Tibial Forces Measured In Vivo After Total Knee Arthroplasty

D’Lima, Darryl D.; Patil, Shantanu; Steklov, Nikolai; Slamin, John; Colwell, Clifford W.

doi:10.1016/j.arth.2005.07.011

Cited by 199 publications

(125 citation statements)

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“…Peak tibial forces during walking increased steadily during the first 12-month postoperative period and remained steady after that at a mean (± SD) 2.5 9 BW (± 0.4) [11,12]. These peak tibial forces were within the predicted range …”

Section: Level Walkingmentioning

confidence: 53%

“…The electronic prosthesis is powered wirelessly by a large circular inductor coil fitted around the patient's knee to power the small internal coil in the implanted prosthesis [12,15]. A 2400-W audio amplifier, driven by a 6.9-KHz sine wave signal, was used to power the inductor coil.…”

Section: A Wearable Force and Kinematics Monitoring Devicementioning

confidence: 99%

“…The first electronic knee prosthesis was implanted on February 27, 2004. Forces were monitored during recovery and rehabilitation in the early postoperative period and for activities of daily living and exercise during the first 24 months after surgery [11,12]. These measurements were supplemented by video motion analysis, EMG, fluoroscopic kinematic analysis, and ground reaction force measurement.…”

Section: Introductionmentioning

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: Level Walkingmentioning

confidence: 53%

Section: A Wearable Force and Kinematics Monitoring Devicementioning

confidence: 99%

Section: Introductionmentioning

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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“…For instance, the asymmetry of the medial and lateral load at the knee based on the adduction moment during walking 11 has been related to tibial component loosening. Thus, a better understanding of the activity dependence of the forces, flexion angle at peak force, and the medial to lateral force distribution is important in examining the factors that influence cartilage breakdown 4 and in establishing improved implant design criteria.A recently developed instrumented total knee replacement with the capacity to measure in vivo joint contact forces directly using force transducers imbedded in the metal tibial tray 3,12,13 offers the opportunity to address many of the questions described above. Our purpose here was to categorize activities of daily living based on load magnitude, knee flexion angle at peak load, medial to lateral load distribution, and the frequency of the activity.…”

mentioning

confidence: 99%

“…A recently developed instrumented total knee replacement with the capacity to measure in vivo joint contact forces directly using force transducers imbedded in the metal tibial tray 3,12,13 offers the opportunity to address many of the questions described above. Our purpose here was to categorize activities of daily living based on load magnitude, knee flexion angle at peak load, medial to lateral load distribution, and the frequency of the activity.…”

mentioning

confidence: 99%

In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement

Mündermann

Dyrby

D’Lima

et al. 2008

Journal Orthopaedic Research

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We examined the relationship between activity, peak load, medial to lateral load distribution, and flexion angle at peak load for activities of daily living. An instrumented knee prosthesis was used to measure knee joint force simultaneously with motion capture during walking, chair sit to stand and stand to sit, stair ascending and descending, squatting from a standing position, and golf swings. The maximum total compressive load at the knee was highest during stair ascending and descending and lowest during rising from a chair. Maximum total compressive load occurred at substantially different flexion angles ranging from 8.58 during walking to 91.88 during squatting. For all activities, total compressive load exceeded 2 times body weight, and for most activities 2.5 times body weight. Most activities placed a greater load on the medial compartment than the lateral compartment. Activities were grouped into three categories: high cycle loading (walk), high load (stair ascent, descent, and golf), and high flexion angle (chair sit to stand/stand to sit, and squat). The results demonstrate that the forces and motion sustained by the knee are highly activity-dependent and that the unique loading characteristics for specific activities should be considered for the design of functional and robust total knee replacements, as well as for rehabilitation programs for patients with knee osteoarthritis or following total knee arthroplasty. Keywords: contact force; ambulation; total knee replacement; arthroplasty; wearThe anatomy of the human knee is complex, and the knee is able to sustain large contact forces over a broad range of flexion angles. The tibial-femoral motion is related to the activity, the phase of the activity, and flexion angle.1,2 Similarly, the magnitude of contact force varies between activities and between the phases of the activity. 3 The relationships among flexion angle, peak joint loading, and the balance of medial to lateral load distribution for different activities can provide important insight for understanding normal and pathological conditions.The human knee experiences flexion angles from 08 to 308 during the stance phase of normal walking and from 308 to 608 during the swing phase of normal walking. Similarly, the load on the knee varies greatly between the stance and swing phase with loads exceeding two times body weight during stance.3 The knee adduction moment as a marker for the medial to lateral load distribution has been related to the ratio of medial to lateral cartilage thickness. 4 Regions of frequent loading, i.e., regions that are in contact over the range of flexion angles during walking, have thicker cartilage, and regions that are less likely to be loaded have thinner cartilage. 4 Therefore, not only the load magnitude seems to be an important determinant of ambulatory mechanics, but also the flexion angle at which these loads occur. The relationship between loads and flexion angle is also important for nonambulatory activities. For instance, the incidence of knee ost...

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2005

Van Nostrand's Scientific Encyclopedia

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Tibial Forces Measured In Vivo After Total Knee Arthroplasty

Cited by 199 publications

References 42 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

In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement

Finite Element Analysis

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