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

Abstract

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.

Keywords

Total knee replacement knee axial force wear testing mathematical modeling standardized testing protocol

Get full access to this article

View all access options for this article.

References

Kurtz

Ong

Lau

. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89(4): 780–785.

Sharkey

Hozack

Rothman

. Why are total knee arthroplasties failing today? Clin Orthop Relat Res 2002; 404: 7–13.

Naudie

Ammeen

Engh

Rorabeck

. Wear and osteolysis around total knee arthroplasty. J Am Acad Orthop Surg 2007; 15(1): 53–64.

National Joint Registry for England and Wales. The seventh annual report for hip and knee replacement, www.njrcentre.org.uk (accessed 8 September 2011).

Crowninshield

Rosenberg

Sporer

. Changing demographics of patients with total joint replacement. Clin Orthop Relat Res 2006; 443: 266–272.

Harman

Desjardins

Benson

. Comparison of polyethylene tibial insert damage from in vivo function and in vitro wear simulation. J Orthop Res 2009; 27(4): 540–548.

Orozco

Schwenke

Wimmer

. Wear scar similarities of retrieved and tested tibial components - an artificial neural network approach. In: Annual meeting of the Society for Biomaterials, 2005.

Ngai

Schwenke

Wimmer

. In vivo kinematics of knee prosthesis patients during level walking compared with the ISO force-controlled simulator standard. Proc IMechE, Part H: J Engng Med 2009; 223(7): 889–896.

Ngai

Wimmer

. Kinematic evaluation of cruciate-retaining total knee replacement patients during level walking: a comparison with the displacement-controlled ISO standard. J Biomech 2009; 42(14): 2363–2368.

10.

Walker

Blunn

Perry

. Methodology for long-term wear testing of total knee replacements. Clin Orthop Relat Res 2000; 372: 290–301.

11.

Morrison

. Function of the knee joint in various activities. Bio-Med Engng 1969; 4(12): 573–580.

12.

Morrison

. The mechanics of the knee joint in relation to normal walking. J Biomech 1970; 3(1): 51–61.

13.

Heinlein

Kutzner

Graichen

. Complete data of total knee replacement loading for level walking and stair climbing measured in vivo with a follow-up of 6-10 months. Clin Biomech 2009; 24(4): 315–326.

14.

D’Lima

Patil

Steklov

. Tibial forces measured in vivo after total knee arthroplasty. J Arthroplasty 2006; 21(2): 255–262.

15.

Kutzner

Heinlein

Graichen

. Loading of the knee joint during activities of daily living measured in vivo in five subjects. J Biomech 2010; 43(11); 2164–2173.

16.

Lundberg

Foucher

Wimmer

. A parametric approach to numerical modeling of TKR contact forces. J Biomech 2009; 42(4): 541–545.

17.

Lundberg

Foucher

Andriacchi

Wimmer

. Comparison of numerically modeled knee joint contact forces to instrumented total knee prosthesis forces. In: ASME summer bioengineering conference, 2009, pp. 379–380.

18.

Andriacchi

Alexander

Toney

. A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. J. Biomech Engng 1998; 120(6): 743–749.

19.

Swanson

. In vivo methods for locating the tibio-femoral contact pathway in total knee replacements during gait. MS Thesis in Bioengineering, University of Illinois at Chicago, USA, 2007.

20.

Swanson

Ngai

Inoue

Wimmer

. Analysis of the tibio-femoral contact point in total knee replacement using a marker based motion analysis system. In: ASME summer bioengineering conference, 2007, pp. 39–40.

21.

Andriacchi

Strickland

. Gait analysis as a tool to assess joint kinetics. In: Berme

Engin

Correia da Silva

. (eds) Biomechanics of normal and pathological human articulating joints, Dordrecht, The Netherlands: Nijhoff, 1985, pp. 83–100.

22.

Wimmer

Andriacchi

. Tractive forces during rolling motion of the knee: implications for wear in total knee replacement. J Biomech 1997; 30(2): 131–137.

23.

Lundberg

Foucher

Andriacchi

Wimmer

. Direct comparison of measured and calculated TKR force envelopes during walking in the presence of normal and abnormal gait pattern. Submitted.

24.

In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement. J Orthop Res 2008; 26(9): 1167–1172.

25.

Kadaba

Ramakrishnan

Wootten

. Repeatability of kinematic, kinetic, and electromyographic data in normal adult gait. J Orthop Res 1989; 7(6): 849–860.

26.

Harman

Banks

Hodge

. Polyethylene damage and knee kinematics after total knee arthroplasty. Clin Orthop Relat Res 2001; 392: 383–393.

27.

Thorp

Sumner

Block

. Knee joint loading differs in individuals with mild compared with moderate medial knee osteoarthritis. Arthritis Rheum 2006; 54(12): 3842–3849.

28.

Cohen

. Statistical power analysis for the behavioral sciences. Second ed. Hillsdale, New Jersey: Lawrence Erlbaum Associates, 1988, p. 567.

29.

Rojas

. Dynamic surface electromyography of total knee replacement patients: muscle activation during gait. MS Thesis in Bioengineering, University of Illinois at Chicago, USA, 2009.

30.

D’Lima

Steklov

Patil

Colwell

. In vivo knee forces during recreation and exercise after knee arthroplasty. Clin Orthop Relat Res 2008; 66: 2605–2611.

31.

Bergmann

. OrthoLoad, http://www.OrthoLoad.com (2008, accessed 2 February 2011).

32.

Laz

Pal

Fields

. Effects of knee simulator loading and alignment variability on predicted implant mechanics: a probabilistic study. J Orthopa Res 2006; 24(12): 2212–2221.