Anthony J. Petrella

Optimizing femoral component rotation in total knee arthroplasty.

Femoral component rotation is important in total knee arthroplasty to optimize patellofemoral and tibiofemoral kinematics. More recently, the epicondylar axis has been cited as the definitive landmark for femoral component rotation. However, there are few studies to support the validity of this rotational landmark and its effect on the patellofemoral and tibiofemoral articulations. In the current study, a total knee arthroplasty was done in 11 knees from cadavers. The knees were tested with various femoral component rotations from 5° internal rotation to 5° external rotation referenced to the epicondylar axis and to the posterior femoral condyles. Each knee acted as its own internal control. The knees were actively ranged from 0° to 100° by a force on the quadriceps tendon in an Oxford knee simulator. Three-dimensional kinematics of all three components were measured whereas a multiaxial transducer imbedded in the patella measured patellofemoral forces. Femoral component rotation parallel to the epicondylar axis resulted in the most normal patellar tracking and minimized patellofemoral shear forces early in flexion. This optimal rotation also minimized tibiofemoral wear motions. These beneficial effects of femoral rotation were less reproducibly related to the posterior condyles. Rotating the femoral component either internal or external to the epicondylar axis worsened knee function by increasing tibiofemoral wear motion and significantly worsening patellar tracking with increased shear forces early in flexion. Based on the current study, the femoral component should be rotationally aligned parallel to the epicondylar axis to avoid patellofemoral and tibiofemoral complications.

Comparison of Deformable and Elastic Foundation Finite Element Simulations for Predicting Knee Replacement Mechanics

Rigid body total knee replacement (TKR) models with tibiofemoral contact based on elastic foundation (EF) theory utilize simple contact pressure-surface overclosure relationships to estimate joint mechanics, and require significantly less computational time than corresponding deformable finite element (FE) methods. However, potential differences in predicted kinematics between these representations are currently not well understood, and it is unclear if the estimates of contact area and pressure are acceptable. Therefore, the objectives of the current study were to develop rigid EF and deformable FE models of tibiofemoral contact, and to compare predicted kinematics and contact mechanics from both representations during gait loading conditions with three different implant designs. Linear and nonlinear contact pressure-surface overclosure relationships based on polyethylene material properties were developed using EF theory. All other variables being equal, rigid body FE models accurately estimated kinematics predicted by fully deformable FE models and required only 2% of the analysis time. As expected, the linear EF contact model sufficiently approximated trends for peak contact pressures, but overestimated the deformable results by up to 30%. The nonlinear EF contact model more accurately reproduced trends and magnitudes of the deformable analysis, with maximum differences of approximately 15% at the peak pressures during the gait cycle. All contact area predictions agreed in trend and magnitude. Using rigid models, edge-loading conditions resulted in substantial overestimation of peak pressure. Optimal nonlinear EF contact relationships were developed for specific TKR designs for use in parametric or repetitive analyses where computational time is paramount. The explicit FE analysis method utilized here provides a unique approach in that both rigid and deformable analyses can be run from the same input file, thus enabling simple selection of the most appropriate representation for the analysis of interest.

Verification of Predicted Knee Replacement Kinematics During Simulated Gait in the Kansas Knee Simulator

Evaluating total knee replacement kinematics and contact pressure distributions is an important element of preclinical assessment of implant designs. Although physical testing is essential in the evaluation process, validated computational models can augment these experiments and efficiently evaluate perturbations of the design or surgical variables. The objective of the present study was to perform an initial kinematic verification of a dynamic finite element model of the Kansas knee simulator by comparing predicted tibio- and patellofemoral kinematics with experimental measurements during force-controlled gait simulation. A current semiconstrained, cruciate-retaining, fixed-bearing implant mounted in aluminum fixtures was utilized. An explicit finite element model of the simulator was developed from measured physical properties of the machine, and loading conditions were created from the measured experimental feedback data. The explicit finite element model allows both rigid body and fully deformable solutions to be chosen based on the application of interest. Six degrees-of-freedom kinematics were compared for both tibio- and patellofemoral joints during gait loading, with an average root mean square (rms) translational error of 1.1 mm and rotational rms error of 1.3 deg. Model sensitivity to interface friction and damping present in the experimental joints was also evaluated and served as a secondary goal of this paper. Modifying the metal-polyethylene coefficient of friction from 0.1 to 0.01 varied the patellar flexion-extension and tibiofemoral anterior-posterior predictions by 7 deg and 2 mm, respectively, while other kinematic outputs were largely insensitive.

An Efficient Probabilistic Methodology for Incorporating Uncertainty in Body Segment Parameters and Anatomical Landmarks in Joint Loadings Estimated From Inverse Dynamics

Inverse dynamics is a standard approach for estimating joint loadings in the lower extremity from kinematic and ground reaction data for use in clinical and research gait studies. Variability in estimating body segment parameters and uncertainty in defining anatomical landmarks have the potential to impact predicted joint loading. This study demonstrates the application of efficient probabilistic methods to quantify the effect of uncertainty in these parameters and landmarks on joint loading in an inverse-dynamics model, and identifies the relative importance of the parameters and landmarks to the predicted joint loading. The inverse-dynamics analysis used a benchmark data set of lower-extremity kinematics and ground reaction data during the stance phase of gait to predict the three-dimensional intersegmental forces and moments. The probabilistic analysis predicted the 1-99 percentile ranges of intersegmental forces and moments at the hip, knee, and ankle. Variabilities, in forces and moments of up to 56% and 156% of the mean values were predicted based on coefficients of variation less than 0.20 for the body segment parameters and standard deviations of 2 mm for the anatomical landmarks. Sensitivity factors identified the important parameters for the specific joint and component directions. Anatomical landmarks affected moments to a larger extent than body segment parameters. Additionally, for forces, anatomical landmarks had a larger effect than body segment parameters, with the exception of segment masses, which were important to the proximal-distal joint forces. The probabilistic modeling approach predicted the range of possible joint loading, which has implications in gait studies, clinical assessments, and implant design evaluations.

Trunk-pelvis motion, joint loads, and muscle forces during walking with a transtibial amputation.

People with unilateral, transtibial amputation (TTA) have an increased prevalence of chronic low back pain (LBP) relative to able-bodied people. However, a definitive cause of increased LBP susceptibility has not been determined. The purpose of this work was to compare dynamic trunk-pelvis biomechanics between people with (n=6) and without (n=6) unilateral TTA during walking using a computational modeling approach. A generic, muscle-actuated whole body model was scaled to each participant, and experimental walking data were used in a static optimization framework to calculate trunk-pelvis motion, L4L5 joint contact forces, and muscle forces within the trunk-pelvis region. Results included several significant between-group differences in trunk-pelvis biomechanics during different phases of the gait cycle. Most significant was greater lateral bending toward the residual side during residual single-limb stance (p<0.01), concurrent with an elevated L4L5 joint contact force (p=0.02) and greater muscle force from the intact-side obliques (p<0.01) in people with TTA relative to able-bodied people. During both double-limb support phases, people with TTA also had a greater range of axial trunk rotation away from the leading limb, concurrent with greater ranges of muscle forces in the erector spinae and obliques. In addition, a greater range of force (p=0.03) in residual-side psoas was found during early residual limb swing in people with TTA. Repeated exposure to atypical motion and joint/muscle loading in people with TTA may contribute to the development of secondary musculoskeletal disorders, including chronic, mechanical LBP.

Automated finite element meshing of the lumbar spine: Verification and validation with 18 specimen-specific models.

The purpose of this study was to seek broad verification and validation of human lumbar spine finite element models created using a previously published automated algorithm. The automated algorithm takes segmented CT scans of lumbar vertebrae, automatically identifies important landmarks and contact surfaces, and creates a finite element model. Mesh convergence was evaluated by examining changes in key output variables in response to mesh density. Semi-direct validation was performed by comparing experimental results for a single specimen to the automated finite element model results for that specimen with calibrated material properties from a prior study. Indirect validation was based on a comparison of results from automated finite element models of 18 individual specimens, all using one set of generalized material properties, to a range of data from the literature. A total of 216 simulations were run and compared to 186 experimental data ranges in all six primary bending modes up to 7.8Nm with follower loads up to 1000N. Mesh convergence results showed less than a 5% difference in key variables when the original mesh density was doubled. The semi-direct validation results showed that the automated method produced results comparable to manual finite element modeling methods. The indirect validation results showed a wide range of outcomes due to variations in the geometry alone. The studies showed that the automated models can be used to reliably evaluate lumbar spine biomechanics, specifically within our intended context of use: in pure bending modes, under relatively low non-injurious simulated in vivo loads, to predict torque rotation response, disc pressures, and facet forces.

A novel cross-shear metric for application in computer simulation of ultra-high molecular weight polyethylene wear

Wear testing of polyethylene in total joint replacements is common and required for any new device. Computational wear modelling has obvious utility in this context as it can be conducted with much greater economy than physical testing. Archards law has become the accepted standard for wear simulation in total joints but it does not account for cross-shear, which is known to increase wear significantly relative to unidirectional sliding. The purpose of this study was to develop a robust cross-shear model applicable to any interface geometry under any kinematic conditions. The proposed metric, x *, is distinguished from existing cross-shear models by the fact that it measures cross-path motion incrementally throughout a motion cycle and quantifies cross-shear based on incremental changes in sliding direction. Validation showed strong support for the predictive capability of x * when applied to pin-on-disc test data.

An Automated Method for Landmark Identification and Finite-Element Modeling of the Lumbar Spine

Goal: The purpose of this study was to develop a method for the automated creation of finite-element models of the lumbar spine. Methods: Custom scripts were written to extract bone landmarks of lumbar vertebrae and assemble L1-L5 finite-element models. End-plate borders, ligament attachment points, and facet surfaces were identified. Landmarks were identified to maintain mesh correspondence between meshes for later use in statistical shape modeling. Results: 90 lumbar vertebrae were processed creating 18 subject-specific finite-element models. Finite-element model surfaces and ligament attachment points were reproduced within 1e-5 mm of the bone surface, including the critical contact surfaces of the facets. Element quality exceeded specifications in 97% of elements for the 18 models created. Conclusion: The current method is capable of producing subject-specific finite-element models of the lumbar spine with good accuracy, quality, and robustness. Significance: The automated methods developed represent advancement in the state of the art of subject-specific lumbar spine modeling to a scale not possible with prior manual and semiautomated methods.

Facet joint biomechanics at the treated and adjacent levels after total disc replacement.

Study Design. Biomechanical study using human cadaveric lumbar spines. Objective. To evaluate effects of total disc replacement (TDR) on spine biomechanics at the treated and adjacent levels. Summary of Background Data. Previous studies on spine biomechanics after TDR were focused on facet forces and range of motion and report contradictory results. Characterization of contact pressure, peak contact pressure, force, and peak force before and after TDR may lead to a better understanding of facet joint function and may aid in prediction of long-term outcomes after TDR. Methods. Seven fresh-frozen human cadaveric lumbar spines were potted at T12 and L5 and installed in a 6 degrees of freedom displacement-controlled testing system. Displacements of 15° flexion/extension, 10° right/left bending, and 10° right/left axial rotation were applied. Contact pressure, peak contact pressure, force, peak force, and contact area for each facet joint were recorded at L2–L3 and L3–L4 both before and after TDR at L3–L4. The data were analyzed with analysis of variance and t tests. Results. Axial rotation had the most impact on contact pressure, peak contact pressure, force, peak force, and contact area in intact spines. During lateral bending and axial rotation, TDR resulted in a significant increase in facet forces at the level of treatment and a decrease in contact pressure, peak contact pressure, and peak force at the level superior to the TDR. With flexion/extension, there was a decrease in peak contact pressure and peak contact force at the superior level. Conclusion. Our study demonstrates that rotation is the most demanding motion for the spine. We also found an increase in facet forces at the treated level after TDR. We are the first to show a decrease in several biomechanical parameters after TDR at the adjacent superior level. In general, our findings suggest there is an increase in loading of the facet joints at the level of disc implantation and an overall unloading effect at the level above.

Evaluating the effects of ankle-foot orthosis mechanical property assumptions on gait simulation muscle force results

Musculoskeletal modeling and simulation techniques have been used to gain insights into movement disabilities for many populations, such as ambulatory children with cerebral palsy (CP). The individuals who can benefit from these techniques are often limited to those who can walk without assistive devices, due to challenges in accurately modeling these devices. Specifically, many children with CP require the use of ankle-foot orthoses (AFOs) to improve their walking ability, and modeling these devices is important to understand their role in walking mechanics. The purpose of this study was to quantify the effects of AFO mechanical property assumptions, including rotational stiffness, damping, and equilibrium angle of the ankle and subtalar joints, on the estimation of lower-limb muscle forces during stance for children with CP. We analyzed two walking gait cycles for two children with CP while they were wearing their own prescribed AFOs. We generated 1000-trial Monte Carlo simulations for each of the walking gait cycles, resulting in a total of 4000 walking simulations. We found that AFO mechanical property assumptions influenced the force estimates for all the muscles in the model, with the ankle muscles having the largest resulting variability. Muscle forces were most sensitive to assumptions of AFO ankle and subtalar stiffness, which should therefore be measured when possible. Muscle force estimates were less sensitive to estimates of damping and equilibrium angle. When stiffness measurements are not available, limitations on the accuracy of muscle force estimates for all the muscles in the model, especially the ankle muscles, should be acknowledged.