Design Of Knee Prosthesis Research Articles

Numerical investigation of knee prosthesis stresses in daily activities: Insight into knee rehabilitation and Creation of a new optimal model

Total knee arthroplasty (TKA) is a cornerstone in addressing knee joint disorders, significantly enhancing patients' quality of life. However, despite technological advancements, a comprehensive understanding of the dynamic stresses experienced by knee prostheses during daily activities, particularly under rehabilitation interventions, remains elusive. This study aims to bridge this gap by employing numerical simulations and finite element analysis to elucidate these dynamic stresses and their interaction with rehabilitation protocols.A real-life knee replacement prosthesis model was meticulously constructed through coordinate measuring and 3D scanning, facilitating detailed finite element analysis in ANSYS Workbench version 17.1. Two distinct boundary conditions and loading scenarios were applied, with comparisons made between linear and nonlinear material assumptions. The simulation results using these different boundary condition methods revealed minimal differences. Specifically, at a knee angle of 0°, the relative stress error rate between the two boundary condition types was approximately 1 % (1.11 MPa and 1.099 MPa, respectively). At 15° and 90°, the error rates were 1.9 % and 0.56 %, respectively (10.275 MPa and 10.078 MPa at 15°; 10.275 MPa and 10.078 MPa at 90°). Given these minimal differences, the first type of boundary condition was adopted for the subsequent scenarios to enhance convergence efficiency in the analysis.Moreover, comparative analyses between linear and nonlinear material behaviors demonstrated acceptable agreement, offering insights into potential efficiency gains in simulation methodologies. Building on this foundation, an optimized tibial model was proposed, incorporating geometric alterations to the tray. Quantitative assessments revealed significant reductions, with von Mises stress decreasing by 23.35 % and equivalent strain by 17 % at a knee angle of 140°. Further evaluations at varying angles, including 60°, consistently showed positive influences on stress and strain. These quantitative findings not only contribute valuable insights into the mechanical behavior of knee prostheses but also provide tangible evidence for the efficacy of linear material behavior assumptions. The proposed optimized model exhibits promising potential for enhancing the design and performance of knee prostheses, particularly under critical loading conditions.In conclusion, these results underscore the importance of a nuanced understanding of knee prosthesis behavior during rehabilitation, offering a quantitative foundation for refining existing designs and informing the development of next-generation prostheses.

Gender-wise Description of Morphometric Measures of Knee Joint Based on Magnetic Resonance Imaging Scan: A Descriptive Cross-sectional Study

Background: Customization of Total Knee Replacement (TKR) and the design of knee prostheses are paramount. Conventionally, surgeons select from a spectrum of pre-fabricated implants, assessing their fit based on the patient’s knee morphology via magnetic resonance imaging. Aim and Objective: This research endeavours to identify and quantify gender-related variations in knee morphometry by examining the distal femur and proximal tibia of the population of North India. Materials and Methods: A Descriptive cross-sectional study included 59 males and 59 females’ knees. A 1.5 TESLA MRI unit (Avanto Magnetomtim + dot system, Siemens, Erlangen, Germany) was utilized for imaging. The morphological features of proximal Tibia and distal femur were taken. Correlation between morphometric parameters were calculated using Karl Pearson’s correlation coefficient. P-value <0.05 was set statistically significant. Results: All the FEMUR parameters were significantly higher in males than females. The mean FML in males was 8.04±0.50SD and in females was 6.97±0.33SD (P<0.05). Mean FMAP in males was 5.98±0.46SD and in females it was 5.36±0.35SD (P<0.05). All the TIBIA parameters were significantly higher in males than females. The mean TML in males was 7.56±0.37SD and in females was 6.49±0.28SD (P<0.05). Mean TAP in males was 4.64±0.41SD and in females it was 4.13±0.25 (P<0.05). Conclusion: Variations in bone dimensions were attributed to a complex interplay of genetic, ethnic, and environmental factors. In conclusion, this study makes a substantial contribution to the understanding of knee joint morphology.

Effect of carbon-fiber-reinforced polyetheretherketone on stress distribution in a redesigned tumor-type knee prosthesis: a finite element analysis.

Background: Surgery for bone tumors around the knee often involves extensive resection, making the subsequent prosthetic reconstruction challenging. While carbon fiber-reinforced polyetheretherketone (CF-PEEK) has been widely used in orthopedic implants, its application in tumor-type prosthesis is limited. This study aims to evaluate the feasibility of using 30wt% and 60wt% carbon fiber-reinforced polyetheretherketone (CF30-PEEK and CF60-PEEK) as materials for a redesigned tumor-type knee prosthesis through numerical analysis. Methods: A knee joint model based on CT data was created, and the resection and prosthetic reconstruction were simulated. Three finite element models of the prostheses, representing the initial and updated designs with CoCrMo and CFR-PEEK components, were constructed. Loading conditions during standing and squatting were simulated with forces of 700N and 2800N, respectively. Finite element analysis was used to analyze the von Mises stress and stability of all components for each prosthesis type. Results: After improvements in both material and design, the new Type 3 prosthesis showed significantly lower overall stress with stress being evenly distributed. Compared with the initial design, the maximum von Mises stress in Type 3 was reduced by 53.9% during standing and 74.2% during squatting. In the standing position, the maximum stress in the CF30-PEEK femoral component decreased by 57.3% compared with the initial design which was composed of CoCrMo, while the stress in the CF60-PEEK cardan shaft remained consistent. In the squatting position, the maximum stress in the femoral component decreased by 81.9%, and the stress in the cardan shaft decreased by 46.5%. Conclusion: The incorporation of CF30-PEEK effectively transmits forces and reduces stress concentration on the femoral component, while CF60-PEEK in the redesigned cardan shaft significantly reduces stress while maintaining stiffness. The redesigned prosthesis effectively conducts loading force and demonstrates favorable biomechanical characteristics, indicating the promising potential of utilizing CF30-PEEK and CF60-PEEK materials for tumor-type knee prostheses. The findings of this study could provide novel insights for the design and development of tumor-type knee prostheses.

Comparison of clinical outcomes among total knee arthroplasties using posterior-stabilized, cruciate-retaining, bi-cruciate substituting, bi-cruciate retaining designs: a systematic review and network meta-analysis.

Despite the advent of innovative knee prosthesis design, a consistent first-option knee implant design in total knee arthroplasty (TKA) remained unsettled. This study aimed to compare the clinical effects among posterior-stabilized (PS), cruciate-retaining (CR), bi-cruciate substituting (BCS), and bi-cruciate retaining designs for primary TKA. Electronic databases were systematically searched to identify eligible randomized controlled trials (RCTs) and cohort studies from inception up to July 30, 2021. The primary outcomes were the range of knee motion (ROM), and the secondary outcomes were the patient-reported outcome measures (PROMs) and complication and revision rates. Confidence in evidence was assessed using Confidence in Network Meta-Analysis. The Bayesian network meta-analysis was performed for synthesis. A total of 15 RCTs and 18 cohort studies involving 3520 knees were included. The heterogeneity and inconsistency were acceptable. There was a significant difference in ROM at the early follow-up when PS was compared with CR (mean difference [MD] = 3.17, 95% confidence interval [CI] 0.07, 7.18) and BCS was compared with CR (MD = 9.69, 95% CI 2.18, 17.51). But at the long-term follow-up, there was no significant difference in ROM in any one knee implant compared with the others. No significant increase was found in the PROMs and complication and revision rates at the final follow-up time. At early follow-up after TKA, PS and BCS knee implants significantly outperform the CR knee implant in ROM. But in the long run, the available evidence suggests different knee prostheses could make no difference in clinical outcomes after TKA with extended follow-up.

Design, Manufacture, and Experimental Validation of a Hydraulic Semi-Active Knee Prosthesis.

In this article, a new hydraulic semi-active knee (HSAK) prosthesis is proposed. Compared with knee prostheses driven by hydraulic-mechanical coupling or electromechanical systems, we novelly combine independent active and passive hydraulic subsystems to solve the incompatibility between low passive friction and high transmission ratio of current semi-active knees. The HSAK not only has the low friction to follow the intentions of users, but also performs adequate torque output. Moreover, the rotary damping valve is meticulously designed to effectively control motion damping. The experimental results demonstrate the HSAK combines the advantages of both passive and active prostheses, including the flexibility of passive prostheses, as well as the stability and the sufficient active torque of active prostheses. The maximum flexion angle in level walking is about 60°, and the peak output torque in stair ascent is greater than 60Nm. Relative to the daily use of prosthetics, the HSAK improves gait symmetry on the affected side and contributes to the amputees better maintain daily activities.

Comparison of the in-vivo kinematics of three different knee prosthesis designs during a step-up movement

BackgroundThere is no consensus on the importance of the kinematics of the prosthetic joint for the clinical outcome after total knee arthroplasty. A 3-armed randomized controlled trial was done to determine and compare the in vivo kinematics of a posterior cruciate-retaining and two posterior cruciate-sacrificing (Anterior-Stabilized and Posterior-Stabilized) prosthetic designs from the same total knee arthroplasty system. Since the anterior-stabilized and posterior-stabilized designs are posterior cruciate ligament-sacrificing designs, we hypothesized they would have similar contact-point kinematics. Further, we hypothesized that the cruciate-retaining design would have contact-point kinematics different from the anterior-stabilized and the posterior-stabilized designs, but comparable to a native knee. MethodsThirty-nine patients with a well-functioning total knee arthroplasty one year postoperatively underwent kinematic analysis of a weight-bearing step-up movement under fluoroscopic recording. Model-based radiostereometric analysis was used to determine anteroposterior contact-point translations and rotations through the movement path to assess knee kinematics. FindingsThe cruciate-retaining and anterior-stabilized groups' medial and lateral contact-points displayed similar paradoxical posterior translations during step-up in the magnitude of 7 and 2 mm, respectively. In contrast, the posterior-stabilized group's contact-points translated anteriorly by 4 and 10 mm throughout the movement and were significantly more posterior than the cruciate-retaining and the anterior-stabilized groups from >100° to 40° of flexion. The femur rotated internally with all designs. InterpretationThe cruciate-retaining and anterior-stabilized designs displayed similar contact-point translation patterns during a step-up movement. Only the posterior-stabilized design showed a pattern comparable to native knees. Conversion from a cruciate-retaining to an anterior-stabilized design because of posterior cruciate ligament insufficiency will not change knee kinematics.

Validation of an MRI Technique for the 6-DOF Knee Kinematics Measurement.

Background: For total knee arthroplasty (TKA), the optimal rotational position of the femoral component is felt to be critically important. The current knee joint kinematics measurement technology is unable to identify the exact rotation axis of the knee joint, the main reasons being low measurement accuracy and insufficient three-dimensional data (2D-3D image matching technology). In order to improve the effect of TKA surgery, we proposed a knee joint kinematics measurement method, based on the MRI technology, and verified its measurement accuracy. We then employed this method to identify the personalized optimal rotation axis of the knee joint for TKA patients. Purposes: The purpose of the study was 1) to propose a method for measuring knee joint kinematics and verify its accuracy and 2) to propose a method for determining the optimal rotation axis of knee joint for TKA surgery, based on accurate kinematic measurement results. Materials and Methods: The experiment was divided into two parts: in vitro and in vivo. The purpose of the in vitro experiment was to verify the measurement accuracy of our method. We fixed two aquarium stones (approximately 10cm * 10cm * 10cm in size, close to the size of the distal femur and proximal tibia) firmly on the fixed and moving arms of the goniometer/vernier caliper with glue and immersed the aquarium stones in the water to capture MRI images. The MRI images were then processed with MATLAB software, and the relative motion of the two aquarium stones was measured. The measurement accuracy of our method was verified via the scale reading of the moving arm on the goniometer/vernier caliper. In vivo, 36 healthy elderly participants (22 females, 14 males) were recruited from the local community; our method was then employed to measure the relative motion of the tibia and femur and to observe the rollback and screw home motion of the medial/lateral condyle of the femur, which was identified as specific kinematic features of the knee joint. Results: In vitro, all measurements were accurate to <1mm and <1°. In vivo, all knee measurements showed rollback motion (the rollback distance of the medial femoral condyle was 18.1 ± 3.7mm and that of the lateral condyle was 31.1 ± 7.3mm) and screw home motion. Conclusion: In the application scenario of knee joint kinematics measurement, our method has an accuracy of <1° of rotation angle and <1mm of translation for all reference points, and it can be employed to identify the most stable axis of the knee joint. Significance: Using our method to accumulate data on the knee rotation axis of more subjects to establish an average rotation axis of a given population may help in knee prosthesis design and reduce the patient dissatisfaction rate. Individually measuring the patient's rotation axis before TKA surgery and adjusting the prosthesis installation in TKA may further reduce the patient dissatisfaction rate, and automatic computer measurement may be realized in the future, but it is still time-consuming for now.

Robotic Knee Prosthesis with Cycloidal Gear and Four-Bar Mechanism Optimized Using Particle Swarm Algorithm

A powered transfemoral prosthesis is needed as people with transfemoral amputation show 60 percent extra metabolic cost when compared to people with no amputation. Recently, as illustrated in the literature, the most high-torque robotic knee prosthesis utilize harmonic reducers. Despite the advantage of high reduction ratio and efficiency, the harmonic drive cannot be back-driven. Therefore, the harmonic drive is not an optimal solution for prosthetic systems with direct and indirect contact with the environment. In this paper, we outline an initial design of robotic knee prosthesis. The proposed robotic knee prosthesis consists of BLDC motor, cycloidal gear with reduction ratio 13:1, four-bar mechanism, and timing belt transmission with 4:1 reduction ratio. To optimize the torque transmission and range of motion (RoM), a multiobjective optimization problem must be undertaken. The end-effector motion depends on each bar length in the four-bar mechanism. The four-bar mechanism was optimized using particle swarm optimization (PSO). To complete the optimization, a set of 50 steps was collected using wearable sensors. Then, the data of sagittal plan were processed to identify the target profile for PSO. The prototype’s computer-aided manufacturing (CAM) was completed using a MarkTwo 3D printer with carbon fiber composite. The overall design can achieve a maximum torque of 84 N.m. However, the current design lacks the elastic component (no spring is added on the actuator output), which is necessary for a functional prosthesis; this limitation will be addressed in future study.

Musculoskeletal multibody dynamics investigation of posterior-stabilized total knee prosthesis

Posterior-stabilized total knee prostheses have been widely used in orthopedic clinical treatment of knee osteoarthritis, but the patients and surgeons are still troubled by the complications, for example severe wear and fracture of the post, as well as prosthetic loosening. Understanding the in vivo biomechanics of knee prostheses will aid in the decrease of postoperative prosthetic revision and patient dissatisfaction. Therefore, six different designs of posterior-stabilized total knee prostheses were used to establish the musculoskeletal multibody dynamics models of total knee arthroplasty respectively, and the biomechanical differences of six posterior-stabilized total knee prostheses were investigated under three simulated physiological activities: walking, right turn and squatting. The results showed that the post contact forces of PFC Sigma and Scorpio NGR prostheses were larger during walking, turning right, and squatting, which may increase the risk of the fracture and wear as well as the early loosening. The post design of Gemini SL prosthesis was more conductive to the knee internal-external rotation and avoided the edge contact and wear. The lower conformity design in sagittal plane and the later post-cam engagement resulted in the larger anterior-posterior translation. This study provides a theoretical support for guiding surgeon selection, improving posterior-stabilized prosthetic design and reducing the prosthetic failure.

Design and Backdrivability Modeling of a Portable High Torque Robotic Knee Prosthesis With Intrinsic Compliance For Agile Activities.

High-performance prostheses are crucial to enable versatile activities like walking, squatting, and running for lower extremity amputees. State-of-the-art prostheses are either not powerful enough to support demanding activities or have low compliance (low backdrivability) due to the use of high speed ratio transmission. Besides speed ratio, gearbox design is also crucial to the compliance of wearable robots, but its role is typically ignored in the design process. This paper proposed an analytical backdrive torque model that accurately estimate the backdrive torque from both motor and transmission to inform the robot design. Following this model, this paper also proposed methods for gear transmission design to improve compliance by reducing inertia of the knee prosthesis. We developed a knee prosthesis using a high torque actuator (built-in 9:1 planetary gear) with a customized 4:1 low-inertia planetary gearbox. Benchtop experiments show the backdrive torque model is accurate and proposed prosthesis can produce 200 Nm high peak torque (shield temperature <60°C), high compliance (2.6 Nm backdrive torque), and high control accuracy (2.7/8.1/1.7 Nm RMS tracking errors for 1.25 m/s walking, 2 m/s running, and 0.25 Hz squatting, that are 5.4%/4.1%/1.4% of desired peak torques). Three able-bodied subject experiments showed our prosthesis could support agile and high-demanding activities.

Morphometric Analysis of Tibial Plateau for Knee Arthroplasty and Prosthesis Design

Morphometric Analysis of Tibial Plateau for Knee Arthroplasty and Prosthesis Design

An automatic measurement system of distal femur morphological parameters using 3D slicer software.

In the field of joint surgery, the computer-aided design of knee prostheses suitable for the Chinese population requires a large quantity of anatomical knee data. In this study, we propose a new method that uses 3D Slicer software to automatically measure the morphological parameters of the distal femur. First, 141 femur samples were segmented from CT data to establish the femoral shape library. Next, balanced iterative reducing and clustering using hierarchies (BIRCH) combined with iterative closest point (ICP) and generalised procrustes analysis (GPA) were used to achieve fast registration of the femur samples. The statistical model was automatically calculated from the registered femur samples, and an orthopaedic surgeon marked the points on the statistical model. Finally, we developed an automatic measurement system using 3D Slicer software, and a deformable model matching method was applied to establish the point correspondence between the statistical model and the other samples. By matching points on the statistical model to corresponding points in other samples, we measured all other samples. We marked six points and measured eight parameters. We evaluated the performance of automatic matching by comparing the points marked manually with those matched automatically and verified the accuracy of the system by comparing the manual and automatic measurement results. The results indicated that the average error of the automatic matching points was 1.03mm, and the average length error and average angle error measured automatically by the system were 0.37mm and 0.63°, respectively. These errors were smaller than the intra-rater and inter-rater errors measured manually by two different surgeons, which showed that the accuracy of our automatic method was high. Taken together, this study established an accurate and automatic measurement system for the distal femur based on the secondary development of 3D Slicer software to assist orthopaedic surgeons in completing the measurements of big data and further promote the improved design of Chinese-specific knee prostheses.

Preliminary Study on Immediate Postoperative CT Images and Values of the Modular Polyetheretherketone Based Total Knee Arthroplasty: An Observational First-in-Human Trial.

BackgroundTotal knee arthroplasty (TKA) is now frequently performed and is highly successful. However, patient satisfaction after TKA is often difficult to achieve. Because of the presence of metallic prosthetic knee joints, there is a lack of imaging tools that can accurately assess the patient's postoperative prosthetic position, soft tissue impingement, and periprosthetic bone density after TKA. We conducted a clinical trial of the world's first totally modular polyetheretherketone (PEEK) TKA and determined the bone density values in the stress concentration area around the prosthesis based on postoperative computed tomography data to reconstruct a three-dimensional model of the PEEK prosthetic knee joint after implantation. Based on the model, the overhang of the prosthesis was measured at various locations on the prosthesis.MethodsAll patients who underwent PEEK-based TKA were postoperatively assessed with radiography and computed tomography (CT). Hounsfield units (HUs) for the different components of the quantitative CT assessment were measured separately.ResultsTen patients (nine female and one male) aged 59–74 (mean 66.9, median 67) years were included. The HU values were as follows: PEEK prosthesis mean 182.95, standard deviation (SD) 4.90, coefficient of variation (CV) 2.68; polyethylene mean −89.41, SD 4.14, CV −4.63; lateral femoral osteochondral mean 192.19, SD 55.05, CV 28.64; lateral tibial osteochondral mean 122.94, SD 62.14, CV 42.86; medial femoral osteophyte mean 180.76, SD 43.48, CV 24.05; and medial tibial osteophyte mean 282.59, SD 69.28, CV 24.52. Analysis of the data at 1, 3, and 6 months showed that the mean PE (p = 0.598) and PEEK (p = 0.916) measurements did not change with the time of measurement. There was a decrease in bone mineral density in the lateral tibia at 3 months (p = 0.044). Otherwise, there was no significant change in bone density in other regions (p = 0.124–0.803). There was no overhang in all femoral prostheses, whereas there were two cases of overhang in tibial prostheses. Overhang measurements do not differ significantly across time points. The overhang measurements were not significantly different at all time points (p = 0.186–0.967).ConclusionPEEK knee joint prosthesis has excellent CT compatibility. The change in periprosthetic bone volume during the follow-up period can be determined using the HU value after CT scan, while the prosthesis position can be assessed. This assessment may potentially guide future improvements in knee prosthesis alignment techniques and artificial knee prosthesis designs.

Design and structural analysis of a passive ankle-foot prosthesis with manually adjustable stiffness and having two degrees of freedom

The majority of commercial Below Knee Prosthetics are Passive Prosthetics as they are lightweight, affordable, durable and require less maintenance. Since the human ankle is a set of highly integrated joints, ankle design is the most crucial aspect of a Below Knee (transtibial) prosthesis design process. This research work focuses on developing and analysing a Passive Ankle-Foot Prosthesis to attain 2 DOF, i.e., plantarflexion-dorsiflexion and inversion-eversion motions of a foot, such that it could mimic the behaviour of a natural lost limb. Further, this study presents the integration of manual ankle stiffness modulation into the same design for dorsiflexion-plantarflexion which can be altered by the amputee to a preferred stiffness for various ambulation requirements. The design proposed in this study also assimilates the features of an ESR and a SACH foot to a significant level. The structural analysis demonstrates that the device can sustain a vertical load of 800 N with the Factor of Safety (FOS) of 1.5. The deflection analysis of the leaf spring used in the design shows the exponential increase in stiffness as the slider moves beyond 70% of the length of the leaf spring towards its free end.

Morphometric measurement of the proximal tibia to design the tibial component of total knee arthroplasty for the Thai population

PurposeThis study evaluates the morphology of the Thai proximal tibia based on three-dimensional (3D) models to design the tibial component.MethodsThe 3D models of 480 tibias were created using reverse engineering techniques from computed tomography imaging data obtained from 240 volunteers (120 males, 120 females; range 20–50 years). Based on 3D measurements, a digital ruler was used to measure the distance between the triangular points of the models. The morphometric parameters consisted of mediolateral length (ML), anteroposterior width (AP), medial anteroposterior width (MAP), lateral anteroposterior width (LAP), central to a medial length (CM), central to a lateral length (CL), medial anterior radius (MAR), lateral anterior radius (LAR), and tibial aspect ratio (AR). An independent t-test was performed for gender differences, and K-means clustering was used to find the optimum sizes of the tibial component with a correlation between ML length and AP width in Thai people.ResultsThe average morphometric parameters of Thai proximal tibia, namely ML, AP, MAP, LAP, CM, and CL, were as follows: 72.52 ± 5.94 mm, 46.36 ± 3.84 mm, 49.22 ± 3.62 mm, 43.59 ± 4.05 mm, 14.29 ± 2.72 mm, and 15.28 ± 2.99 mm, respectively. The average of MAR, LAR, and AR was 24.43 ± 2.11 mm, 21.52 ± 2.00 mm, and 1.57 ± 0.08, respectively. All morphometric parameters in males were significantly higher than those of females. There was a difference between the Thai proximal tibia and other nationalities and a mismatch between the size of the commercial tibial component and the Thai knee. Using K-means clustering analysis, the recommended number of ML and AP is seven sizes for the practical design of tibial components to cover the Thai anatomy.ConclusionThe design of the tibial component should be recommended to cover the anatomy of the Thai population. These data provide essential information for the specific design of Thai knee prostheses.

Síntesis mediante algoritmos genéticos de mecanismos articulados de seis barras rígidas para prótesis de rodilla

Using the method of genetic algorithms, the synthesis process of a Watt I type six-bar flat mechanism is developed and applied to the design of a polycentric knee prosthesis to guarantee stability in the extension and total flexion phase of the knee during the knee. gait cycle of a person. Six precision points of the trajectory of the instantaneous center of rotation of the coupling link were selected, with a population of one thousand individuals formed with the lengths of links and angles of movement of the mechanism. The fitness function was obtained with the Freudenstein equation applied to two four-bar mechanisms that make up the prosthesis and the design restrictions were: minimum and maximum bar dimensions, Grashof criterion, angular relationships for ternary elements, transmission angle and instantaneous inactive joints.

Defect free optimization of a polycentric prosthetic knee design using imperialist competition-inspired optimization method

The disability of lower limbs is one of the major problems facing human lives. In order to restore the missing functionality and aesthetic feature of the amputee's locomotion, finding the optimal design of the human lower limb knee prosthesis is crucial. This paper focuses the design optimization of a four bar knee mechanism capable to reproduce the complex flexion/extension knee joint motion in the sagittal plane with variable instantaneous center of rotation positions. Thus an optimization approach with appropriate constraints is formulated in order to consider the degree of compatibility between the instantaneous center of rotation trajectories of the human reference knee joint and the four bar knee mechanism. To solve this high nonlinear optimization problem, an algorithm based on multi-objective modified imperialist competitive method is proposed where all the constraints are managed with the penalty method. The results obtained by the multi-objective modified imperialist competitive method showed the capability to reach a small tracking error. The obtained results prove the effectiveness of the proposed optimization approach for the optimal synthesis of the four bar knee mechanism, compared with other literature techniques.

Multiscale finite element musculoskeletal model for intact knee dynamics

Background and objectiveThe dynamic characteristics of the intact knee joint are valuable for treating knee osteoarthritis and designing knee prostheses. However, it remains a challenge to elucidate the detailed dynamics of the knee due to its complexity of anatomical structure and complex interaction with body dynamics. MethodsIn this study, a unique subject-specific musculoskeletal model with a concurrent high-accuracy intact finite element knee model was created and used to simultaneously evaluate the kinematics and mechanics of an intact knee joint during the gait cycle. ResultsA medial pivot motion with external rotation, and a large parallel anterior translation were observed in the stance and swing phases, respectively, which is consistent with the in vivo fluoroscopy measurements. The maximum axial contact force on the knee joint, observed at 45% of the gait cycle, is approximately 2.89 times the body weight. The medial cartilage bears 65.7% of the total axial contact force. The results demonstrate that the cartilage–cartilage contact bears most of the joint load (62.5%) compared to the cartilage–meniscus–cartilage contact (37.5%). Regarding contact mechanics, the maximum contact pressure on both sides of the tibial cartilage (8.2 MPa) is almost similar to the first axial loading peak (14%) of the gait cycle. Additionally, the maximum contact pressure (6.01 MPa) was observed during the stance phase of the gait cycle on the patellofemoral joint. ConclusionsThe predicted results on the tibiofemoral and patellofemoral joints provide a theoretical basis for the treatment of knee joint diseases and knee prosthesis design. Moreover, this approach presents a comprehensive tool to evaluate the mechanics at both the body and tissue levels. Therefore, it has a high potential for application in human biomechanics.

Does the anatomic design of total knee prosthesis allow for a better component fit than its nonanatomic predecessor? A matched cohort Study.

BackgroundTotal knee arthroplasty (TKA) is considered the most efficient treatment of end-stage osteoarthritis. There is an ongoing debate about proper implant designs and articulation types. One of the considered causes of unsatisfactory outcome and patients’ dissatisfaction is femoral or tibial component overhanging, which can lead to chronic knee pain and restricted motion. The aim of this study is to compare radiological outcomes of TKA using an anatomic PERSONA Posterior-Stabilized (PS) knee design with its nonanatomic predecessor, the NexGen LPS.MethodsA group of 39 patients who received the PERSONA PS system and 33 patients who received the NexGen LPS was included. PERSONA patients were matched to NexGen patients using a 0.1 propensity score threshold with priority given to exact matches. Anteroposterior, lateral, and long-leg radiographs were taken preoperatively and at 6 weeks postoperatively to perform radiological and statistical analysis.ResultsThe PERSONA subgroup had statistically higher posterior condylar offset. There is no statistically significant difference in posterior condylar offset ratio. There were less cases of femoral notching, femoral overhang, and placing tibial baseplate in the medial overhang in the PERSONA PS subgroup than in the NexGen subgroup (each statistically significant). Occurrence of tibial underhang was not statistically significant.ConclusionRadiological assessment in short-term follow-up showed excellent results for PERSONA knee design with better fit to native femur and tibia. In comparison to its predecessor, it also spares more bone tissue. As the aforementioned parameters are risk factors of lesser clinical outcomes, the PERSONA design gives high hopes for improvement of TKA satisfaction rate.

Sex-specific versus standard posterior cruciate-substituting total knee prosthesis

Background The introduction of sex-specific (SS) knee prosthesis designs was an approach to offer more sizing options and is based on the anatomic sex differences. These SS components were though to provide better fitting to female femora and consequently improve the clinical outcome. Materials and methods In the period between February 2011 and March 2013, a prospective superiority randomized controlled clinical trial was conducted to compare the clinical outcome of SS versus the standard posterior stabilized (PS) knee prosthesis in women. The primary outcome measure was the postoperative range of knee flexion, and the secondary outcome measure was the knee function as reflected on the performance of daily activities. The OXFORD Knee Score, Knee Society Score, and Knee Society Score for function were recorded preoperatively and then at 3, 12 months, and annually thereafter. Female patients with degenerative or inflammatory arthritis who were 50 years or older and their knee deformities were totally articular were included. A total of 64 patients with 80 knees were enrolled in this trial, and 40 knees were allocated to each group. Knees in the SS group had total knee arthroplasty using SS knee prosthesis, with SS femoral component (the experimental group), whereas knees in the PS group had standard PS knee design with standard femoral component (the control group). Equal randomization (1 : 1 ratio) was undertaken according to a computer-generated randomization table. Results The mean preoperative knee flexion range of motion (ROM) was 110 and 108° in the SS and PS groups, respectively. At the latest follow-up, the mean postoperative knee flexion ROM was 115 and 113° the SS and PS groups, respectively. The mean improvement in the knee flexion ROM in both groups was 5° (range: 0–25), with no statistically significant difference between the two groups. All knees except one had full extension. No statistically significant difference was observed between the two groups when the OXFORD Knee Score, the Knee Society Score, and the Knee Society Score for function were compared. Conclusion No clinical advantage was observed in the ROM or function between knees that received SS knee prosthesis when compared with those who received PS knee implants. The SS total knee arthroplasty though designed to provide better fitting to the female distal femur does not provide any clinical advantage over the standard PS knee prosthesis. A logic question is whether a separate implant is required for women or modifications to the knee prostheses geometry and more sizes are required to accommodate all patients? Level of evidence Level II.