Time-dependent elastohydrodynamic lubrication analysis of total knee replacement under walking conditions

This work is concerned with the lubrication analysis of artificial knee joints, which plays an increasing significant role in clinical performance and longevity of components. Time-dependent elastohydrodynamic lubrication analysis for normal total knee replacement is carried out under the cyclic variation in both load and speed representative of normal walking. An equivalent ellipsoid-on-plane model is adopted to represent an actual artificial knee. A full numerical method is developed to simultaneously solve the Reynolds and elasticity equations using the multigrid technique. The elastic deformation is based on the constrained column model. Results show that, under the combined effect of entraining and squeeze-film actions throughout the walking cycle, the predicted central film thickness tends to decrease in the stance phase but keeps a relatively larger value at the swing phase. Furthermore, the geometry of knee joint implant is verified to play an important role under its lubrication condition, and the length of time period is a key point to influence the lubrication performance of joint components.     

Hard-on-Hard Lubrication in the Artificial Hip under Dynamic Loading Conditions

The tribological performance of an artificial hip joint has a particularly strong influence on its success. The principle causes for failure are adverse short- and long-term reactions to wear debris and high frictional torque in the case of poor lubrication that may cause loosening of the implant. Therefore, using experimental and theoretical approaches models have been developed to evaluate lubrication under standardized conditions. A steady-state numerical model has been extended with dynamic experimental data for hard-on-hard bearings used in total hip replacements to verify the tribological relevance of the ISO 14242-1 gait cycle in comparison to experimental data from the Orthoload database and instrumented gait analysis for three additional loading conditions: normal walking, climbing stairs and descending stairs. Ceramic-on-ceramic bearing partners show superior lubrication potential compared to hard-on-hard bearings that work with at least one articulating metal component. Lubrication regimes during the investigated activities are shown to strongly depend on the kinematics and loading conditions. The outcome from the ISO gait is not fully confirmed by the normal walking data and more challenging conditions show evidence of inferior lubrication. These findings may help to explain the differences between the in vitro predictions using the ISO gait cycle and the clinical outcome of some hard-on-hard bearings, e.g., using metal-on-metal.     

Stance phase control of above-knee prostheses: knee control versus SACH foot design

The mobility of above-knee amputees (A/K) is limited, in part, due to the performance of A/K prostheses during the stance phase. Currently stance phase control of most conventional A/K prostheses can only be achieved through leg alignment and choice of the SACH (Solid Ankle Cushioned Heel) foot. This paper examines the role of the knee controller in relation to a SACH foot during the stance phase of level walking. The three-dimensional gait mechanics were measured under two stance phase conditions. In the first set of trials, the amputee used a prosthesis with a conventional knee controller that allowed the amputee to maintain the knee joint in full extension during the stance phase. In the second set of trials, the prosthetic knee, during stance, echoed the modified kinematics of the amputee's sound (intact) knee that had been recorded during the previous sound stance phase. Analysis and interpretation of the data indicate the following: (1) SACH foot design can strongly influence the walking mechanics independent of the knee controller; (2) knee controller design and SACH foot design are mutually interdependent; and (3) normal kinematics imposed on the prosthetic knee does not necessarily produce normal hip kinematics (e.g. reduce the abnormal rise in the prosthetic side hip trajectory). Future research is necessary to explore and exploit the interdependency of prosthetic knee control and foot design.     

The impact of adding trunk motion to the interpretation of the role of joint moments during normal walking

Biomechanical model assumptions affect the interpretation of the role of the muscle or joint moments to the segmental power estimated by induced acceleration analysis (IAA). We evaluated the effect of modeling the pelvis and trunk segments as two separate segments (8 SM) versus as a single segment (7 SM) on the segmental power, support of the body, knee and hip extension acceleration produced by the joint moments during the stance phase of normal walking. Significant differences were observed in the contribution of the stance hip abductor and extensor moments to support, ipsilateral knee and hip acceleration, and ipsilateral thigh and upper body power. The primary finding was that the role of the stance hip moment in generating ipsilateral thigh and upper body power differed based on degrees of freedom in the model. Secondarily, the magnitude of contributions also differed. For example, the hip abductor and extensor moments showed greater contribution to support, hip and knee acceleration in the 8 SM. IAA and segment power analysis are sensitive to the degrees of freedom between the pelvis and trunk. There is currently no gold standard by which to evaluate the accuracy of IAA predictions. However, modeling the pelvis and trunk as separate segments is closer to the anatomical architecture of the body. An 8 SM appears to be more appropriate for estimating the role of joint moments, particularly to motion of more proximal segments during normal walking.     

Analysis of a new polycentric above-knee prosthesis with a pneumatic swing phase control

The four-bar linkage mechanism used by many designers for the knee joint of an above-knee prosthesis can provide knee rotation suitable for walking only. In Afro-Asian countries people are habituated to the squatting posture in their daily activities. A six-bar linkage knee-ankle mechanism above-knee prosthesis with a pneumatic swing phase control is developed and its analysis shows its suitability for producing a motion closely resembling that of a normal subject during walking and squatting.     

The effect of hamstring muscle compensation for anterior laxity in the ACL-deficient knee during gait

The hamstring muscles have been recognized as an important element in compensating for the loss of stability in the ACL-deficient knee, but it is still not clear whether the hamstring muscle force can completely compensate for the loss of ACL, and the consequences of increased hamstring muscle force. A two-dimensional anatomical knee model in the sagittal plane was developed to examine the effect of various levels of hamstring muscle activation on restraining anterior tibial translation in the ACL-deficient knee during level walking. The model included the tibiofemoral and patellofemoral joints, four major ligaments, the medial capsule, and five muscle units surrounding the knee. Simulations were conducted to determine anterior tibial translation and internal joint loading at a single selected position when the knee was under a peak external flexion moment during early stance phase of gait. Incremental hamstring muscle forces were applied to the modeled normal and the ACL-deficient knees. Results of simulations showed that the ACL injury increased the anterior tibial translation by 11.8mm, while 56% of the maximal hamstring muscle force could reduce the anterior translation of the tibia to a normal level during the stance phase of gait. The consequences of increased hamstring muscle force included increased quadriceps muscle force and joint contact force.     

In vitro measurement of the restraining role of the anterior cruciate ligament during walking and stair ascent

The study aimed to test the hypothesis that the restraining role of the anterior cruciate ligament (ACL) of the knee is significant during the activities of normal walking and stair ascent. The role of the ACL was determined from the effect of ACL excision on tibiofemoral displacement patterns measured in vitro for fresh-frozen knee specimens subjected to simulated knee kinetics of walking (n = 12) and stair ascent (n = 7). The knee kinetics were simulated using a newly developed dynamic simulator able to replicate the sagittal-plane knee kinetics with reasonable accuracy while ensuring unconstrained tibiofemoral kinematics. The displacements were measured using a calibrated six degree-of-freedom electromechanical goniometer. For the simulation of the walking cycle, two types of knee flexion/extension moment patterns were used: the more common "biphasic" pattern, and an extensor muscle force intensive pattern. For both of these patterns, the restraining role of the ACL to tibial anterior translation was found to be significant throughout the stance phase and in the terminal swing phase, when the knee angle was in the range of 4 degrees to 30 degrees. The effect of ACL excision was an increase in tibial anterior translation by 4 mm to 5 mm. For the stair ascent cycle, however, the restraining role of the ACL was significant only during the terminal stance phase, and not during the initial and middle segments of the phase. Although, in these segments, the knee moments were comparable to that in walking, the knee angle was in the range of 60 degrees to 70 degrees. These results have been shown to be consistent with available data on knee mechanics and ACL function measured under static loading conditions.     

Modulation of limb dynamics in the swing phase of locomotion

A method was presented for quantifying cat (Felis catus) hind limb dynamics during swing phase of locomotion using a two-link rigid body model of leg and paw, which highlighted the dynamic interactions between segments. Comprehensive determination was made of cat segment parameters necessary for dynamic analysis, and regression equations were formulated to predict the inertial parameters of any comparable cat. Modulations in muscle and non-muscle components of knee and ankle joint moments were examined at two treadmill speeds using three gaits: (a) pace-like walk and trot-like walk, at 1.0 ms-1, and (b) gallop, at 2.1 ms-1. Results showed that muscle and segment interactive moments significantly effected limb trajectories during swing. Some moment components were greater in galloping than in walking, but net joint maxima were not significantly different between speeds. Moment magnitudes typically were greater for pace-like walking than for trot-like walking at the same speed. Generally, across gaits, the net and muscle moments were in phase with the direction of distal joint motion, and these same moments were out of phase with proximal joint motion. Intersegmental dynamics were not modulated exclusively by speed of locomotion, but interactive moments were also influenced significantly by gait mode.     

Meniscal wear at a three-component total ankle prosthesis by a knee joint simulator

Despite the fundamental value of wear simulation studies to assess wear resistance of total joint replacements, neither specialised simulators nor established external conditions are available for the human ankle joint. The aim of the present study was to verify the suitability of a knee wear simulator to assess wear rates in ankle prostheses, and to report preliminary this rate for a novel three-component total ankle replacement design. Four intact 'small' size specimens of the Box ankle were analysed in a four-station knee wear simulator. Special component-to-actuator holders were manufactured and starting spatial alignment of the three-components was sought. Consistent load and motion cycles representing conditions at the ankle joint replaced exactly with the prosthesis design under analysis were taken from a corresponding mechanical model of the stance phase of walking. The weight loss for the three specimens, after two million cycles, was 32.68, 14.78, and 62.28mg which correspond to a linear penetration of 0.018, 0.008, and 0.034mm per million-cycle, respectively for the specimens #1, #2, and #3. The knee wear simulator was able to reproduce load-motion patterns typical of a replaced ankle. Motion of the meniscal bearing in between the tibial and talar components was smooth, this component remaining in place and in complete congruence with the metal components throughout the test.     

3-D model of a total hip replacement in vivo providing hydrodynamic pressure and film thickness for walking and bicycling

Formulation of a 3-D lubrication simulation of a total hip replacement in vivo is presented using a finite difference approach. The goal is to determine if hydrodynamic lubrication is taking place, how thick the joint fluid film is and over what percentage of two gait cycles, (walking and bicycling), the hydrodynamic lubricating action is occurring, if at all. The assumption of rigid surfaces is made, which is conservative in the sense that pure hydrodynamic lubrication is well known to predict thinner films than elasto-hydrodynamic lubrication (EHL) for the same loading. The simulation method includes addressing the angular velocity direction changes and accurate geometry configuration for the acetabular cup and femoral head components and provides a range of results for material combinations of CoCrMo-on-UHMWPE, CoCrMo-on-CoCrMo, and alumina-on-alumina components. Results are in the form of the joint fluid film pressure distributions, load components and film thicknesses of the joint fluid, for the gait cycles of walking and bicycling. Results show hydrodynamic action occurs in only about 10% of a walking gait cycle and throughout nearly 90% of a bicycling gait. During the 10% of the walking cycle that develops hydrodynamic lubrication, the minimum fluid film thicknesses are determined to be between 0.05 micron and 1.1 microns, while the range of film thicknesses for bicycling is between 0.1 micron and 1.4 microns, and occurs over 90% of the bicycling gait. Pressure distributions for these same periods are in the range of 2 MPa to 870 MPa for walking and 1 MPa to 24 MPa for bicycling.     

Walking on high heels changes muscle activity and the dynamics of human walking significantly

The aim of the study was to investigate the distribution of net joint moments in the lower extremities during walking on high-heeled shoes compared with barefooted walking at identical speed. Fourteen female subjects walked at 4 km/h across three force platforms while they were filmed by five digital video cameras operating at 50 frames/second. Both barefooted walking and walking on high-heeled shoes (heel height: 9 cm) were recorded. Net joint moments were calculated by 3D inverse dynamics. EMG was recorded from eight leg muscles. The knee extensor moment peak in the first half of the stance phase was doubled when walking on high heels. The knee joint angle showed that high-heeled walking caused the subjects to flex the knee joint significantly more in the first half of the stance phase. In the frontal plane a significant increase was observed in the knee joint abductor moment and the hip joint abductor moment. Several EMG parameters increased significantly when walking on high-heels. The results indicate a large increase in bone-on-bone forces in the knee joint directly caused by the increased knee joint extensor moment during high-heeled walking, which may explain the observed higher incidence of osteoarthritis in the knee joint in women as compared with men.     

Influence of walking speed on gait parameters

Modern three-dimensional gait analysis systems give information on joint angles and moments in the sagittal and coronal planes, for which normal ranges may not be readily available in the literature. Since patients with joint disease tend to walk slowly and with a short stride, it is essential that normal ranges for gait parameters should be defined with reference to speed of walking. This we have done using a population of 10 normal male subjects agea from 18 to 63 years, walking at speeds which range from very slow to very fast. The ranges of knee angle and moment are given, together with the changes in these parameters with walking speed. Peak knee flexion moment is strongly related to walking speed, whereas coronal plane knee angle is virtually independent of it. The stride length is probably the best basis for deciding the normal range for a particular measurement.     

The effects of alignment of an articulated ankle-foot orthosis on lower limb joint kinematics and kinetics during gait in individuals post-stroke

Mechanical tuning of an ankle-foot orthosis (AFO) is important in improving gait in individuals post-stroke. Alignment and resistance are two factors that are tunable in articulated AFOs. The aim of this study was to investigate the effects of changing AFO ankle alignment on lower limb joint kinematics and kinetics with constant dorsiflexion and plantarflexion resistance in individuals post-stroke. Gait analysis was performed on 10 individuals post-stroke under four distinct alignment conditions using an articulated AFO with an ankle joint whose alignment is adjustable in the sagittal plane. Kinematic and kinetic data of lower limb joints were recorded using a Vicon 3-dimensional motion capture system and Bertec split-belt instrumented treadmill. The incremental changes in the alignment of the articulated AFO toward dorsiflexion angles significantly affected ankle and knee joint angles and knee joint moments while walking in individuals post-stroke. No significant differences were found in the hip joint parameters. The alignment of the articulated AFO was suggested to play an important role in improving knee joint kinematics and kinetics in stance through improvement of ankle joint kinematics while walking in individuals post-stroke. Future studies should investigate long-term effects of AFO alignment on gait in the community in individuals post-stroke.     

Segment and joint angles of hind limb during bipedal and quadrupedal walking of the bonobo (Pan paniscus)

We describe segment angles (trunk, thigh, shank, and foot) and joint angles (hip, knee, and ankle) for the hind limbs of bonobos walking bipedally ("bent-hip bent-knee walking," 17 sequences) and quadrupedally (33 sequences). Data were based on video recordings (50 Hz) of nine subjects in a lateral view, walking at voluntary speed. The major differences between bipedal and quadrupedal walking are found in the trunk, thigh, and hip angles. During bipedal walking, the trunk is approximately 33-41 degrees more erect than during quadrupedal locomotion, although it is considerably more bent forward than in normal human locomotion. Moreover, during bipedal walking, the hip has a smaller range of motion (by 12 degrees ) and is more extended (by 20-35 degrees ) than during quadrupedal walking. In general, angle profiles in bonobos are much more variable than in humans. Intralimb phase relationships of subsequent joint angles show that hip-knee coordination is similar for bipedal and quadrupedal walking, and resembles the human pattern. The coordination between knee and ankle differs much more from the human pattern. Based on joint angles observed throughout stance phase and on the estimation of functional leg length, an efficient inverted pendulum mechanism is not expected in bonobos.     

Muscle activation profiles about the knee during Tai-Chi stepping movement compared to the normal gait step.

The purpose of this study was to investigate knee muscle activity patterns in experienced Tai-Chi (TC) practitioners during normal walking and TC stepping. The electromyographic (EMG) activity of vastus lateralis (VL), vastus medialis (VM), bicep femoris (BF), and gastrocnemius (GS) muscles of 11 subjects (five females and six males) during the stance phase of normal walking was compared to stance phase of a TC step. Knee joint motion was also monitored by using an Optotrak motion analysis system. Raw EMG was processed by root-mean-square (RMS) technique using a time constant of 50 ms, and normalized to maximum of voluntary contraction for each muscle, referred to as normalized RMS (nRMS). Peak nRMS and co-contraction (quantified by co-contraction index) during stance phase of a gait cycle and a TC step were calculated. Paired t-tests were used to compare the difference for each muscle group peak and co-contraction pair between the tasks. The results showed that only peak values of nRMS in quadriceps and co-contraction were significantly greater in TC stepping compared to normal walking (Peak values of nRMS for VL were 26.93% for normal walking and 52.14% for TC step, p=0.001; VM are 29.12% for normal walking and 51.93% for TC stepping, p=0.028). Mean co-contraction index for VL-BF muscle pairs was 13.24+/-11.02% during TC stepping and 9.47+/-7.77% in stance phase of normal walking (p=0.023). There was no significant difference in peak values of nRMS in the other two muscles during TC stepping compared to normal walking. Preliminary EMG profiles in this study demonstrated that experienced TC practitioners used relatively higher levels of knee muscle activation patterns with greater co-contraction during TC exercise compared to normal walking.     

Biomechanical mechanism of lateral trunk lean gait for knee osteoarthritis patients

The biomechanical mechanism of lateral trunk lean gait employed to reduce external knee adduction moment (KAM) for knee osteoarthritis (OA) patients is not well known. This mechanism may relate to the center of mass (COM) motion. Moreover, lateral trunk lean gait may affect motor control of the COM displacement. Uncontrolled manifold (UCM) analysis is an evaluation index used to understand motor control and variability of the motor task. Here we aimed to clarify the biomechanical mechanism to reduce KAM during lateral trunk lean gait and how motor variability controls the COM displacement. Twenty knee OA patients walked under two conditions: normal and lateral trunk lean gait conditions. UCM analysis was performed with respect to the COM displacement in the frontal plane. We also determined how the variability is structured with regards to the COM displacement as a performance variable. The peak KAM under lateral trunk lean gait was lower than that under normal gait. The reduced peak KAM observed was accompanied by medially shifted knee joint center, shortened distance of the center of pressure to knee joint center, and shortened distance of the knee–ground reaction force lever arm during the stance phase. Knee OA patients with lateral trunk lean gait could maintain kinematic synergy by utilizing greater segmental configuration variance to the performance variable. However, the COM displacement variability of lateral trunk lean gait was larger than that of normal gait. Our findings may provide clinical insights to effectively evaluate and prescribe gait modification training for knee OA patients.     

Synthesis of human walking: A planar model for single support

A mathematical model for the single support phase of normal, level, human walking is formulated. The motion of the lower extremity is synthesized using a preprogrammed set of inputs, recognized by the model as a simple collection of applied joint moments.

Two mechanisms are forwarded as candidates for producing the observed peaks in the vertical ground reaction. The first, stance knee flexion-extension, generates the necessary level of whole-body vertical acceleration during the initial region of single support (opposite toe-off to heel-off). A model accounting for the determinants of foot and knee interaction then predicts the second peak to be the result of an increasing ankle moment in the region from heel-off to opposite heel-strike.     

Swing phase simulation and design of above knee prostheses

A detailed dynamic model of the stump-prosthesis system for an above knee amputee was developed. The model was used to examine the influence of controls and design parameters on the limb system performance during the swing phase of gait. The model duplicated the clinically known fact that hydraulic knee controllers allow the amputee to change walking speed while mechanical knee controllers limit the amputee to a single walking speed. Contrary to current practice, the simulations suggest that light weight prosthesis designs do not perform as well as heavier designs. A simple design based on a constant friction knee is shown to yield good overall performance.     

Minimization of the gliding index: criterion for the generation of the surfaces of a knee endoprosthesis

Previous studies on removed failed artificial knees revealed significant degradation of the articular surfaces, including pitting and shredding, as well as burnishing accompanied by score marks and scratches, the latter damage group being related to the gliding motion of the joint. In an attempt to introduce an improved version of an artificial knee joint, we have proposed a general model by which the opposing surfaces of the prosthesis components can be synthesized. The criterion applied was that of minimization of a defined gliding index. The femoral condyles in this model were expressed in terms of torus geometry, and the kinematics of motion fed into the model was that of normal motion in the sagittal plane, including angles as well as the displacement vector in the knee joint. Geometry of the tibial component was obtained from the tangents of the femoral surface, in subsequent positions of motion. The optimal surfaces were those for which the gliding index assumed a minimal value. The solutions obtained for various input motions are presented and discussed.     

Gait analysis using gravitational acceleration measured by wearable sensors

A novel method for measuring human gait posture using wearable sensor units is proposed. The sensor units consist of a tri-axial acceleration sensor and three gyro sensors aligned on three axes. The acceleration and angular velocity during walking were measured with seven sensor units worn on the abdomen and the lower limb segments (both thighs, shanks and feet). The three-dimensional positions of each joint are calculated from each segment length and joint angle. Joint angle can be estimated mechanically from the gravitational acceleration along the anterior axis of the segment. However, the acceleration data during walking includes three major components; translational acceleration, gravitational acceleration and external noise. Therefore, an optimization analysis was represented to separate only the gravitational acceleration from the acceleration data. Because the cyclic patterns of acceleration data can be found during constant walking, a FFT analysis was applied to obtain some characteristic frequencies in it. A pattern of gravitational acceleration was assumed using some parts of these characteristic frequencies. Every joint position was calculated from the pattern under the condition of physiological motion range of each joint. An optimized pattern of the gravitational acceleration was selected as a solution of an inverse problem. Gaits of three healthy volunteers were measured by walking for 20 s on a flat floor. As a result, the acceleration data of every segment was measured simultaneously. The characteristic three-dimensional walking could be shown by the expression using a stick figure model. In addition, the trajectories of the knee joint in the horizontal plane could be checked by visual imaging on a PC. Therefore, this method provides important quantitive information for gait diagnosis.