The effect of ankle constraint on the torsional laxity of the knee during internal-external rotation of the foot

The in vivo torsional laxity and stiffness of the knee joint are usually determined by rotating the foot and measuring the torque generated at the knee. However, when rotation is applied to the foot, significant three-dimensional forces and moments are produced at the knee. These forces and moments depend upon the external constraint of the ankle complex, and as a result, the observed laxity of the knee also depends on the ankle constraint. Tests are conducted with the foot of a subject in a shoe, with and without the ankle taped, and in a buckled and unbuckled (ski) boot that can effectively constrain ankle rotation. The average laxity of the primary (linear) region of the axial moment vs internal-external rotation is 30% greater when the ankle is constrained by the buckled boot than it is in three other cases of lesser ankle constraint.     

Effect of conformity and contact stress on wear in fixed-bearing total knee prostheses

Ultra high molecular weight polyethylene (PE) remains the primary bearing surface of choice in total knee replacements (TKR). Wear is controlled by levels of cross-shear motion and contact stress. The aim of this study was to compare the wear of fixed-bearing total knee replacements with curved and flat inserts and to test the hypothesis that the flat inserts which give higher contact stresses and smaller contact areas would lead to lower levels of surface wear. A low-conforming, high contact stress knee with a low-medium level of cross shear resulted in significantly lower wear rates in comparison to a standard cruciate sacrificing fixed-bearing knee. The low wear solution found in the knee simulator was supported by fundamental studies of wear as a function of pressure and cross shear in the pin on plate system. Current designs of fixed-bearing knees do not offer this low wear solution due to their medium cross shear, moderate conformity and medium contact stress.     

Limited rotation of the mobile-bearing in a rotating platform total knee prosthesis

The hypothesis of this study was that the polyethylene bearing in a rotating platform total knee prosthesis shows axial rotation during a step-up motion, thereby facilitating the theoretical advantages of mobile-bearing knee prostheses. We examined 10 patients with rheumatoid arthritis who had a rotating platform total knee arthroplasty (NexGen LPS mobile, Zimmer Inc. Warsaw, USA). Fluoroscopic data was collected during a step-up motion six months postoperatively. A 3D-2D model fitting technique was used to reconstruct the in vivo 3D kinematics. The femoral component showed more axial rotation than the polyethylene mobile-bearing insert compared to the tibia during extension. In eight knees, the femoral component rotated internally with respect to the tibia during extension. In the other two knees the femoral component rotated externally with respect to the tibia. In all 10 patients, the femur showed more axial rotation than the mobile-bearing insert indicating the femoral component was sliding on the polyethylene of the rotating platform during the step-up motion. Possible explanations are a too limited conformity between femoral component and insert, the anterior located pivot location of the investigated rotating platform design, polyethylene on metal impingement and fibrous tissue formation between the mobile-bearing insert and the tibial plateau.     

Automatic model-based roentgen stereophotogrammetric analysis (RSA) of total knee prostheses

Conventional radiography is insensitive for early and accurate estimation of the mal-alignment and wear of knee prostheses. The two-staged (rough and fine) registration of the model-based RSA technique has recently been developed to in vivo estimate the prosthetic pose (i.e, location and orientation). In the literature, rough registration often uses template match or manual adjustment of the roentgen images. Additionally, possible error induced by the nonorthogonality of taking two roentgen images neither examined nor calibrated prior to fine registration. This study developed two RSA methods for automate the estimation of the prosthetic pose and decrease the nonorthogonality-induced error. The predicted results were validated by both simulative and experimental tests and compared with reported findings in the literature. The outcome revealed that the feature-recognized method automates pose estimation and significantly increases the execution efficiency up to about 50 times in comparison with the literature counterparts. Although the nonorthogonal images resulted in undesirable errors, the outline-optimized method can effectively compensate for the induced errors prior to fine registration. The superiority in automation, efficiency, and accuracy demonstrated the clinical practicability of the two proposed methods especially for the numerous fluoroscopic images of dynamic motion.     

Influence of patellar position on tibial rotation after total knee arthroplasty]

AIM: Common total knee arthroplasty leads to resection of the anterior cruciate ligament. Lacking the ligamentous guidance, tibial rotation depends on different factors, i.e., muscle vectors. The present study measured the influence of the knee extensor mechanism determined by the mediolateral patella position on tibial rotation after implantation of two different knee prostheses. MATERIALS AND METHODS: Physiologic tibial rotation and mediolateral patella translation were measured in ten fresh-frozen knee specimens. After implantation of the Interax- and Genesis II-prosthesis in each five of the ten specimens, kinematic measurements were made again with a determination of significant alterations. RESULTS: The maximal medial patella position relative to the centre of the tibia was -6.6 mm (representing lateralisation); the maximal external tibial rotation was 4.1 degrees. After implantation of the Genesis II-prosthesis the external tibial rotation was reduced (p=0.03) with a relatively medialised patella (p=0.01), whereas after implantation of the Interax-prosthesis the external tibial rotation was increased (p=0.01) while the patella was measured to be lateralised similar to physiologic conditions. CONCLUSION: The results of the current study revealed a potential influence of mediolateral patella position on tibial rotation following total knee arthroplasty, while both prosthesis systems were not able to reproduce physiologic joint kinematics.     

Identification of knee joint models for varus-valgus and internal-external rotations: snow skiing experiments

Sprains at the knee are the most frequent of the severe injuries occurring during alpine snow skiing. This paper discusses the development of analytical models describing rotations across the knee joint caused by varus-valgus and internal-external moments applied at the foot during skiing. Identification of an ARMAX model requires simultaneous measurements of the rotations across the knee and the moments at the foot during skiing. As the models only relate the measured input (moment) and output (rotation) data, they also identify components of apparent rotation resulting from imperfect fixation of the rotation measuring instrument on the test subject and resulting from other inputs. The models identified for all subjects are of order four or five for both varus-valgus and internal-external rotation, and they describe modes with oscillatory and exponentially decaying components. Application of the models to prediction of rotation across the knee from the measured moment at the foot is illustrated by example. A new, and virtually mechanically uncoupled, six degrees-of-freedom, strain gauge dynamometer is developed to record the moments at the foot during skiing. The concept of the dynamometer design has general application.     

Stance and swing phase knee flexion recover at different rates following total knee arthroplasty: An inertial measurement unit study

Total knee arthroplasty (TKA) is the most common joint replacement in the United States. Range of motion (ROM) monitoring includes idealized clinic measures (e.g. goniometry during passive ROM) that may not accurately represent knee function. Accordingly, a novel, portable, inertial measurement unit (IMU) based ROM measurement method was developed, validated, and implemented. Knee flexion was computed via relative motion between two IMUs and validated via optical motion capture (p > 0.05). Prospective analyses of 10 healthy individuals (5M, 50 ± 19 years) and 20 patients undergoing TKA (3 lost to follow up, 10M, 65 ± 6 years) were completed. Controls wore IMUs for 1-week. Patients wore IMUs for 1-week pre-TKA, 6-weeks immediately post-TKA, and 1-week at 1-year post-TKA. Flexion was computed continuously each day (8–12 h). Metrics included daily maximum flexion and flexion during stance/swing phases of gait. Maximum flexion was equal between cohorts at all time points. Contrastingly, patient stance and swing flexion were reduced pre-TKA, yet improved post-TKA. Specifically, patient stance and swing flexion were reduced below control/pre-TKA values during post-TKA week 1. Stance flexion exceeded pre-TKA and equaled control levels after week 2. However, swing flexion only exceeded pre-TKA and equaled control levels at 1-year post-TKA. This novel method improves upon the accuracy/portability of current methods (e.g. goniometry). Interestingly, surgery did not impact maximum ROM, yet improved the ability to flex during gait allowing more efficient and safe ambulation. This is the first study continuously monitoring long-term flexion before/after TKA. The results offer richer information than clinical measures about expected TKA rehabilitation.     

A novel method for in vivo knee prosthesis wear measurement

Wear remains an important cause of failure in knee replacement. Of the current methods of early performance assessment or prediction, simulators have been un-physiological, single X-ray film analyses remain limited by accuracy and retrieval and survival methods have a prohibitive time scale. An accurate method is needed to allow a timely assessment of polyethylene component wear in vivo, when a new design is introduced, in order to predict likely outcome. We present a new method for measuring wear in vivo that we believe will allow this prediction of long-term wear. X-ray film pairs were taken of implanted prosthetic metal components. When the X-ray system was calibrated, projections of the appropriate Computer Aided Design (CAD) model could be matched to the shapes on the scanned X-ray films to find component positions. Interpenetration of the metal femoral component into the polyethylene component could then be established and represents our estimate of "wear". This method was used to measure in vivo prosthesis wear to an accuracy of 0.11 mm.     

Accurate measurement of psoralen-crosslinked DNA: direct biochemical measurements and indirect measurement by hybridization

This paper evaluates methods to measure crosslinkage due to psoralen plus light in total DNA and in specific sequences. DNA exposed in cells or in vitro to a bifunctional psoralen and near ultraviolet light accumulates interstrand crosslinks. Crosslinkage is the DNA mass fraction that is attached in both strands to a crosslink. We show here biochemical methods to measure psoralen photocrosslinkage accurately in total DNA. We also describe methods to measure photocrosslinkage indirectly, in specific sequences, by nucleic acid hybridization. We show that a single 4,5',8-trimethylpsoralen (TMP) crosslink causes at least 50 kbp of alkali-denatured DNA contiguous in both strands with it to snap back into the duplex form when the denatured preparation is returned to neutral pH. This process was so efficient that the DNA was not nicked by the single-strand nuclease S1 at 100-fold excess after snapping back. Uncrosslinked DNA was digested to acid-soluble material by the enzyme. Crosslinkage therefore equals the fraction of S1-resistant nucleotide in this kind of experiment. We alkali-denatured DNA samples crosslinked to varying degrees by varying TMP concentration at constant light exposure. We then measured crosslinkage by ethidium bromide (EtBr) fluorometry at pH 11.8; by EtBr fluorometry at neutral pH of S1 digests of the DNA; and by the fraction of radioactivity remaining acid insoluble in S1-digests of DNA labeled uniformly with [3H]deoxythymidine. These assays measure distinct physical properties of crosslinked DNA. Numerical agreement is expected only when all three measurements are accurate. Under optimum conditions, the three methods yielded identical results over the range of measurement. Using alkaline EtBr fluorescence in crude cell lysates, we detected crosslinks at frequencies in the range of 1.6 X 10(-7) per base pair. These levels were compatible with cell survival, attesting to the sensitivity of the measurement system. Crosslinkage affected hybridization as well. One crosslink prevented all alkali-denatured DNA contiguous in both strands with it from hybridizing to complementary DNA either on solid supports or in solution. Strand-length effects on crosslinkage and on reassociation caused solution hybridization levels to exceed those predicted by simple theory. In a quantitative, dot-blotting assay hybridization was linear up to membrane saturation by denatured, uncrosslinked DNA of any strand length.(ABSTRACT TRUNCATED AT 400 WORDS)     

A six-degree-of-freedom acoustic transducer for rotation and translation measurements across the knee

An acoustic transducer design to measure the relative translations and rotations across the knee with no mechanical coupling between the tibia and femur is presented. Platforms attached to femoral and tibial tracking fixtures hold acoustic sources and receivers, respectively. The distance from each source to each receiver is measured by the acoustic transit time and the translations and rotations across the knee joint are computed. For rotations less than 30 deg around the expected operating position, the resolution of the transducer is 0.3 deg; for translations less than 1.5 cm around the expected operating position, the resolution is 0.03 cm. Theoretical error analysis using a Monte Carlo method shows that the uncertainty in the measurement depends on the relative position of the sources and receivers. The analysis predicts the worst case resolution of the transducer as 0.09 cm in translation and 0.6 deg in rotation when the receiver platform is translated 8.0 cm parallel to the source platform. The transducer and fixturing system are demonstrated on a cadaver specimen for applied anterior force and applied internal-external rotation. Errors due to (soft tissue) motion of the transducer relative to the bone during in vivo measurements are assessed on the cadaver specimen. For internal-external rotation the error due to soft tissue motion is a maximum of 0.5 cm in translation and 1.8 deg in rotation. For applied anterior force the error due to soft tissue motion is a maximum of 0.16 cm in translation and 2.7 deg in rotation.     

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.     

Stress analysis of cemented glenoid prostheses in total shoulder arthroplasty

Glenoid component loosening is the most-frequently encountered problem in the total shoulder arthroplasty. The purpose of the study was to investigate whether failure of the glenoid component is caused by stresses generated within the cement mantle, implant materials and at the various interfaces during humeral abduction, using 3-D FE analyses of implanted glenoid structures. FE models, one total polyethylene and the other, metal backed polyethylene, were developed using CT-scan data and submodelling technique, which was based on an overall solution of a natural scapula model acted upon by all the muscles, ligaments and joint reaction forces. Material interfaces were assumed to be fully bonded. Based on the FE stress analysis, the following observations were made. (1) The submodelling technique, which required a large-size submodel and the use of prescribed displacements at cut-boundaries located far away from the glenoid, was crucial for evaluations on glenoid component. (2) Total polyethylene results in lower-peak stresses (tensile: 10 MPa, Von-Mises: 8.31 MPa) in the cement as compared to a metal-backed design (tensile: 11.5 MPa, Von-Mises: 9.81 MPa). The maximum principal (tensile) stresses generated in the cement mantle for both the designs were below its failure strength, but might evoke crack initiation. (3) The cement-bone interface adjacent to the tip of the keel seemed very likely to fail for both the designs. In case of metal-backed design, this interface adjacent to the tip of the keel appears even more likely to fail. (4) High metal-cement interface stresses for a moderate load might indicate failure at higher load. (5) It appears that both the designs were vulnerable to failure in some ways or the other. A part of the subchondral bone along the longitudinal axis of the glenoid cavity should be preserved to strengthen the glenoid structure and to reduce the use of cement.     

Surgical navigation for total knee arthroplasty: a perspective

A new generation of surgical tools, known as surgical navigation systems, has been developed to help surgeons install implants more accurately and reproducibly. Navigation systems also record quantitative information such as joint range of motion, laxity, and kinematics intra-operatively. This article reviews the history of surgical navigation for total knee arthroplasty, the biomechanical principles associated with this technology, and the related clinical research studies. We describe how navigation has the potential to address three main challenges for total knee arthroplasty: ensuring excellent and consistent outcomes, treating younger and more physically active patients, and enabling less invasive surgery.     

Accurate measurement of residual dipolar couplings in anisotropic phase

The determination of residual dipolar couplings (RDCs) by quantitative J spectroscopy methods such as Heteronuclear Single Quantum Correlation with Phase Encoded Coupling (HSQC-PEC) is prone to systematic errors that may be caused by differential attenuation during the conversion of orthogonal density operator components into observable terms. The attenuation may be caused by miscalibration of radio-frequency pulses and by relaxation effects. A simple method is presented that allows one to remove most of these systematic errors without losses in sensitivity or resolution.     

A mathematical model for the evaluation of the behaviour during flexion of condylar-type knee prostheses

A 3D knee model was developed in order to evaluate the mechanical behaviour during flexion of condylar-type knee prosthesis. Based on the total energy minimization principle, it takes into account the articular surfaces (the tibial surface being deformable), the body weight, and the patello femoral joint. It generates the kinematics of the joint, the motion of the centre of contact, the quadriceps forces, the pressure distribution on the tibial plateau, and ligament lengths and forces between 0 and 120 degrees of flexion. The results for ten digitized knees and the commercially available prostheses are presented. They are in general agreement with experimental results published in the literature. It is concluded that this computer program may be, within its limitations, a useful tool in the preliminary evaluation of new condylar-type knee prosthesis designs.     

A novel mechanism of actin filament processive capping by formin: solution of the rotation paradox

The FH2 domains of formin family proteins act as processive cappers of actin filaments. Previously suggested stair-stepping mechanisms of processive capping imply that a formin cap rotates persistently in one direction with respect to the filament. This challenges the formin-mediated mechanism of intracellular cable formation. We suggest a novel scenario of processive capping that is driven by developing and relaxing torsion elastic stresses. Based on the recently discovered crystal structure of an FH2-actin complex, we propose a second mode of processive capping-the screw mode. Within the screw mode, the formin dimer rotates with respect to the actin filament in the direction opposite to that generated by the stair-stepping mode so that a combination of the two modes prevents persistent torsion strain accumulation. We determine an optimal regime of processive capping, whose essence is a periodic switch between the stair-stepping and screw modes. In this regime, elastic energy does not exceed feasible values, and supercoiling of actin filaments is prevented.     

H nuclear magnetic resonance study of restricted internal rotation of N-6,N-6-dimethyladenine in aqueous solution.

Kinetics of internal rotation about the C(6)-N(6) bond of N-6,N-6-dimethyladenine (M2-6A) was investigated by -1H nuclear magnetic resonance line-shape analysis of the methyl resonances (220 MHz). Rates of rotation were determined for M2-6A deuterated at N(1) and for neutral M2-6A. Activation parameters for monodeuterated M2-6A at 22 degrees are Ea = 13.8kcal/mol, log A = 12.6, incrementG++=14.9 kcal/mol, incrementH++ = 13.1 kcal/mol, incrementS++ = minus 5.8 eu; for neutral M2-6A: Ea = 15.5 kcal/mol, log A = 14.9, incrementG++ = 12.6 kcal/mol, incrementH++ = 14.9 kcal/mol, incrementS++ =7.8 eu. Vertical stacking of bases interferes with internal rotation of the dimethylamino group.