In vivo contact stresses during activities of daily living after knee arthroplasty

D’Lima, Darryl D.; Steklov, Nikolai; Fregly, Benjamin J.; Banks, Scott A.; Colwell, Clifford W.

doi:10.1002/jor.20670

Cited by 70 publications

(56 citation statements)

References 43 publications

(47 reference statements)

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“…Peak contact stresses, mean contact stresses, and contact areas for gait at two speeds were similar [13]. The ISO loading waveform applies greater axial load (peak 2600 N) and therefore generated higher contact stresses.…”

Section: Walkingmentioning

confidence: 71%

“…Our finding of high contact stresses during the lunge and kneeling activities (Fig. 6) owing to the small area of contact indicate that designs with a broader articular contact area at high flexion might reduce the risk for polyethylene damage [13].…”

Section: Deep-flexion Activitiesmentioning

confidence: 77%

“…During the lunge activity, the ground reaction force was transmitted through the foot. The lunge activity generated modest knee contact forces (1.6 9 BW) relative to walking and stair climbing [13] owing to the reduced contact area in deep flexion (less than 50% of the contact area calculated for stair climbing). Kneeling generated the lowest contact forces (0.3 9 BW) and the lowest contact area (29 mm 2 ) owing to the poor femorotibial contact in deep flexion.…”

Section: Deep-flexion Activitiesmentioning

confidence: 97%

“…Stair climbing generated higher total contact forces (peak 3.5 9 BW) with concomitantly higher contact stresses [13]. The center of pressure moved posteriorly with knee flexion indicative of femoral rollback.…”

Section: Stair Climbingmentioning

confidence: 98%

“…Tibial forces used to generate contact stresses in previous studies have been mathematical estimates. We used tibial forces and knee kinematics measured in vivo to calculate contact stresses for activities of daily living [13].…”

Section: In Vivo Contact Stressesmentioning

confidence: 99%

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The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

D’Lima

Patil

Steklov

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Tibiofemoral forces are important in the design and clinical outcomes of TKA. We developed a tibial tray with force transducers and a telemetry system to directly measure tibiofemoral compressive forces in vivo. Knee forces and kinematics traditionally have been measured under laboratory conditions. Although this approach is useful for quantitative measurements and experimental studies, the extrapolation of results to clinical conditions may not always be valid. Questions/purposes We therefore developed wearable monitoring equipment and computer algorithms for classifying and identifying unsupervised activities outside the laboratory. Methods Tibial forces were measured for activities of daily living, athletic and recreational activities, and with orthotics and braces, during 4 years postoperatively. Additional measurements included video motion analysis, EMG, fluoroscopic kinematic analysis, and ground reaction force measurement. In vivo measurements were used to evaluate computer models of the knee. Finite element models were used for contact analysis and for computing knee kinematics from measured knee forces. A thirdgeneration system was developed for continuous monitoring of knee forces and kinematics outside the laboratory using a wearable data acquisition hardware. Results By using measured knee forces and knee flexion angle, we were able to compute femorotibial AP translation (À12 to +4 mm), mediolateral translation (À1 to 1.5 mm), axial rotation (À3°to 12°), and adduction-abduction (À1°t o +1°). The neural-network-based classification system was able to identify walking, stair-climbing, sit-to-stand, and stand-to-sit activities with 100% accuracy. Conclusions Our data may be used to improve existing in vitro models and wear simulators, and enhance prosthetic designs and biomaterials.

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Section: Walkingmentioning

confidence: 71%

Section: Deep-flexion Activitiesmentioning

confidence: 77%

Section: Deep-flexion Activitiesmentioning

confidence: 97%

Section: Stair Climbingmentioning

confidence: 98%

Section: In Vivo Contact Stressesmentioning

confidence: 99%

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The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

D’Lima

Patil

Steklov

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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The effects of presence of a backside screw hole on biotribological behavior of phospholipid polymer‐grafted crosslinked polyethylene

et al. 2017

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One of the important factors in determining the success of joint replacement is the wear performance of polyethylene. Although highly crosslinked polyethylene (CLPE) is presently used, it is still not adequate. We have developed a surface modification technology using poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) in an attempt to improve wear performance. In this study, we evaluated the wear and creep deformation resistances of 3-mm and 6-mm thick PMPC-grafted CLPE disks, set on a metal back-plate, with and without a sham screw hole. The gravimetric wear and volumetric change of the disks were examined using a multidirectional pin-on-disk tester. PMPC grafting decreased the gravimetric wear of CLPE regardless of the presence of a screw hole, and did not affect the volumetric change. The volumetric change in the bearing and backside surfaces of the 3-mm thick disk with a screw hole was much larger than that of those without a screw hole or those of the 6-mm thick disk, which was caused by creep deformation. PMPC grafting on the bearing surface can be a material engineering approach to reduce the wear without changing the creep deformation resistance, and is a promising surface modification technology that can be used to increase the longevity of various artificial joints. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 610-618, 2018.

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Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty

Wong

Steklov

Patil

et al. 2010

Journal Orthopaedic Research

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Tibial tray malalignment has been associated with increased subsidence and failure. We constructed a finite element model of knee arthroplasty to determine the biomechanical factors involved in increasing the risk of subsidence with malalignment. Four fresh-frozen human knees were implanted with a tibial tray and subjected to forces representative of walking for up to 100,000 cycles. Cyclic displacement was measured between the tray and proximal tibia. The vertical load was shifted medially to generate a load distribution ratio of 55:45 (medial/lateral) to represent neutral alignment or 75:25 to represent varus alignment. Subjected specific geometry and material properties were obtained from qCT scans of tibia to construct a finite element model. The tray was subjected to a single load cycle representing experimental conditions. Tray displacement computed by the model matched that measured experimentally. Forces representing varus tray alignment generated greater strains in the proximal tibia and a greater volume of bone was subjected to strains higher than the fatigue threshold. Local compressive strains directly correlated with experimental subsidence and failure. Our results indicate that failure after tray malalignment is likely due to fatigue damage to the proximal tibia rather than shear across the implant-bone interface or failure of the cement mantle. ß

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In vivo contact stresses during activities of daily living after knee arthroplasty

Cited by 70 publications

References 43 publications

The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

The effects of presence of a backside screw hole on biotribological behavior of phospholipid polymer‐grafted crosslinked polyethylene

Predicting the effect of tray malalignment on risk for bone damage and implant subsidence after total knee arthroplasty

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