Differential shock transmission response of the human body to impact severity and lower limb posture

The shocks imparted to the foot during locomotion may lead to joint-degenerative diseases and jeopardize the visual-vestibular functions. The body relies upon several mechanisms and structures that have unique viscoelastic properties for shock attenuation. The purpose of the present study was to determine whether impact severity and initial knee angle (IKA) could alter the shock transmission characteristics of the body. Impacts were administered to the right foot of 38 subjects with a human pendulum device. Combinations of velocities (0.9, 1.05 and 1.2 m s⁻¹) and surfaces (soft and hard foams) served to manipulate impact severity in the first experiment. Three IKA (0, 20 and 40°) were examined in the second experiment. Transmission between shank and head was characterized by measuring the shock at these sites with miniature accelerometers. Velocity and surface had no effect on the frequency profile of shock transmission suggesting a consistent response of the body to impact severity. Shank shock power spectrum features accounted for the lower shock ratio (head/shank) measured under the hard surface condition. IKA flexion caused considerable reduction in effective axial stiffness of the body (EASB), 28.7–7.9 kNm⁻¹, which improved shock attenuation. The high correlation (r=0.97) between EASB and shock ratio underscored the importance of EASB to shock attenuation. The present findings provide valuable information for the development of strategies aimed at protecting the joints, articular cartilage, spine and head against locomotor shock.     

Leg stiffness primarily depends on ankle stiffness during human hopping

When humans hop in place or run forward, they adjust leg stiffness to accommodate changes in stride frequency or surface stiffness. The goal of the present study was to determine the mechanisms by which humans adjust leg stiffness during hopping in place. Five subjects hopped in place at 2.2 Hz while we collected force platform and kinematic data. Each subject completed trials in which they hopped to whatever height they chose ("preferred height hopping") and trials in which they hopped as high as possible ("maximum height hopping"). Leg stiffness was approximately twice as great for maximum height hopping as for preferred height hopping. Ankle torsional stiffness was 1.9-times greater while knee torsional stiffness was 1.7-times greater in maximum height hopping than in preferred height hopping. We used a computer simulation to examine the sensitivity of leg stiffness to the observed changes in ankle and knee stiffness. Our model consisted of four segments (foot, shank, thigh, head-arms-trunk) interconnected by three torsional springs (ankle, knee, hip). In the model, increasing ankle stiffness by 1.9-fold, as observed in the subjects, caused leg stiffness to increase by 2.0-fold. Increasing knee stiffness by 1.7-fold had virtually no effect on leg stiffness. Thus, we conclude that the primary mechanism for leg stiffness adjustment is the adjustment of ankle stiffness.     

Variables during swing associated with decreased impact peak and loading rate in running

When the foot impacts the ground in running, large forces and loading rates can arise that may contribute to the development of overuse injuries. Investigating which biomechanical factors contribute to these impact loads and loading rates in running could assist clinicians in developing strategies to reduce these loads. Therefore, the goals of our work were to determine variables that predict the magnitude of the impact peak and loading rate during running, as well as to investigate how modulation of knee and hip muscle activity affects these variables. Instrumented gait analysis was conducted on 48 healthy subjects running at 3.3 m/s on a treadmill. The top four predictors of loading rate and impact peak were determined using a stepwise multiple linear regression model. Forward dynamics was performed using a whole body musculoskeletal model to determine how increased muscle activity of the knee flexors, knee extensors, hip flexors, and hip extensors during swing altered the predictors of loading rate and impact peak. A smaller impact peak was associated with a larger downward acceleration of the foot, a higher positioned foot, and a decreased downward velocity of the shank at mid-swing while a lower loading rate was associated with a higher positioned thigh at mid-swing. Our results suggest that an alternative to forefoot striking may be increased hip flexor activity during swing to alter these mid-swing kinematics and ultimately decrease the leg's velocity at landing. The decreased velocity would decrease the downward momentum of the leg and hence require a smaller force at impact.     

Mechanism of leg stiffness adjustment for hopping on surfaces of different stiffnesses

When humans hopin place or run forward, leg stiffness is increased to offsetreductions in surface stiffness, allowing the global kinematics andmechanics to remain the same on all surfaces. The purpose of thepresent study was to determine the mechanism for adjusting legstiffness. Seven subjects hopped in place on surfaces of differentstiffnesses (23-35,000 kN/m) while force platform, kinematic, andelectromyographic data were collected. Leg stiffness approximatelydoubled between the most stiff surface and the least stiff surface.Over the same range of surfaces, ankle torsional stiffness increased1.75-fold, and the knee became more extended at the time of touchdown(2.81 vs. 2.65 rad). We used a computer simulation to examine thesensitivity of leg stiffness to the observed changes in ankle stiffnessand touchdown knee angle. Our model consisted of four segments (foot,shank, thigh, head-arms-trunk) interconnected by three torsionalsprings (ankle, knee, hip). In the model, an increase in anklestiffness 1.75-fold caused leg stiffness to increase 1.7-fold. A changein touchdown knee angle as observed in the subjects caused legstiffness to increase 1.3-fold. Thus both joint stiffness and limbgeometry adjustments are important in adjusting leg stiffness to allow similar hopping on different surfaces.

     

Intralimb compensation strategy depends on the nature of joint perturbation in human hopping

Due to the well-described spring-mass dynamics of bouncing gaits, human hopping is a tractable model for elucidating basic neuromuscular compensation principles. We tested whether subjects would employ a multi-joint or single-joint response to stabilize leg stiffness while wearing a spring-loaded ankle-foot orthosis (AFO) that applied localized resistive and assistive torques to the ankle. We analyzed kinematics and kinetics data from nine subjects hopping in place on one leg, at three frequencies (2.2, 2.4, and 2.8Hz) and three orthosis conditions (freely articulating AFO, AFO with plantarflexion resistance, and AFO with plantarflexion assistance). Leg stiffness was invariant across AFO conditions, however, compensation strategy depended upon the nature of the applied load. Biological ankle stiffness increased in response to a resistive load at twice the rate that it decreased with an assitive load. Ankle adjustments alone fully compensated for an assistive load with no net change in combined (biological plus applied) total ankle stiffness (p > or =0.133). In contrast, a resistive load resulted in a 7.4-9.0% increase in total ankle stiffness across frequencies and a concomitant 10-15% increase in knee joint stiffness at each frequency (p< or =0.037). The increased knee joint stiffness in response to resistive ankle load allowed subjects to maintain a more flexed knee at mid-stance, which attenuated the effect of the increased total ankle joint stiffness to preserve leg stiffness and whole limb biomechanical performance. Our findings suggest humans maintain invariant leg stiffness in bouncing gaits through different intralimb compensation strategies that are specific to the nature of the joint loading.     

Leg and Joint Stiffness in Children with Spastic Diplegic Cerebral Palsy during Level Walking

Individual joint deviations are often identified in the analysis of cerebral palsy (CP) gait. However, knowledge is limited as to how these deviations affect the control of the locomotor system as a whole when striving to meet the demands of walking. The current study aimed to bridge the gap by describing the control of the locomotor system in children with diplegic CP in terms of their leg stiffness, both skeletal and muscular components, and associated joint stiffness during gait. Twelve children with spastic diplegia CP and 12 healthy controls walked at a self-selected pace in a gait laboratory while their kinematic and forceplate data were measured and analyzed during loading response, mid-stance, terminal stance and pre-swing. For calculating the leg stiffness, each of the lower limbs was modeled as a non-linear spring, connecting the hip joint center and the corresponding center of pressure, with varying stiffness that was calculated as the slope (gradient) of the axial force vs. the deformation curve. The leg stiffness was further decomposed into skeletal and muscular components considering the alignment of the lower limb. The ankle, knee and hip of the limb were modeled as revolute joints with torsional springs whose stiffness was calculated as the slope of the moment vs. the angle curve of the joint. Independent t-tests were performed for between-group comparisons of all the variables. The CP group significantly decreased the leg stiffness but increased the joint stiffness during stance phase, except during terminal stance where the leg stiffness was increased. They appeared to rely more on muscular contributions to achieve the required leg stiffness, increasing the muscular demands in maintaining the body posture against collapse. Leg stiffness plays a critical role in modulating the kinematics and kinetics of the locomotor system during gait in the diplegic CP.     

Muscle pre- and coactivity during downward stepping are associated with leg stiffness in aging.

We have previously reported that elderly compared to young women executed downward stepping with substantially greater leg stiffness. Because antagonist muscle coactivity increases joint stiffness we hypothesized that increased leg stiffness in aging is associated with increased muscle coactivity. We also explored the possibility that the magnitude of the preparatory muscle activity preceding impact also differed between young and old subjects. Young (n=11, 20. 8 yr) and old (n=12, 69 yr) women performed downward stepping from a platform set at 20% body height. The leg was modeled as a simple mass-spring system. From video and ground reaction force data leg stiffness was computed as the ratio of force under the foot and the linear shortening of the limb. EMG activity of the vastus lateralis, biceps femoris, gastrocnemius lateralis, and tibialis anterior were recorded with a telemetric system. Elders compared to young subjects had 64% greater leg stiffness during downward stepping. Muscle activity over a 200-ms period preceding touch down was 136% greater in elderly than in young subjects. Biceps femoris and tibialis anterior coactivity during ground contact was 120% greater in the elders. Muscle pre- and coactivity, respectively, accounted for about 50% of the variance in leg stiffness. In conclusion, elderly people elevate muscle pre- and coactivity during downward stepping to stiffen the leg in compensation for impaired neuromotor functions.     

Running kinematics and shock absorption do not change after brief exhaustive running

Because of the nature of running, the forces encountered require a proper coordination of joint action of the lower extremity to dissipate the ground reaction forces and accelerations through the kinetic chain. Running-related muscle fatigue may reduce the shock absorbing capacity of the lower extremity and alter running kinematics. The purpose of this study was to determine if a bout of exhaustive running at a physiologically determined high intensity, changes running kinematics, impact accelerations, and alters shock attenuating capabilities. It was hypothesized that as a result of fatigue induced by an exhaustive run, running kinematics, impact accelerations at the head and shank, acceleration reduction, and shock attenuation would change. A within-subject, repeated-measures design was used for this study. Twelve healthy, competitive male and female distance runners participated. Subjects performed 2 testing sessions consisting of a VO2max treadmill protocol to determine the heart rate at ventilatory threshold and a fatigue-inducing running bout at the identified ventilatory threshold heart rate. Kinematic data included knee flexion, pronation, time to maximum knee flexion, and time to maximum pronation. Acceleration data included shank acceleration, head acceleration, and shock attenuation. No significant differences resulted for the kinematic or acceleration variables. Although the results of this study do not support the original hypotheses, the influence of running fatigue on kinematics and accelerations remains inconclusive. Future research is necessary to examine fatigue-induced changes in running kinematics and accelerations and to determine the threshold at which point the changes may occur.     

Alterations to movement mechanics can greatly reduce anterior cruciate ligament loading without reducing performance

Anterior cruciate ligament (ACL) injuries are one of the most common and potentially debilitating sports injuries. Approximately 70% of ACL injuries occur without contact and are believed to be preventable. Jump stop movements are associated with many non-contact ACL injuries. It was hypothesized that an athlete performing a jump stop movement can reduce their peak tibial shear force (PTSF), a measure of ACL loading, without compromising performance, by modifying their knee flexion angle, shank angle, and foot contact location during landing. PTSF was calculated for fourteen female basketball players performing jump stops using their normal mechanics and mechanics modified to increase their knee flexion angle, decrease their shank angle relative to vertical and land more on their toes during landing. Every subject tested experienced drastic reductions in their PTSF (average reduction=56.4%) using modified movement mechanics. The athletes maintained or improved their jump height with the modified movement mechanics (an average increase in jump height of 2.5 cm). The hypothesis was supported: modifications to jump stop movement mechanics greatly reduced PTSF and therefore ACL loading without compromising performance. The results from this study identify crucial biomechanical quantities that athletes can easily modify to reduce ACL loading and therefore should be targeted in any physical activity training programs designed to reduce non-contact ACL injuries.     

Applied horizontal force increases impact loading in reduced-gravity running

The chronic exposure of astronauts to microgravity results in structural degradation of their lower limb bones. Currently, no effective exercise countermeasure exists. On Earth, the impact loading that occurs with regular locomotion is associated with the maintenance of bone's structural integrity, but impact loads are rarely experienced in space. Accurately mimicking Earth-like impact loads in a reduced-gravity environment should help to reduce the degradation of bone caused by weightlessness. We previously showed that running with externally applied horizontal forces (AHF) in the anterior direction qualitatively simulates the high-impact loading associated with downhill running on Earth. We hypothesized that running with AHF at simulated reduced gravity would produce impact loads equal to or greater than values experienced during normal running at Earth gravity. With an AHF of 20% of gravity-specific body weight at all gravity levels, impact force peaks increased 74%, average impact loading rates increased 46%, and maximum impact loading rates increased 89% compared to running without any AHF. In contrast, AHF did not substantially affect active force peaks. Duty factor and stride frequency decreased modestly with AHF at all gravity levels. We found that running with an AHF in simulated reduced gravity produced impact loads equal to or greater than those experienced at Earth gravity. An appropriate AHF could easily augment existing partial gravity treadmill running exercise countermeasures used during spaceflight and help prevent musculoskeletal degradation.     

Biomechanical modeling of deep squatting: Effects of the interface contact between posterior thigh and shank

Epidemiological studies indicate that occupational activities that require extended deep knee flexion or kneeling are associated with a higher prevalence of knee osteoarthritis. In many sport activities, such as a catcher in a baseball or a softball game, athletes have to make repetitive deep squatting motions, which have been associated with the development of osteochondritis dissecans. Excessive deep knee flexion postures may cause excessive loading in the knee joint. In deep knee flexion postures, the posterior aspect of the shank will contact the posterior thigh, resulting in a compressive force within the soft tissues. The current study was aimed at analyzing the effects of the posterior thigh/shank contact on the joint loading during deep knee flexion in a natural knee. An existing, whole body model with detailed anatomical components of the knee (AnyBody) has been adopted and modified for this study. The effects of the posterior thigh/shank contact were evaluated by comparing the results of the inverse dynamic analysis for two scenarios: with and without the posterior thigh/shank contact force. Our results showed that, in a deep squatting posture (knee flexion 120+ degrees), the posterior thigh/shank contact helps reduce the patellofemoral (PF) and tibiofemoral (TF) normal contact forces by 42% and 57%, respectively.     

Gait alterations in rats following attachment of a device and application of altered knee loading

Animal models are widely used to study cartilage degeneration. Experimental interventions to alter contact mechanics in articular joints may also affect the loads borne by the leg during gait and consequently affect the overall loading experienced in the joint. In this study, force plate analyses were utilized to measure parameters of gait in the rear legs of adult rats following application of a varus loading device that altered loading in the knee. Adult rats were assigned to Control, Sham, or Loaded groups (n≥4/each). Varus loading devices were surgically attached to rats in the Sham and Loaded groups. In the Loaded group, this device applied a controlled compressive overload to the medial compartment of the knee during periods of engagement. Peak ground reaction forces during walking were recorded for each rear leg of each group. Analyses of variance were used to compare outcomes across groups (Control, Sham, and Loaded), leg (contralateral, experimental) and device status (disengaged, engaged) to determine the effects of surgically attaching the device and applying a compressive overload to the joint with the device. The mean peak vertical force in the experimental leg was reduced to 30% in the Sham group in comparison to the contralateral leg and the Control group, indicating an effect of attaching the device to the leg (p<0.01). No differences were found in ground reaction forces between the Sham and Loaded groups with application of compressive overloads with the device. The significant reduction in vertical force due to the surgical attachment of the varus loading device must be considered and accounted for in future studies.     

Simulating dynamic activities using a five-axis knee simulator

This work describes the design and capabilities of the Purdue Knee Simulator: Mark II and a sagittal-plane model of the machine. This five-axis simulator was designed and constructed to simulate dynamic loading activities on either cadaveric knee specimens or total knee prostheses mounted on fixtures. The purpose of the machine was to provide a consistent, realistic loading of the knee joint, allowing the kinematics and specific loading of the structures of the knee to be determined based on condition, articular geometry, and simulated activity. The sagittal-plane model of the knee simulator was developed both to predict the loading at the knee from arbitrary inputs and to generate the necessary inputs required to duplicate specified joint loading. Measured tibio-femoral compressive force and quadriceps tension were shown to be in good agreement with the predicted loads from the model. A controlled moment about the ankle-flexion axis was also shown to change the loading on the quadriceps.     

Stability of an underactuated bipedal gait

A self-excited biped walking mechanism consisting of two legs that are connected in series at the hip joint through a servomotor is studied as a cyclic system with collisions. A torque proportional to angle between the shank of the swinging leg and the vertical is seen to sustain a gait. Each leg has a thigh and a shank connected at a passive knee joint that has a knee stopper restricting hyperextension similar to the human knee. A mathematical model for the dynamics of the system including the impact equations is used to analyse the stability of the system through examination of phase plane plots. Attractor lines along which the system approaches stability have been identified. A leg length for optimal stability has been identified. The biological basis for the proposed system has been identified by comparison with human gait.     

Investigation of muscle tone in patients with Parkinson’s disease in unloading conditions

Parkinson’s disease (PD) is a progressive neurodegenerative disorder, the main symptoms of which are hypertonicity and difficulties emerging during performance of stepping movements due to increased muscle stiffness. Biomechanical (stiffness) and electrophysiological (shortening reaction, SR) characteristics of hip and shank muscles were examined in 25 patients with mild and moderate stages of PD (1 to 3 of Hoehn and Yahr Rating Scale, 61 ± 9 years) and 22 age-matched healthy controls in unloading leg conditions during passive flexion/extension of hip, knee, and ankle joints, as well as the changes in the tonic state of muscles under the influence of levodopa. The data obtained were compared with similar findings in healthy subjects. Essentially greater stiffness in all leg muscle groups (except foot extensors) was observed in patients with PD as compared to the healthy subjects. In patients with PD, SR values in hip and shank extensors as well as in foot flexors and extensors were essentially greater then in the healthy subjects. The medicine essentially reduced the stiffness of hip flexors and knee flexors and extensors. The SR persisted, although the frequency of its occurrence decreased in half of studied muscles, and a significant decrease in the SR value was observed in foot extensors. The medicine had no marked effect on the SR in the proximal muscles. Thus, the increased muscle stiffness in patients with PD manifests itself as distorted reactions to external disturbances and increased reflectory reactions of muscles.     

A comparison and update of direct kinematic-kinetic models of leg stiffness in human running

Direct kinematic-kinetic modelling currently represents the “Gold-standard” in leg stiffness quantification during three-dimensional (3D) motion capture experiments. However, the medial-lateral components of ground reaction force and leg length have been neglected in current leg stiffness formulations. It is unknown if accounting for all 3D would alter healthy biologic estimates of leg stiffness, compared to present direct modelling methods. This study compared running leg stiffness derived from a new method (multiplanar method) which includes all three Cartesian axes, against current methods which either only include the vertical axis (line method) or only the plane of progression (uniplanar method). Twenty healthy female runners performed shod overground running at 5.0 m/s. Three-dimensional motion capture and synchronised in-ground force plates were used to track the change in length of the leg vector (hip joint centre to centre of pressure) and resultant projected ground reaction force. Leg stiffness was expressed as dimensionless units, as a percentage of an individual’s bodyweight divided by standing leg length (BW/LL). Leg stiffness using the line method was larger than the uniplanar method by 15.6%BW/LL (P < .001), and multiplanar method by 24.2%BW/LL (P < .001). Leg stiffness from the uniplanar method was larger than the multiplanar method by 8.5%BW/LL (6.5 kN/m) (P < .001). The inclusion of medial-lateral components significantly increased leg deformation magnitude, accounting for the reduction in leg stiffness estimate with the multiplanar method. Given that limb movements typically occur in 3D, the new multiplanar method provides the most complete accounting of all force and length components in leg stiffness calculation.     

Parameter identification of the human lower limb under dynamic, transient torsional loading

The response of the lower limb to dynamic, transient torsional loading applied at the foot has been measured for a male test subject. The dynamic loading was provided by a computer controlled pneumatic system which applied single haversine (i.e. half cycle of a sine wave) axial moment pulses of variable amplitude (0-100 Nm) and duration (50-600 ms). Potentiometers measured the absolute rotations of the three leg segments. Test variables included rotation direction, weight bearing and joint flexion. Two approaches were explored for specifying parameters (i.e. inertia, damping, stiffness) of a three degree-of-freedom dynamic system model which best duplicated the measured response. One approach involved identification of linear parameters by means of optimization while the other approach entailed estimation. Parameter estimates, which included non-linear, asymmetric stiffness functions, were derived from the literature. The optimization was undertaken so as to identify parameter dependence on test variables. Results indicate that parameter values are influenced by test variables. Results also indicate that the non-linear, estimated model better approximates the experimental data than the linear, identified model. In addition to identifying parameters of a three degree-of-freedom model, parameters were also identified for a single degree-of-freedom model where the motion variable was intended to indicate the rotation of the in vivo knee. It is concluded that the simpler model offers good accuracy in predicting both magnitude and time of occurrence of peak knee axial rotations. Model motion fails to track the measured knee rotation subsequent to the peak, however.     

Neuromechanical adaptation to hopping with an elastic ankle-foot orthosis.

When humans hop or run on different surfaces, they adjust their effective leg stiffness to offset changes in surface stiffness. As a result, the overall stiffness of the leg-surface series combination remains independent of surface stiffness. The purpose of this study was to determine whether humans make a similar adjustment when springs are placed in parallel with the leg via a lower limb orthosis. We studied seven human subjects hopping in place on one leg while wearing an ankle-foot orthosis. We used an ankle-foot orthosis because the ankle joint is primarily responsible for leg stiffness during hopping. A spring was added to the ankle-foot orthosis so that it increased orthosis stiffness by providing plantar flexor torque during ankle dorsiflexion. We hypothesized that subjects would decrease their biological ankle stiffness when the spring was added to the orthosis, keeping total ankle stiffness constant. We collected kinematic, kinetic, and electromyographic data during hopping with and without the spring on the orthosis. We found that total ankle stiffness and leg stiffness did not change across the two orthosis conditions (ANOVA, P > 0.05). This was possible because subjects decreased their biological ankle stiffness to offset the orthosis spring stiffness (P < 0.0001). The reduction in biological ankle stiffness was accompanied by decreases in soleus, medial gastrocnemius, and lateral gastrocnemius muscle activation (P < 0.0002). These results suggest that an elastic exoskeleton might improve human running performance by reducing muscle recruitment.     

Mechanical energy and effective foot mass during impact loading of walking and running

The human heel pad is considered an important structure for attenuation of the transient force caused by heel-strike. Although the mechanical properties of heel pads are relatively well understood, the mechanical energy (Etot) absorbed by the heel pad during the impact phase has never been documented directly because data on the effective foot mass (Meff) was previously unavailable during normal forward locomotion. In this study, we use the impulse-momentum method (IMM) for calculating Meff from moving subjects. Mass-spring-damper models were developed to evaluate errors and to examine the effects of pad property, upper body mass, and effective leg spring on Meff. We simultaneously collected ground reaction forces, pad deformation, and lower limb kinematics during impact phase of barefoot walking, running, and crouched walking. The latter was included to examine the effect of knee angle on Meff. The magnitude of Meff as a percentage of body mass (M(B)) varies with knee angle at impact and significantly differs among gaits: 6.3%M(B) in walking, 5.3%M(B) in running, and 3.7%M(B) in crouched walking. Our modeling results suggested that Meff is insensitive to heel pad resilience and effective leg stiffness. At the instant prior to heel strike, Etot ranges from 0.24 to 3.99 J. The combination of video and forceplate data used in this study allows analyses of Etot and Etot as a function of heel-strike kinematics during normal locomotion. Relationship between Meff and knee angle provides insights into how changes in posture moderate impact transients at different gaits.     

Analysis of bone–prosthesis interface micromotion for cementless tibial prosthesis fixation and the influence of loading conditions

A lack of initial stability of the fixation is associated with aseptic loosening of the tibial components of cementless knee prostheses. With sufficient stability after surgery, minimal relative motion between the prosthesis and bone interfaces allows osseointegation to occur thereby providing a strong prosthesis-to-bone biological attachment. Finite element modelling was used to investigate the bone–prosthesis interface micromotion and the relative risk of aseptic loosening. It was anticipated that by prescribing different joint loads representing gait and other activities, and the consideration of varying tibial–femoral contact points during knee flexion, it would influence the computational prediction of the interface micromotion. In this study, three-dimensional finite element models were set up with applied loads representing walking and stair climbing, and the relative micromotions were predicted. These results were correlated to in-vitro measurements and to the results of prior retrieval studies. Two load conditions, (i) a generic vertical joint load of 3×body weight with 70%/30% M/L load share and antero-posterior/medial-lateral shear forces, acted at the centres of the medial and lateral compartments of the tibial tray, and (ii) a peak vertical joint load at 25% of the stair climbing cycle with corresponding antero-posterior shear force applied at the tibial–femoral contact points of the specific knee flexion angle, were found to generate interface micromotion responses which corresponded to in-vivo observations. The study also found that different loads altered the interface micromotion predicted, so caution is needed when comparing the fixation performance of various reported cementless tibial prosthetic designs if each design was evaluated with a different loading condition.