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Research Papers

Fine Tuning Total Knee Replacement Contact Force Prediction Algorithms Using Blinded Model Validation

[+] Author and Article Information
Hannah J. Lundberg

Department of Orthopedic Surgery,
Rush University Medical Center,
1611 West Harrison,
Suite 201 Chicago, IL 60612
e-mail: Hannah_Lundberg@rush.edu

Christopher Knowlton

Department of Orthopedic Surgery,
Rush University Medical Center,
1611 West Harrison,
Suite 201 Chicago, IL 60612;
Department of Bioengineering,
University of Illinois at Chicago,
851 South Morgan Street,
218 SEO Chicago, IL 60607

Markus A. Wimmer

Department of Orthopedic Surgery,
Rush University Medical Center,
1611 West Harrison,
Suite 201 Chicago, IL 60612

1Corresponding author.

Contributed by the Bioengineering Division of ASME for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING. Manuscript received October 22, 2012; final manuscript received January 7, 2013; accepted manuscript posted January 18, 2013; published online February 7, 2013. Editor: Beth Winkelstein.

J Biomech Eng 135(2), 021015 (Feb 07, 2013) (9 pages) Paper No: BIO-12-1506; doi: 10.1115/1.4023388 History: Received October 22, 2012; Revised January 07, 2013; Accepted January 18, 2013

The purpose of this study was to perform a blinded comparison of model predictions of total knee replacement contact forces to in vivo forces from an instrumented prosthesis during normal walking and medial thrust gait by participating in the “Third Grand Challenge Competition to Predict in vivo Knee Loads.” We also evaluated model assumptions that were critical for accurate force predictions. Medial, lateral, and total axial forces through the knee were calculated using a previously developed and validated parametric numerical model. The model uses equilibrium equations between internal and external moments and forces to obtain knee joint contact forces and calculates a range of forces at instances during the gait cycle through parametric variation of muscle activity levels. For 100 instances during a normal over-ground gait cycle, model root mean square differences from eTibia data were 292, 248, and 281 for medial, lateral, and total contact forces, respectively. For 100 instances during a medial thrust gait cycle, model root mean square differences from eTibia data were 332, 234, and 470 for medial, lateral, and total contact forces, respectively. The percent difference between measured and predicted peak total axial force was 2.89% at the first peak and 9.36% at the second peak contact force for normal walking and 3.94% at the first peak and 14.86% at the second peak contact force for medial thrust gait. After unblinding, changes to model assumptions improved medial and lateral force predictions for both gait styles but did not improve total force predictions. Axial forces computed with the model compared well to the eTibia data under blinded and unblinded conditions. Knowledge of detailed knee kinematics, namely anterior-posterior translation, appears to be critical in obtaining accurate force predictions.

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References

Komistek, R. D., Kane, T. R., Mahfouz, M., Ochoa, J. A., and Dennis, D. A., 2005, “Knee Mechanics: A Review of Past and Present Techniques to Determine In Vivo Loads,” J. Biomech., 38(2) pp. 215–228. [CrossRef] [PubMed]
Fregly, B. J., Besier, T. F., Lloyd, D. G., Delp, S. L., Banks, S. A., Pandy, M. G., and D'Lima, D. D., 2012, “Grand Challenge Competition to Predict In Vivo Knee Loads,” J. Orthop. Res., 30(4), pp. 503–513. [CrossRef] [PubMed]
Paul, J. P., and McGrouther, D. A., 1975, “Forces Transmitted at the Hip and Knee Joint of Normal and Disabled Persons During a Range of Activities,” Acta Orthop. Belg., 41Suppl. 1(1), pp. 78–88. [PubMed]
Morrison, J. B., 1968, “Bioengineering Analysis of Force Actions Transmitted by the Knee Joint,” Biomed. Mater. Eng., 3, pp. 164–170.
Seireg, A., and Arvikar, R. J., 1975, “The Prediction of Muscular Lad Sharing and Joint Forces in the Lower Extremities During Walking,” J. Biomech., 8(2), pp. 89–102. [CrossRef] [PubMed]
D'Lima, D. D., Patil, S., Steklov, N., Slamin, J. E., and Colwell, Jr., C. W., 2005, “The Chitranjan Ranawat Award: In Vivo Knee Forces After Total Knee Arthroplasty,” Clin. Orthop. Relat. Res., 440, pp. 45–49. [CrossRef] [PubMed]
D'Lima, D. D., Patil, S., Steklov, N., Slamin, J. E., and Colwell, Jr., C. W., 2006, “Tibial Forces Measured In Vivo After Total Knee Arthroplasty,” J. Arthroplasty, 21(2), pp. 255–262. [CrossRef] [PubMed]
D'Lima, D. D., Patil, S., Steklov, N., Chien, S., and Colwell, Jr., C. W, 2007, “In Vivo Knee Moments and Shear After Total Knee Arthroplasty,” J. Biomech., 40(Suppl 1), pp. S11–S17. [CrossRef] [PubMed]
Zhao, D., Banks, S. A., D'Lima, D. D., Colwell, Jr., C. W., and Fregly, B. J., 2007, “In Vivo Medial and Lateral Tibial Loads During Dynamic and High Flexion Activities,” J. Orthop. Res., 25(5), pp. 593–602. [CrossRef] [PubMed]
D'Lima, D. D., Steklov, N., Patil, S., and Colwell, Jr., C. W, 2008, “The Mark Coventry Award: In Vivo Knee Forces During Recreation and Exercise After Knee Arthroplasty,” Clin. Orthop. Relat. Res., 466(11), pp. 2605–2611. [CrossRef] [PubMed]
Müendermann, A., Dyrby, C. O., D'Lima, D. D., Colwell, Jr., C. W., and Andriacchi, T. P., 2008, “In Vivo Knee Loading Characteristics During Activities of Daily Living as Measured by an Instrumented Total Knee Replacement,” J. Orthop. Res., 26(9), pp. 1167–1172. [CrossRef] [PubMed]
Heinlein, B., Graichen, F., Bender, A., Rohlmann, A., and Bergmann, G., 2007, “Design, Calibration and Pre-Clinical Testing of an Instrumented Tibial Tray,” J. Biomech., 40(Suppl 1), pp. S4–S10. [CrossRef] [PubMed]
Bergmann, G., 2008, “OrthoLoad,” Charite – Universitaetsmedizin Berlin, http://www.OrthoLoad.com
Kutzner, I., Heinlein, B.Graichen, F., Bender, A., Rohlmann, A., Halder, A., Beier, A., and Bergmann, G., 2010, “Loading of the Knee Joint During Activities of Daily Living Measured In Vivo in Five Subjects,” J. Biomech., 43(11), pp. 2164–2173. [CrossRef] [PubMed]
Lundberg, H. J., Foucher, K. C., and Wimmer, M. A., 2009, “A Parametric Approach to Numerical Modeling of TKR Contact Forces,” J. Biomech., 42(4), pp. 541–545. [CrossRef] [PubMed]
Hurwitz, D. E., Foucher, K. C., and Andriacchi, T. P., 2003, “A New Parametric Approach for Modeling Hip Forces During Gait,” J. Biomech., 36(1), pp. 113–119. [CrossRef] [PubMed]
Lundberg, H. J., Foucher, K. C., Andriacchi, T. P., and Wimmer, M. A., 2012, “Direct Comparison of Measured and Calculated Total Knee Replacement Force Envelopes During Walking in the Presence of Normal and Abnormal Gait Patterns,” J. Biomech., 45(6), pp. 990–996. [CrossRef] [PubMed]
Reinbolt, J. A., Schutte, J. F., Fregly, B. J., Koh, B. I., Haftka, R. T., George, A. D., and Mitchell, K. H., 2005, “Determination of Patient-Specific Multi-Joint Kinematic Models Through Two-Level Optimization,” J. Biomech., 38(3), pp. 621–626. [CrossRef] [PubMed]
Swanson, A. J., Ngai, V., Inoue, N., and Wimmer, M. A., 2007, “Analysis of the Tibio-Femoral Contact Point in Total Knee Replacement Using a Marker Based Motion Analysis System,” Proc. ASME, 2007 SBC, pp. 39–40.
Delp, S. L., Loan, J. P., Hoy, M. G., Zajac, F. E., Topp, E. L., and Rosen, J. M., 1990, “An Interactive Graphics-Based Model of the Lower Extremity to Study Orthopaedic Surgical Procedures,” IEEE Trans. Biomed. Eng., 37(8), pp. 757–767. [CrossRef] [PubMed]
Delp, S. L., Anderson, F. C., Arnold, A. S., Loan, P., Habib, A., John, C. T., Guendelman, E., and Thelen, D. G., 2007, “OpenSim: Open-Source Software to Create and Analyze Dynamic Simulations of Movement,” IEEE Trans. Biomed. Eng., 54(11), pp. 1940–1950. [CrossRef] [PubMed]
Lundberg, H. J., Ngai, V., and Wimmer, M. A., 2012, “Comparison of ISO Standard and TKR Patient Axial Force Profiles During the Stance Phase of Gait,” Proc. Inst. Mech. Eng. Part H J. Eng. Med., 226(3), pp. 227–234. [CrossRef]
Ngai, V., and Wimmer, M. A., 2009, “Kinematic Evaluation of Cruciate-Retaining Total Knee Replacement Patients During Level Walking: A Comparison With the Displacement-Controlled ISO Standard,” J. Biomech., 42(14), pp. 2363–2368. [CrossRef] [PubMed]
Ngai, V., Uth, T., Kunze, J., and Wimmer, M. A., 2011, “Backside Wear of Tibial Polyethylene Components Is Affected by Gait,” Trans. ORS, 36, p. 1142.
Wimmer, M. A., and Andriacchi, T. P., 1997, “Tractive Forces During Rolling Motion of the Knee: Implications for Wear in Total Knee Replacement,” J. Biomech., 30(2), pp. 131–137. [CrossRef] [PubMed]
Lundberg, H. J., Foucher, K. C., Ngai, V., Rojas, I., Swanson, A., and Wimmer, M. A., 2009, “The Influence of Kinematic Input Variability on Calculated Knee Joint Contact Forces,” Trans. ORS, 34, p. 1975.
Whelan, P., Wimmer, M. A., and Lundberg, H. J., 2012, “The Effect of Anatomical Variation on TKR Contact Forces During the Stance Phase of Gait,” Trans. ORS, 37, p. 1980.
Draganich, L. F., Andriacchi, T. P., and Andersson, G. B., 1987, “Interaction Between Intrinsic Knee Mechanics and the Knee Extensor Mechanism,” J. Orthop. Res., 5(4), pp. 539–547. [CrossRef] [PubMed]
Haas, B. D., Komistek, R. D., Stiehl, J. B., Anderson, D. T., and Northcut, E. J., 2002, “Kinematic Comparison of Posterior Cruciate Sacrifice Versus Substitution in a Mobile Bearing Total Knee Arthroplasty,” J. Arthroplasty, 17(6), pp. 685–692. [CrossRef] [PubMed]
Orozco, D. A., and Wimmer, M. A., 2011, “Development of a Multi-Activity Protocol for TKR Wear Assessment,” Trans. ORS, 36, p. 1109.
Stiehl, J. B., Komistek, R., and Dennis, D. A., 2001, “A Novel Approach to Knee Kinematics,” Am. J. Orthop., 30(4), pp. 287–293. [CrossRef] [PubMed]
Alexander, E. J., and Andriacchi, T. P., 2001, “Correcting for Deformation in Skin-Based Marker Systems,” J. Biomech., 34(3), pp. 355–361. [CrossRef] [PubMed]
Lundberg, H. J., and Wimmer, M. A., 2013, “Relative Antagonist Activity During Walking for TKR Patients and Asymptomatic Controls,” Trans. ORS, 38, p. 1679.
Halder, A., Kutzner, I., Graichen, F., Heinlein, B., Beier, A., and Bergmann, G., 2012, “Influence of Limb Alignment on Mediolateral Loading in Total Knee Replacement: In Vivo Measurements in Five Patients,” J. Bone Joint. Surg. Am., 94(11), pp. 1023–1029. [CrossRef] [PubMed]
Heinlein, B., Kutzner, I., Graichen, F., Bender, A., Rohlmann, A., Halder, A. M.,Beier, A., and Bergmann, G., 2009, “ESB Clinical Biomechanics Award 2008: Complete Data of Total Knee Replacement Loading for Level Walking and Stair Climbing Measured In Vivo With a Follow-Up of 6-10 Months,” Clin. Biomech., 24(4), pp. 315–326. [CrossRef]

Figures

Grahic Jump Location
Fig. 1

Gait kinematics and kinetics used as inputs to the parametric model were computed in MotionMonitor for normal and medial thrust gait. Solid lines show the data used in blinded model predictions. Dashed lines show the kinematics that were changed for unblinded model predictions: internal-external (I/E) rotation. and anterior-posterior (A/P) translation for normal gait, and A/P translation for medial thrust gait. Gray areas of the graph represent the swing phase. Note for blinded predictions of medial thrust gait, A/P translation was set to zero throughout the gait cycle. Units for external moments are in percent body weight times height (BW*Ht).

Grahic Jump Location
Fig. 2

Nine equilibrium equations used to solve for 9 unknowns. Fmedialx, Flateralx, Fmedialy, Flateraly, Fmedialz, and Flateralz are the unknown medial and lateral tibial plateau contact force components. A, B, and C are the unknown muscle group activation levels. D is the activation of passive structures (0 or 1). E is the antagonist activation level. Mexternalx, Mexternaly, and Mexternalz are the external knee joint moments, and Fexternalx, Fexternaly, and Fexternalz are the external knee joint forces. Mix, Miy, and Miz are the maximum physiological muscle moments, and Fix, Fiy, and Fiz are the maximum physiological muscle forces. ai, bi, and ci are the parametrically varied relative muscle activation levels. mamedx, malatx, mamedy, malaty, mamedz, malatz define the location of the contact point from the center of the medial (med) and lateral (lat) tibial plateau. ml_ratio is the ratio of medial to total contact force through the knee. x, y, and z: point laterally, anteriorly, and superiorly, respectively, from the center of the surface of the tibial plateau. Note that in the coordinate system a right-hand rule is used for a right knee and a left-hand rule is used for a left knee where y points in the direction of walking.

Grahic Jump Location
Fig. 3

Original blinded model predictions of axial force in the medial (dark diamonds) and lateral (light triangles) compartments of the knee compared to the regressed eTibia medial (dark line) and lateral (light line) axial forces for the normal walking and medial thrust gait competition trials. Note different y-axis scales.

Grahic Jump Location
Fig. 4

Unblinded model predictions of axial force in the medial (dark diamonds) and lateral (light triangles) compartments of the knee compared to the regressed eTibia medial (dark line) and lateral (light line) axial forces for five normal walking trials and five medial thrust gait trials. Note different y-axis scales for each gait style.

Grahic Jump Location
Fig. 5

Unblinded model mean predictions (dots) and solution spaces (shaded area) of total axial force compared to the total axial force from eTibia data (line) for five normal walking trials and five medial thrust gait trials. Note different y-axis limits for each gait style.

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