A holistic numerical model to predict strain hardening and damage of UHMWPE under multiple total knee replacement kinematics and experimental validation

Experimental wear testing is an essential step in the evaluation of total knee replacement (TKR) design. Unfortunately, experiments can be prohibitively expensive and time consuming, which has made computational wear simulation a more desirable alternative for screening designs. While previous attempts have demonstrated positive results, few models have fully incorporated the affect of strain hardening (or cross shear), or tested the model under more than one loading condition. The objective of this study was to develop and evaluate the performance of a new holistic TKR damage model, capable of predicting damage caused by wear, including the effects of strain hardening and creep. For the first time, a frictional work-based damage model was compared against multiple sets of experimental TKR wear testing data using different input kinematics. The wear model was tuned using experimental measurements and was then able to accurately predict the volumetric polyethylene wear volume during experiments with different kinematic inputs. The size and shape of the damage patch on the surface of the polyethylene inserts were also accurately predicted under multiple input kinematics. The ability of this model to predict implant damage under multiple loading profiles by accounting for strain hardening makes it ideal for screening new implant designs, since implant kinematics are largely a function of the shape of the components.     

Predicting knee replacement damage in a simulator machine using a computational model with a consistent wear factor

Wear of ultrahigh molecular weight polyethylene remains a primary factor limiting the longevity of total knee replacements (TKRs). However, wear testing on a simulator machine is time consuming and expensive, making it impractical for iterative design purposes. The objectives of this paper were first, to evaluate whether a computational model using a wear factor consistent with the TKR material pair can predict accurate TKR damage measured in a simulator machine, and second, to investigate how choice of surface evolution method (fixed or variable step) and material model (linear or nonlinear) affect the prediction. An iterative computational damage model was constructed for a commercial knee implant in an AMTI simulator machine. The damage model combined a dynamic contact model with a surface evolution model to predict how wear plus creep progressively alter tibial insert geometry over multiple simulations. The computational framework was validated by predicting wear in a cylinder-on-plate system for which an analytical solution was derived. The implant damage model was evaluated for 5 million cycles of simulated gait using damage measurements made on the same implant in an AMTI machine. Using a pin-on-plate wear factor for the same material pair as the implant, the model predicted tibial insert wear volume to within 2% error and damage depths and areas to within 18% and 10% error, respectively. Choice of material model had little influence, while inclusion of surface evolution affected damage depth and area but not wear volume predictions. Surface evolution method was important only during the initial cycles, where variable step was needed to capture rapid geometry changes due to the creep. Overall, our results indicate that accurate TKR damage predictions can be made with a computational model using a constant wear factor obtained from pin-on-plate tests for the same material pair, and furthermore, that surface evolution method matters only during the initial "break in" period of the simulation.     

A direct comparison of patient and force-controlled simulator total knee replacement kinematics

The need to critically evaluate the efficacy of current total knee replacement (TKR) wear testing methodologies is great. Proposed international standards for TKR wear simulation have been drafted, yet their methods continue to be debated. The "gold standard" to which all TKR wear testing methodologies should be compared is measured in vivo TKR performance in patients. The current study compared patient TKR kinematics from fluoroscopic analysis and simulator TKR kinematics from force-controlled wear testing to quantify similarities in clinical ranges of motion and contact bearing kinematics and to evaluate the proposed ISO force-controlled wear testing methodology. The treadmill walking kinematics from eight well-functioning, 13 month average post-op patients were compared to the 2 million cycle interval walking cycle kinematics from a force-controlled (Instron/Stanmore Knee Joint Simulator, Instron, Canton, MA) knee simulator using identical implant designs (Natural Knee II, Standard Congruent, Zimmer, Warsaw, IN). The in vivo and simulator data showed good agreement in kinematic patterns and ranges of clinical motion. Tribologically the data sets showed similar contact pathway ranges of motion and wear travel distances per cycle. Surgical and simulator alignments of the implant systems were determined to be a contributing factor in observed kinematic differences. This study's statistical findings offer supporting evidence that the simulation of in vivo walking cycle wear kinematics can be accurately reproduced with a force controlled testing methodology.     

Simulation of a knee joint replacement during a gait cycle using explicit finite element analysis.

The stress distribution within the polyethylene insert of a total knee joint replacement is dependent on the kinematics, which in turn are dependent on the design of the articulating surfaces, the relative position of the components and the tension of the surrounding soft tissues. Implicit finite element analysis techniques have been used previously to examine the polyethylene stresses. However, these have essentially been static analyses and hence ignored the influence of the kinematics. The aim of this work was to use an explicit finite element approach to simulate both the kinematics and the internal stresses within a single analysis. A simulation of a total knee joint replacement subjected to a single gait cycle within a knee wear simulator was performed and the results were compared with experimental data.The predicted kinematics were in close agreement with the experimental data. Various solution-dependent parameters were found to have little influence on the predicted kinematics. The predicted stresses were found to be dependent on the mesh density. This study has shown that an explicit finite element approach is capable of predicting the kinematics and the stresses within a single analysis at relatively low computational cost.     

Dynamic finite element knee simulation for evaluation of knee replacement mechanics

In vitro pre-clinical testing of total knee replacement (TKR) devices is a necessary step in the evaluation of new implant designs. Whole joint knee simulators, like the Kansas knee simulator (KKS), provide a controlled and repeatable loading environment for comparative evaluation of component designs or surgical alignment under dynamic conditions. Experimental testing, however, is time and cost prohibitive for design-phase evaluation of tens or hundreds of design variations. Experimentally-verified computational models provide an efficient platform for analysis of multiple components, sizes, and alignment conditions. The purpose of the current study was to develop and verify a computational model of a dynamic, whole joint knee simulator. Experimental internal-external and valgus-varus laxity tests, followed by dynamic deep knee bend and gait simulations in the KKS were performed on three cadaveric specimens. Specimen-specific finite element (FE) models of posterior-stabilized TKR were created from magnetic resonance images and CAD geometry. The laxity data was used to optimize mechanical properties of tibiofemoral soft-tissue structures on a specimen-specific basis. Each specimen was subsequently analyzed in a computational model of the experimental KKS, simulating both dynamic activities. The computational model represented all joints and actuators in the experimental setup, including a proportional-integral-derivative (PID) controller to drive quadriceps actuation. The computational model was verified against six degree-of-freedom patellofemoral (PF) and tibiofemoral (TF) kinematics and actuator loading during both deep knee bend and gait activities, with good agreement in trends and magnitudes between model predictions and experimental kinematics; differences were less than 1.8 mm and 2.2° for PF and TF translations and rotations. The whole joint FE simulator described in this study can be applied to investigate a wide range of clinical and research questions.     

Computational wear prediction of a total knee replacement from in vivo kinematics

Wear of ultra-high molecular weight polyethylene bearings in total knee replacements remains a major limitation to the longevity of these clinically successful devices. Few design tools are currently available to predict mild wear in implants based on varying kinematics, loads, and material properties. This paper reports the implementation of a computer modeling approach that uses fluoroscopically measured motions as inputs and predicts patient-specific implant damage using computationally efficient dynamic contact and tribological analyses. Multibody dynamic simulations of two activities (gait and stair) with two loading conditions (70-30 and 50-50 medial-lateral load splits) were generated from fluoroscopic data to predict contact pressure and slip velocity time histories for individual elements on the tibial insert surface. These time histories were used in a computational wear analysis to predict the depth of damage due to wear and creep experienced by each element. Predicted damage areas, volumes, and maximum depths were evaluated against a tibial insert retrieved from the same patient who provided the in vivo motions. Overall, the predicted damage was in close agreement with damage observed on the retrieval. The gait and stair simulations separately predicted the correct location of maximum damage on the lateral side, whereas a combination of gait and stair was required to predict the correct location on the medial side. Predicted maximum damage depths were consistent with the retrieval as well. Total computation time for each damage prediction was less than 30 min. Continuing refinement of this approach will provide a robust tool for accurately predicting clinically relevant wear in total knee replacements.     

Experimental evaluation of an elastic foundation model to predict contact pressures in knee replacements

Computational wear prediction is an attractive concept for evaluating new total knee replacement designs prior to physical testing and implementation. An important hurdle to such technology is the lack of in vivo contact pressure predictions. To address this issue, this study evaluates a computationally efficient simulation approach that combines the advantages of rigid and deformable body modeling. The hybrid method uses rigid body dynamics to predict body positions and orientations and elastic foundation theory to predict contact pressures between general three-dimensional surfaces. To evaluate the method, we performed static pressure experiments with a commercial knee implant in neutral alignment using flexion angles of 0, 30, 60, and 90 degrees and loads of 750, 1500, 2250, and 3000N. Using manufacturer CAD geometry for the same implant, an elastic foundation model with linear or nonlinear polyethylene material properties was implemented within a commercial multibody dynamics software program. The model's ability to predict experimental peak and average contact pressures simultaneously was evaluated by performing dynamic simulations to find the static configuration. Both the linear and nonlinear material models predicted the average contact pressure data well, while only the linear material model could simultaneously predict the trends in the peak contact pressure data. This novel modeling approach is sufficiently fast and accurate to be used in design sensitivity and optimization studies of knee implant mechanics and ultimately wear.     

Effect of joint laxity on polyethylene wear in total knee replacement

Experimental simulator studies are frequently performed to evaluate wear behavior in total knee replacement. It is vital that the simulation conditions match the physiological situation as closely as possible. To date, few experimental wear studies have examined the effects of joint laxity on wear and joint kinematics and the absence of the anterior cruciate ligament has not been sufficiently taken into account in simulator wear studies.The aim of this study was to investigate different ligament and soft tissue models with respect to wear and kinematics.A virtual soft tissue control system was used to simulate different motion restraints in a force-controlled knee wear simulator.The application of more realistic and sophisticated ligament models that considered the absence of anterior cruciate ligament lead to a significant increase in polyethylene wear (p=0.02) and joint kinematics (p<0.01). We recommend the use of more complex ligament models to appropriately simulate the function of the human knee joint and to evaluate the wear behavior of total knee replacements. A feasible simulation model is presented.     

Computational wear prediction of artificial knee joints based on a new wear law and formulation

Laboratory joint wear simulator testing has become the standard means for preclinical evaluation of wear resistance of artificial knee joints. Recent simulator designs have been advanced and become successful at reproducing the wear patterns observed in clinical retrievals. However, a single simulator test can be very expensive and take a long time to run. On the other hand computational wear modelling is an alternative attractive solution to these limitations. Computational models have been used extensively for wear prediction and optimisation of artificial knee designs. However, all these models have adopted the classical Archard's wear law, which was developed for metallic materials, and have selected wear factors arbitrarily. It is known that such an approach is not generally true for polymeric bearing materials and is difficult to implement due to the high dependence of the wear factor on the contact pressure. Therefore, these studies are generally not independent and lack general predictability. The objective of the present study was to develop a new computational wear model for the knee implants, based on the contact area and an independent experimentally determined non-dimensional wear coefficient. The effects of cross-shear and creep on wear predictions were also considered. The predicted wear volume was compared with the laboratory simulation measurements. The model was run under two different kinematic inputs and two different insert designs with curved and custom designed flat bearing surfaces. The new wear model was shown to be capable of predicting the difference of the wear volume and wear pattern between the two kinematic inputs and the two tibial insert designs. Conversely, the wear factor based approach did not predict such differences. The good agreement found between the computational and experimental results, on both the wear scar areas and volumetric wear rates, suggests that the computational wear modelling based on the new wear law and the experimentally calculated non-dimensional wear coefficient should be more reliable and therefore provide a more robust virtual modelling platform.     

Influence of kinematics on the wear of a total ankle replacement

Total ankle replacement (TAR) is an alternative to fusion, replacing the degenerated joint with a mechanical motion-preserving alternative. Minimal pre-clinical testing has been reported to date and existing wear testing standards lack definition. Ankle gait is complex, therefore the aim of this study was to investigate the effect on wear of a range of different ankle gait kinematic inputs. Five Zenith (Corin Group) TARs were tested in a modified knee simulator for twelve million cycles (Mc). Different combinations of IR rotation and AP displacement were applied every 2Mc to understand the effects of the individual kinematics. Wear was assessed gravimetrically every Mc and surface profilometry undertaken after each condition. With the initial unidirectional input with no AP displacement the wear rate measured 1.2±0.6 mm³/Mc. The addition of 11° rotation and 9 mm of AP displacement caused a statistically significant increase in the wear rate to 25.8±3.1 mm³/Mc. These inputs seen a significant decrease in the surface roughness at the tibial articulation. Following polishing three displacement values were tested; 0, 4 and 9 mm with no significant difference in wear rate ranging 11.8–15.2 mm³/Mc. TAR wear rates were shown to be highly dependent on the addition of internal/external rotation within the gait profile with multidirectional kinematics proving vital in the accurate wear testing of TARs. Prior to surface polishing wear rates were significantly higher but once in a steady state the AP displacement had no significant effect on the wear.     

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.     

The use of a force-controlled dynamic knee simulator to quantify the mechanical performance of total knee replacement designs during functional activity

The experimental evaluation of any total knee replacement (TKR) design should include the pre-implantation quantification of its mechanical performance during tests that simulate the common activities of daily living. To date, few dynamic TKR simulation studies have been conducted before implantation. Once in vivo, the accurate and reproducible assessment of TKR design mechanics is exceedingly difficult, with the secondary variables of the patient and the surgical technique hindering research. The current study utilizes a 6-degree-of-freedom force-controlled knee simulator to quantify the effect of TKR design alone on TKR mechanics during a simulated walking cycle. Results show that all eight TKR designs tested elicited statistically different measures of tibial/femoral kinematics, simulated soft tissue loading, and implant geometric restraint loading during an identical simulated gait cycle, and that these differences were a direct result of TKR design alone. Maximum ranges of tibial kinematics over the eight designs tested were from 0.8mm anterior to 6.4mm posterior tibial displacement, and 14.1 degrees internal to 6.0 degrees external tibial rotation during the walking cycle. Soft tissue and implant reaction forces ranged from 106 and 222N anteriorly to 19 and 127N posteriorly, and from 1.6 and 1.8Nm internally to 3.5 and 5.9Nm externally, respectively. These measures provide valuable experimental insight into the effect of TKR design alone on simulated in vivo TKR kinematics, bone interface loading and soft tissue loading. Future studies utilizing this methodology should investigate the effect of experimentally controlled variations in surgical and patient factors on TKR performance during simulated dynamic activity.     

Kinematic evaluation of cruciate-retaining total knee replacement patients during level walking: A comparison with the displacement-controlled ISO standard

Differences between wear-scar features of simulator-tested and retrieved tibial total knee replacement (TKR) liners have been reported. This disagreement may result from differences between in vivo kinematic profiles and those defined by the International Organization for Standardization (ISO). The purpose of this study was to determine the knee kinematics of a TKR subject group during level walking and compare them with the motion profiles defined by the ISO standard for a displacement-controlled knee wear testing simulator. Twenty-nine patients with a posterior cruciate ligament-retaining TKR design were gait tested using the point cluster technique to obtain flexion–extension (FE) rotation, anterior–posterior (AP) translation and internal–external (IE) rotation knee motions during a complete cycle of level walking. Relative ranges of motion and timing of key points within the in vivo motion data were compared against the same ranges and same key points from the input profiles of the displacement-controlled wear testing standard ISO14243-3. The subjects exhibited a FE pattern similar to ISO, with an insignificant difference in range of FE rotation from midstance to terminal stance. However, the subjects had a significantly higher range of knee flexion from terminal stance into swing. The subjects also exhibited a phase delay for the entire gait cycle. For AP translation, the standard profile had statistically significant lower magnitudes than seen in vivo. Opposite pattern of AP motion was also apparent from midstance and swing. Similarly, ISO specified a smaller IE total range of rotation with a motion pattern in complete opposition to that seen in vivo. In conclusion, significant differences were found in both the magnitudes and pattern of in vivo motion compared with ISO.     

Patellofemoral interactions in walking,stair ascent,and stair descent using a virtual patella model

Restoration of normal patella kinematics is an important clinical outcome of total knee arthroplasty. Failure of the patella within total knee systems has been documented and, upon occurrence, often necessitates revision surgery. It is thus important to understand patella mechanics following implantation, subject to load states that are typically realized during walking and other gaits. Here, a computational model of the patella is developed and used to examine the effects of walking, stair ascent, and stair descent on the development of stress and contact pressure in the patella throughout the gait cycle. Motion of the patella was governed by a combination of kinematic and force control, based on knee flexion and patellofemoral joint reaction force data from the literature. Unlike most previous analyses of full gait, quasi-static equilibrium was enforced throughout the cycle. Results indicate that, though peak forces vary greatly between the three gaits, maximum contact pressure and von Mises stress are roughly equivalent. However, contact area is larger in stair ascent and descent than walking, as patellofemoral loading, implant geometry, and polyethylene yield increase conformity between the femoral component and patella. Additionally, maximum contact pressure does not coincide with maximum load except for the case of walking. Though specific to the implant design considered here, this result has important ramifications for patella testing and emphasizes the need to characterize patella mechanics throughout gait.     

Explicit finite element modeling of total knee replacement mechanics

Joint kinematics and contact mechanics dictate the success of current total knee replacement (TKR) devices. Efficient computer models present an effective way of evaluating these characteristics. Predicted contact stress and area due to articulations at the tibio-femoral and patello-femoral interfaces indicate potential clinical performance. Previous finite element (FE) knee models have generally been used to predict contact stresses and/or areas during static or quasi-static loading conditions. Explicit dynamic FE analyses have recently been used to efficiently predict TKR kinematics and contact mechanics during dynamic loading conditions. The objective of this study was to develop and experimentally validate an explicit FE TKR model that incorporates tibio-femoral and patello-femoral articulations. For computational efficiency, we developed rigid body analyses that can reasonably reproduce the kinematics, contact pressure distribution, and contact area of a fully deformable system. Results from the deformable model showed that the patello-femoral and tibio-femoral kinematics were in good agreement with experimental knee simulator measurements. Kinematic results from the rigid body analyses were nearly identical to those from the fully deformable model, and the contact pressure and contact area correlation was acceptable given the great reduction in analysis time. Component mesh density studied had little effect on the predicted kinematics, particularly for the patellar component, and small effects on the predicted contact pressure and area. These analyses have shown that, at low computational cost, a force-control dynamic simulation of a gait cycle can yield useful and predictable results.     

Development of a statistical shape-function model of the implanted knee for real-time prediction of joint mechanics

Outcomes of total knee arthroplasty (TKA) are dependent on surgical technique, patient variability, and implant design. Non-optimal design or alignment choices may result in undesirable contact mechanics and joint kinematics, including poor joint alignment, instability, and reduced range of motion. Implant design and surgical alignment are modifiable factors with potential to improve patient outcomes, and there is a need for robust implant designs that can accommodate patient variability. Our objective was to develop a statistical shape-function model (SFM) of a posterior stabilized implanted knee to instantaneously predict joint mechanics in an efficient manner. Finite element methods were combined with Latin hypercube sampling and regression analyses to produce modeling equations relating nine implant design and six surgical alignment parameters to tibiofemoral (TF) joint mechanics outcomes during a deep knee bend. A SFM was developed and TF contact mechanics, kinematics, and soft tissue loads were instantaneously predicted from the model. Average normalized root-mean-square error predictions were between 2.79% and 9.42%, depending on the number of parameters included in the model. The statistical shape-function model generated instantaneous joint mechanics predictions using a maximum of 130 training simulations, making it ideally suited for integration into a patient-specific design and alignment optimization pipeline. Such a tool may be used to optimize kinematic function to achieve more natural motion or minimize implant wear, and may aid the engineering and clinical communities in improving patient satisfaction and surgical outcomes.     

Probabilistic finite element prediction of knee wear simulator mechanics

Computational models have recently been developed to replicate experimental conditions present in the Stanmore knee wear simulator. These finite element (FE) models, which provide a virtual platform to evaluate total knee replacement (TKR) mechanics, were validated through comparisons with experimental data for a specific implant. As with any experiment, a small amount of variability is inherently present in component alignment, loading, and environmental conditions, but this variability has not been previously incorporated in the computational models. The objectives of the current research were to assess the impact of experimental variability on predicted TKR mechanics by determining the potential envelope of joint kinematics and contact mechanics present during wear simulator loading, and to evaluate the sensitivity of the joint mechanics to the experimental parameters. In this study, 8 component alignment and 4 experimental parameters were represented as distributions and used with probabilistic methods to assess the response of the system, including interaction effects. The probabilistic FE model evaluated two levels of parameter variability (with standard deviations of component alignment parameters up to 0.5mm and 1 degrees ) and predicted a variability of up to 226% (3.44mm) in resulting anterior-posterior (AP) translation, up to 169% (4.30 degrees ) in internal-external (IE) rotation, but less than 10% (1.66MPa) in peak contact pressure. The critical alignment parameters were the tilt of the tibial insert and the IE rotational alignment of the femoral component. The observed variability in kinematics and, to a lesser extent, contact pressure, has the potential to impact wear observed experimentally.     

Wear in the prosthetic shoulder: association with design parameters

Total replacement of the glenohumeral joint provides an effective means for treating a variety of pathologies of the shoulder. However, several studies indicate that the procedure has not yet been entirely optimized. Loosening of the glenoid component remains the most likely cause of implant failure, and generally this is believed to stem from either mechanical failure of the fixation in response to high tensile stresses, or through osteolysis of the surrounding bone stock in response to particulate wear debris. Many computational studies have considered the potential for the former, although only few have attempted to tackle the latter. Using finite-element analysis an investigation, taking into account contact pressures as well as glenohumeral kinematics, has thus been conducted, to assess the potential for polyethylene wear within the artificial shoulder. The relationships between three different aspects of glenohumeral design and the potential for wear have been considered, these being conformity, polyethylene thickness, and fixation type. The results of the current study indicate that the use of conforming designs are likely to produce slightly elevated amounts of wear debris particles when compared with less conforming joints, but that the latter would be more likely to cause material failure of the polyethylene. The volume of wear debris predicted was highly influenced by the rate of loading, however qualitatively it was found that wear predictions were not influenced by the use of different polyethylene thicknesses nor fixation type while the depth of wearing was. With the thinnest polyethylene designs (2 mm) the maximum depth of the wear scar was seen to be upwards of 20% higher with a metal-backed fixation as opposed to a cemented design. In all-polyethylene designs peak polymethyl methacrylate tensile stresses were seen to reduce with increasing polyethylene thickness. Irrespective of the rate of loading of the shoulder joint, the current study indicates that it is possible to optimize glenoid component design against abrasive wear through the use of high conformity designs, possessing a polyethylene thickness of at least 6 mm.     

Verification of predicted specimen-specific natural and implanted patellofemoral kinematics during simulated deep knee bend

Verified computational models represent an efficient method for studying the relationship between articular geometry, soft-tissue constraint, and patellofemoral (PF) mechanics. The current study was performed to evaluate an explicit finite element (FE) modeling approach for predicting PF kinematics in the natural and implanted knee. Experimental three-dimensional kinematic data were collected on four healthy cadaver specimens in their natural state and after total knee replacement in the Kansas knee simulator during a simulated deep knee bend activity. Specimen-specific FE models were created from medical images and CAD implant geometry, and included soft-tissue structures representing medial–lateral PF ligaments and the quadriceps tendon. Measured quadriceps loads and prescribed tibiofemoral kinematics were used to predict dynamic kinematics of an isolated PF joint between 10° and 110° femoral flexion. Model sensitivity analyses were performed to determine the effect of rigid or deformable patellar representations and perturbed PF ligament mechanical properties (pre-tension and stiffness) on model predictions and computational efficiency.Predicted PF kinematics from the deformable analyses showed average root mean square (RMS) differences for the natural and implanted states of less than 3.1° and 1.7 mm for all rotations and translations. Kinematic predictions with rigid bodies increased average RMS values slightly to 3.7° and 1.9 mm with a five-fold decrease in computational time. Two-fold increases and decreases in PF ligament initial strain and linear stiffness were found to most adversely affect kinematic predictions for flexion, internal–external tilt and inferior–superior translation in both natural and implanted states. The verified models could be used to further investigate the effects of component alignment or soft-tissue variability on natural and implant PF mechanics.     

The conflicting requirements of laxity and conformity in total knee replacement

Bearing surfaces of total condylar knees which are designed with a high degree of conformity to produce low stresses in the polyethylene tibial insert may be overconstrained. This study determines femoral and tibial bearing surface geometries which will induce the least destructive fatigue mechanisms in the polyethylene whilst conserving the laxity of the natural knee. Sixteen knee designs were generated by varying four parameters systematically to cover the range of contemporary knee designs. The parameters were the femoral frontal radius (30 or 70 mm), the difference between the femoral and tibial frontal radii (2 or 10 mm), the tibial sagittal radius (56 or 80 mm) and the posterior-distal transition angle (-8 or -20 degrees), which is the angle at which the small posterior arc of the sagittal profile transfers to the larger distal arc. Rigid body analyses determined the anterior-posterior and rotational motions as well as the contact points during the stance phase of gait for the different designs. In addition, a damage function which accumulated the fluctuating maximum shear stresses was used to predict the susceptibility to delamination wear of the polyethylene (damage score). This study predicted that of the 16 designs, the knee with a frontal radius of 70 mm, a difference in femoral and tibial frontal radii of 2 mm, a tibial sagittal radius of 80 mm and a posterior distal transition angle of -20 degrees would satisfy the conflicting needs of both resistance to delamination wear and natural kinematics.