaction after a total knee arthroplasty (TKA). Therefore, the objective of this study is to analyze in vivo patellar mechanism forces and kinematics throughout flexion to determine influencing factors that may lead to patient dissatisfaction.

Introduction

Many groups consider passive flexion to be a good indicator of postoperative success, to the point where this outcome directly influences certain outcome scores such as Knee Society Scores (KSS). However, it is alternatively believed that normal-like kinematics result in better TKA outcomes, and previous fluoroscopy studies have demonstrated that there are many parameters that affect weight-bearing range-of-motion. The objective of this study to investigate the correlations between patient-reported outcomes, passive flexion, and weight-bearing knee kinematics.

Introduction

Although surgical remedies tend to be the long-term solutions for patients with osteoarthritis (OA), many alternatives exist that offer the potential to slow progression, alleviate pain, and/or restore function. One such option is the unloader OA knee brace. The objective of this study was to assess the in vivo medial joint space narrowing with and without the brace during weight-bearing portion of gait.

Background

While posterior cruciate retaining (PCR) implants are a more common total knee arthroplasty (TKA) design, newer bi-cruciate retaining (BCR) TKAs are now being considered as an option for many patients, especially those that are younger. While PCR TKAs remove the ACL, the BCR TKA designs keep both cruciate ligaments intact, as it is believed that the resection of the ACL greatly affects the overall kinematic patterns of TKA designs. Various fluoroscopic studies have focused on determination of kinematics but haven't defined differentiators that affect motion patterns. This research study assesses the importance of the cruciate ligaments and femoral geometry for Bi-Cruciate Retaining (BCR) and Posterior Cruciate Retaining (PCR) TKAs having the same femoral component, compared to the normal knee.

Introduction

Current methodologies for designing and validating existing THA systems can be expensive and time-consuming. A validated mathematical model provides an alternative solution with immediate predictions of contact mechanics and an understanding of potential adverse effects. The objective of this study is to demonstrate the value of a validated forward solution mathematical model of the hip that can offer kinematic results similar to fluoroscopy and forces similar to telemetric implants.

Introduction

A common goal of total knee arthroplasty (TKA) is to restore normal knee kinematics. While substantial data is available on TKA kinematics, information regarding non-implanted knee kinematics is less well studied especially in larger patient populations. The objectives of this study were to determine normal femorotibial kinematics in a large number of non-implanted knees and to investigate parameters that yield higher knee flexion with weight-bearing activities.

Introduction

Forward solution joint models (FSMs) can be powerful tools, leading to fast and cost-efficient simulation revealing in vivo mechanics that can be used to predict implant longevity. Unlike most joint analysis methods, mathematical modeling allows for nearly instantaneous evaluations, yielding more rapid surgical technique and implant design iterations as well as earlier insight into the follow-up outcomes used to better assess potential success. The current knee FSM has been developed to analyze both the kinematics and kinetics of commercial TKA designs as well as novel implant designs.

Introduction

Conventional hip radiographs allow surgeons, during preoperative planning, to make important decisions. Size and location of implants are routinely measured by overlaying schematics of the implanted components onto preoperative radiographs. Most currently available planning tools are in two-dimensions (2D), using X-ray images and 2D templates of the implants. Determination of the ideal component size requires two radiographic views of the femur: the anterior-posterior (AP) and the lateral direction. The surgeon uses this information to determine component sizes. Even though this approach has been used for many years leading to very good results, this manual process potentially carries multiple shortcomings. The biggest issue with the AP X-ray image is the fact that it is 2D in nature while the measurement's objective is to obtain three-dimensional (3D) parameters.

Introduction

Traditionally, conventional radiographs of the hip are used to assist surgeons during the preoperative planning process, and these processes generally involve two-dimensional X-ray images with implant templates. Unfortunately, while this technique has been used for many years, it is very manual and can lead to inaccurate fits, such as “good” fits in the frontal view but misalignment in the sagittal view. In order to overcome such shortcomings, it is necessary to fully describe the morphology of the femur in three dimensions, therefore allowing the surgeon to successfully view and fit the components from all possible angles.

Introduction

Untreated hip osteoarthritis is a debilitating condition leading to pain, bone deformation, and limited range of motion. Unfortunately, studies have not been conducted under in vivo conditions to determine progressive kinematics variations to a hip joint from normal to pre-operative and post-operative THA conditions. Therefore, the objective was this study was to quantify normal and degenerative hip kinematics, compared to post-operative hip kinematics.

Introduction

Numerous fluoroscopic studies have been conducted to investigate kinematic variabilities of total knee arthroplasty (TKA). In those studies, subjects having a posterior stabilized (PS) TKA experience greater weightbearing knee flexion and posterior femoral rollback of the lateral condyle. In those same studies, subjects did experience a high incidence of variable medial condyle motion and reverse axial rotation, especially occurring when the cam engaged the post. More recently, a PS TKA was designed to accommodate both gender and ethnicity. Therefore, the objective of this study was to assess in vivo kinematics for subjects having this TKA type to determine if subjects having this PS TKA experienced more optimal knee kinematics.

Introduction

Obtaining accurate anatomical landmarks may lead to a better morphologic understanding, but this is challenging due to the variation of bony geometries. A manual approach, non-ideal for surgeons or engineers, requires a CT or MRI scan, and landmarks must be chosen based on the 3D representation of the scanned data. Ideally, anatomical landmarking is achieved using either a statistical shape model or template matching. Statistical modeling approaches require multitude of training data to capture population variation. Prediction of anatomical landmarks through template matching techniques has also been extensively investigated. These techniques are based on the minimization or maximization of an objective or cost function. As is the nature of non-rigid algorithms, these techniques can fail in the local maxima if the template and new bone models have noise or outliers. Therefore, a combination of rigid and non-rigid registration techniques is needed, in order to obtain accurate anatomical landmarks and improve the prediction process.

Introduction

Previous research defines the existence of a “safe zone” (SZ) pertaining to acetabular cup implantation during total hip arthroplasty (THA). It is believed that if the cup is implanted at 40°±10° inclination and 15°±10° anteversion, risk of dislocation is reduced. However, recent studies have documented that even when the acetabular cup is placed within the SZ, high incidence dislocation and instability remains due to the combination of patient-specific configuration, cup diameter, head size, and surgical approach. The SZ only investigates the angular orientation of the cup, ignoring translational location. Translational location of the cup can cause a mismatch between anatomical hip center and implanted cup center, which has not been widely explored.

Summary

The mathematical model has proven to be highly accurate in measuring leg length before and after surgery to determine how leg length effects hip joint mechanics.

Introduction

Many fluoroscopic studies on total knee arthroplasty (TKA) have identified kinematic variabilities compared to the normal knee, with many subjects experiencing paradoxical motion patterns. The intent of this study was to investigate the results of a newly designed PCR TKA to determine kinematic variabilities and assess these kinematic patterns with those previously documented for the normal knee.

Background

Although early TKA designs were symmetrical, during the past two decades TKA have been designed to include asymmetry, pertaining to either the trochlear groove, femoral condylar shapes or the tibial component. More recently, a new TKA was designed to include symmetry in all areas of the design, in the hopes of reducing design and inventory costs.

Introduction

Diagnosis of osteoarthritis relies primarily on image-based analyses. X-ray, CT, and MRI can be used to evaluate various features associated with OA including joint space narrowing, deformity, articular cartilage integrity, and other joint parameters. While effective, these exams are costly, may expose the patient to ionizing radiation, and are often conducted under passive, non-weightbearing conditions. A supplemental form of analysis utilizing vibroarthrographic (VAG) signals provides an alternative that is safer and more cost-effective for the patient. The objective of this study is to correlate the kinematic patterns of normal, diseased (pre-operative), and implanted (post-operative) hip subjects to their VAG signals that were collected and to more specifically, determine if a correlation exists between femoral head center displacement and vibration signal features.

Introduction

At present, orthopaedic surgeons utilize either CT, MRI or X-ray for imaging a joint. Unfortunately, CT and MRI are quite expensive, non weight-bearing and the orthopaedic surgeon does not receive revenue for these procedures. Although x-rays are cheaper, similar to CT scans, patients incur radiation. Also, all three of these imaging modalities are static. More recently, a new ultrasound technology has been developed that will allow a surgeon to image their patients in 3D. The objective of this study is to highlight the new opportunity for orthopaedic surgeons to use 3D ultrasound as alternative to CT, MRI and X-rays.

During the preoperative examination, surgeons determine whether a patient, with a degenerative hip, is a candidate for total hip arthroplasty (THA). Although research studies have been conducted to investigate in vivo kinematics of degenerative hips using fluoroscopy, surgeons do not have assessment tools they can use in their practice to further understand patient assessment. Ideally, if a surgeon could have a theoretical tool that efficiently allows for predictive post-operative assessment after virtual surgery and implantation, they would have a better understanding of joint conditions before surgery.

The objectives of this study were (1) to use a validated forward solution hip model to theoretically predict the in vivo kinematics of degenerative hip joints, gaining a better understanding joint conditions leading to THA and (2) compare the predicted kinematic patterns with those derived using fluoroscopy for each subject.

A theoretical model, previously evaluated using THA kinematics and telemetry, was used for this study, incorporating numerous muscles and ligaments, including the quadriceps, hamstring, gluteus, iliopsoas, tensor fasciae latae, an adductor muscle groups, and hip capsular ligaments. Ten subjects having a pre-operative degenerative hip were asked to perform gait while under surveillance using a mobile fluoroscopy unit. The hip joint kinematics for ten subjects were initially assessed using in vivo fluoroscopy, and then compared to the predicted kinematics determined using the model. Further evaluations were then conducted varying implanted component position to assess variability.

The fluoroscopic evaluation revealed that 33% of the degenerative hips experienced abnormal hip kinematics known as “hip separation” where the femoral head slides within the acetabulum, resulting in a decrease in contact area. Interestingly, the mathematical model produced similar kinematic profiles, where the femoral head was sliding within the acetabulum (Figure 1).

During swing phase, it was determined that this femoral head sliding (FHS) is caused by hip capsular laxity resulting in reducing joint tension. At the point of maximum velocity of the foot, the momentum of the lower leg becomes too great for capsule to properly constrain the hip, leading to the femoral component pistoning outwards.

During stance phase, kinematics of degenerative hips were similar to kinematics of a THA subject with mal-positioning of the acetabular cup. Further evaluation revealed that if the cup was placed at a position other than its native, anatomical center, abnormal forces and torques acting within the joint lead to the femoral component sliding within the acetabular cup. It was hypothesized that in degenerative hips, similar to THA, the altered center of rotation is a leading influence of FHS (Figure 2).

The theoretical model has now been validated for subjects having a THA and degenerative subjects. The model has successfully derived kinematic patterns similar to subjects evaluated using fluoroscopy. The results in this study revealed that altering the native joint center is the most influential factor leading to FHS, or more commonly known as hip separation. A new module for the mathematical model is being implemented to simulate virtual surgery so that the surgery can pre- operatively plan and then simulate post-operative results.

Introduction

Many fluoroscopic studies on total knee arthroplasty (TKA) have identified kinematic variabilities compared to the normal knee, with many subjects experiencing paradoxical motion patterns. The intent of this research study was to investigate the results of customized-individual-made (CIM) and off-the-shelf (OTS) PS and PCR TKA to determine kinematic variabilities and to assess these kinematic patterns with those previously documented for the normal knee.