Comparison of ISO Standard and TKR patient axial force profiles during the stance phase of gait

Preclinical endurance testing of total knee replacements (TKRs) is performed using International Organization for Standardization (ISO) load and motion protocols. The standards are based on data from normal subjects and may not sufficiently mimic in vivo implant conditions. In this study, a mathematical model was used to calculate the axial force profile of 30 TKR patients with two current implant types, 22 with NexGen and eight with Miller-Galante II Cruciate-Retaining TKRs, and statistically compare the axial force specified by the ISO standard to the TKR patients. Significant differences were found between the axial forces of both groups of TKR patients and the ISO standard at local maxima and minima points in the first half of stance. The force impulse (area under the axial force curve, representing cumulative loading) was smaller for the ISO standard than the TKR patients, but only for those with NexGen implants. Waveform analysis using the coefficient of multiple correlation showed that the ISO and TKR patient axial force profiles were similar. The combined effect of ISO standard compressive load and motion differences from TKR patients could explain some of the differences between the wear scars on retrieved tibial components and those tested in total joint simulators.

[1]  G. Bergmann,et al.  Loading of the knee joint during activities of daily living measured in vivo in five subjects. , 2010, Journal of biomechanics.

[2]  Annegret Mündermann,et al.  In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[3]  P. Sharkey,et al.  Why Are Total Knee Arthroplasties Failing Today? , 2002 .

[4]  S. Pal,et al.  Effects of knee simulator loading and alignment variability on predicted implant mechanics: A probabilistic study , 2006, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[5]  T. Andriacchi,et al.  Tractive forces during rolling motion of the knee: implications for wear in total knee replacement. , 1997, Journal of biomechanics.

[6]  Thomas P Andriacchi,et al.  Direct comparison of measured and calculated total knee replacement force envelopes during walking in the presence of normal and abnormal gait patterns. , 2012, Journal of biomechanics.

[7]  J B Morrison,et al.  The mechanics of the knee joint in relation to normal walking. , 1970, Journal of biomechanics.

[8]  Lisa Benson,et al.  Comparison of polyethylene tibial insert damage from in vivo function and in vitro wear simulation , 2009, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[9]  Morrison Jb.  Function of the knee joint in various activities. , 1969 .

[10]  Aaron G Rosenberg,et al.  Changing Demographics of Patients with Total Joint Replacement , 2006, Clinical orthopaedics and related research.

[11]  Shantanu Patil,et al.  In Vivo Knee Forces During Recreation and Exercise After Knee Arthroplasty , 2008 .

[12]  T P Andriacchi,et al.  Methodology for Long-Term Wear Testing of Total Knee Replacements , 2000, Clinical orthopaedics and related research.

[13]  S. Kurtz,et al.  Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. , 2007, The Journal of bone and joint surgery. American volume.

[14]  M. Wimmer,et al.  Kinematic evaluation of cruciate-retaining total knee replacement patients during level walking: a comparison with the displacement-controlled ISO standard. , 2009, Journal of biomechanics.

[15]  D. D’Lima,et al.  AT THE ANNUAL MEETINGS OF THE KNEE SOCIETY The Mark Coventry Award In Vivo Knee Forces During Recreation and Exercise After Knee Arthroplasty , 2008 .

[16]  Markus A Wimmer,et al.  A parametric approach to numerical modeling of TKR contact forces. , 2009, Journal of biomechanics.

[17]  C. Charalambous.  Repeatability of Kinematic, Kinetic, and Electromyographic Data in Normal Adult Gait , 2014 .

[18]  Laura E Thorp,et al.  Knee joint loading differs in individuals with mild compared with moderate medial knee osteoarthritis. , 2006, Arthritis and rheumatism.

[19]  D. D’Lima,et al.  Tibial forces measured in vivo after total knee arthroplasty. , 2006, The Journal of arthroplasty.

[20]  J. B. Morrison.  Function of the knee joint in various activities. , 1969, Biomedical engineering.

[21]  C. Rorabeck,et al.  Wear and osteolysis around total knee arthroplasty. , 2007, The Journal of the American Academy of Orthopaedic Surgeons.

[22]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[23]  W. A. Hodge,et al.  Polyethylene Damage and Knee Kinematics After Total Knee Arthroplasty , 2001, Clinical orthopaedics and related research.

[24]  G. Bergmann,et al.  ESB Clinical Biomechanics Award 2008: Complete data of total knee replacement loading for level walking and stair climbing measured in vivo with a follow-up of 6-10 months. , 2009, Clinical biomechanics.

[25]  T. Schwenke,et al.  In-vivo kinematics of knee prostheses patients during level walking compared with the ISO force-controlled simulator standard , 2009, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[26]  T. P. Andriacchi,et al.  Gait Analysis as a Tool to Assess Joint Kinetics , 1985 .

[27]  T P Andriacchi,et al.  A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. , 1998, Journal of biomechanical engineering.