Abstract
Although simulation models are heavily used in biomechanical research and testing of TKA implants, pre-clinical tools for a holistic estimation of implant performance under dynamic loading conditions are rare. The objective of this study was the development of an efficient pre-clinical test method for analyzing knee contact mechanics and kinematics based on a dynamic FE model and to evaluate the effects of the proximo-distal patella position and the patellar tendon stiffness on the patellar kinematics. A finite element-based workflow for knee prostheses designs was developed based on standardized in vivo load data, which included the tibial forces and moments. In a new research approach, the tibial forces are used as input for the model, whereas the tibial moments were used to validate the results. For the standardized sit down, stand up, and knee bend load cycles, the calculated tibial moments show only small deviations from the reference values—especially for high flexion angles. For the knee bend cycle, the maximum absolute value of patellar flexion decreases for higher patellar tendon stiffness and more distally placed patellar components. Therefore, patella-related clinical problems caused by patella baja may also arise if the patellar tendon is too weak for high tibiofemoral flexion angles.
Highlights
Total knee arthroplasty (TKA) is a prevalent treatment option for osteoarthritis [1], which is the indication for 88% of TKA surgeries [2]
The objective of this study was to develop a dynamic FE model for pre-clinical analysis of knee contact mechanics and kinematics based on standardized loading conditions and to analyze the effects of various changes of anatomic properties of a knee, such as the patellar tendon stiffness or the proximo-distal position of the patella
The remaining tissues were implicitly contained into the tibial forces used as input
Summary
Total knee arthroplasty (TKA) is a prevalent treatment option for osteoarthritis [1], which is the indication for 88% of TKA surgeries [2]. Survival rates are 86.1–93.8% [3,4,5,6,7,8] and satisfaction rates are 81%. This means 19% of patients are either dissatisfied with or uncertain about the results of their procedure [9]. The rate of revisions due to aseptic causes in the first 15 years after primary TKA is 3% [10]
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