Abstract
Background
Detailed information about the loading of the knee joint is required for various investigations
in total knee replacement. Up to now, gait analysis plus analytical musculo-skeletal
models were used to calculate the forces and moments acting in the knee joint. Currently,
all experimental and numerical pre-clinical tests rely on these indirect measurements
which have limitations. The validation of these methods requires in vivo data; therefore, the purpose of this study was to provide in vivo loading data of the knee joint.
Methods
A custom-made telemetric tibial tray was used to measure the three forces and three
moments acting in the implant. This prosthesis was implanted into two subjects and
measurements were obtained for a follow-up of 6 and 10 months, respectively.
Subjects performed level walking and going up and down stairs using a self-selected
comfortable speed. The subjects’ activities were captured simultaneously with the
load data on a digital video tape. Customized software enabled the display of all
information in one video sequence.
Findings
The highest mean values of the peak load components from the two subjects were as
follows: during level walking the forces were 276 %BW (percent body weight) in axial direction, 21 %BW (medio-lateral), and 29 %BW (antero-posterior). The moments were 1.8 %BW*m in the sagittal plane, 4.3 %BW*m (frontal plane) and 1.0 %BW*m (transversal plane). During stair climbing the axial force increased to 306 %BW, while the shear forces changed only slightly. The sagittal plane moment increased
to 2.4 %BW*m, while the frontal and transversal plane moments decreased slightly. Stair descending
produced the highest forces of 352 %BW (axial), 35 %BW (medio-lateral), and 36 %BW (antero-posterior). The sagittal and frontal plane moments increased to 2.8 %BW*m and 4.6 %BW*m, respectively, while the transversal plane moment changed only slightly.
Interpretation
Using the data obtained, mechanical simulators can be programmed according to realistic
load profiles. Furthermore, musculo-skeletal models can be validated, which until
now often lacked the ability to predict properly the non-sagittal load values, e.g.
varus–valgus and internal–external moments.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical BiomechanicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The functional flexion–extension axis of the knee corresponds to the surgical epicondylar axis: in vivo analysis using a biplanar image-matching technique.J. Arthroplasty. 2005; 20: 1060-1067
- A three-dimensional dynamic finite element model of the prosthetic knee joint: simulation of joint laxity and kinematics.Proc. Inst. Mech. Eng. [H]. 2005; 219: 415-424
- Soft tissue balance in total knee arthroplasty: does stress relaxation occur perioperatively?.Clin. Orthop. Relat. Res. 2006; 452: 49-52
Benson, L.C., LaBerge, M., Pace, T.B., 2003, Knee joint loading patterns during activities of daily living in TKR patients. In: Proceedings of IMEC’03, 2003 ASME International Mechanical Engineering Congress, Washington, DC.
- In vivo measurement of hip joint stress.1. Physical therapy.Z. Orthop. Ihre. Grenzgeb. 1989; 127: 672-679
- Design and calibration of load sensing orthopaedic implants.J. Biomech. Eng. 2008; 130: 021009
- Knee and hip kinetics during normal stair climbing.Gait Posture. 2002; 16: 31-37
- Development of a force amplitude- and location-sensing device designed to improve the ligament balancing procedure in TKA.IEEE Trans. Biomed. Eng. 2005; 52: 1609-1611
- Ligament balancing in TKA: evaluation of a force-sensing device and the influence of patellar eversion and ligament release.J. Biomech. 2007; 40: 1709-1715
- The Chitranjan Ranawat award: in vivo knee forces after total knee arthroplasty.Clin. Orthop. Relat. Res. 2005; 440: 45-49
- Tibial forces measured in vivo after total knee arthroplasty.J. Arthroplasty. 2006; 21: 255-262
- In vivo knee moments and shear after total knee arthroplasty.J. Biomech. 2007;
- The Mark Coventry award: in vivo knee forces during recreation and exercise after knee arthroplasty.Clin. Orthop. Relat. Res. 2008;
- Implantable 9-channel telemetry system for in vivo load measurements with orthopedic implants.IEEE Trans. Biomed. Eng. 2007; 54: 253-261
- Accuracy considerations for an instrumented tibial baseplate.J. Biomech. 2006; 39: S137
Heinlein, B., Rohlmann, A., Graichen, F., Bergmann, G., 2006b. Accuracy of an instrumented total knee arthroplasty for six-component in vivo load measurements. In: Transactions of the 52rd Annual Meeting of the Orthopedic Research Society, Chicago, IL.
- Design, calibration and pre-clinical testing of an instrumented tibial tray.J. Biomech. 2007; 40: S4-S10
ISO14243, 2002. ISO 14243: Implants for surgery – wear of total knee joint prostheses – Part 1: loading and displacement parameters for wear-testing machines with load control and corresponding environmental conditions for test.
- The variation in medial and lateral collateral ligament strain and tibiofemoral forces following changes in the flexion and extension gaps in total knee replacement. A laboratory experiment using cadaver knees.J. Bone Joint Surg. Br. 2007; 89: 1528-1533
- Instrumented implant for measuring tibiofemoral forces.J. Biomech. 1996; 29: 667-671
- In vivo measurement of total knee replacement wear.Knee. 2004; 11: 183-187
- Comparison of long-term numerical and experimental total knee replacement wear during simulated gait loading.J. Biomech. 2007; 40: 1550-1558
- Joint load considerations in total knee replacement.J. Bone Joint Surg. Br. 1997; 79: 109-113
- The mechanics of the knee joint in relation to normal walking.J. Biomech. 1970; 3: 51-61
- In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement.J. Orthop. Res. 2008;
- Simulated normal gait wear testing of a highly cross-linked polyethylene tibial insert.J. Arthroplasty. 2007; 22: 435-444
- Mechanical loads at the knee joint during deep flexion.J. Orthop. Res. 2002; 20: 881-886
- Tibiofemoral force following total knee arthroplasty: comparison of four prosthesis designs in vitro.J. Orthop. Res. 2007; 25: 1506-1512
- Hip, knee, ankle kinematics and kinetics during stair ascent and descent in healthy young individuals.Clin. Biomech. 2007; 22: 203-210
- The prediction of muscular load sharing and joint forces in the lower extremities during walking.J. Biomech. 1975; 8: 89-102
- Insall award paper. Why are total knee arthroplasties failing today?.Clin. Orthop. Relat. Res. 2002; 52: 7-13
- A six-degree-of-freedom transducer for in vitro measurement of patellofemoral contact forces.J. Biomech. 1994; 27: 233-238
- In vitro forces in the normal and cruciate-deficient knee during simulated squatting motion.J. Biomech. Eng. 1999; 121: 234-242
- The forces in the distal femur and the knee during walking and other activities measured by telemetry.J. Arthroplasty. 1998; 13: 428-437
- Tibio-femoral loading during human gait and stair climbing.J. Orthop. Res. 2004; 22: 625-632
- Reduction of wear volume from ultrahigh molecular weight polyethylene knee components by the addition of vitamin E.J. Orthop. Res. 2007;
- Helical axes of skeletal knee joint motion during running.J. Biomech. 2008; 41: 1632-1638
- In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities.J. Biomech. 2008;
- The Chitranjan Ranawat award: long term survivorship and failure modes of 1000 cemented condylar total knee arthroplasties.Clin. Orthop. Relat. Res. 2006;
- Methodology for long-term wear testing of total knee replacements.Clin. Orthop. Relat. Res. 2000; : 290-301
Article info
Publication history
Published online: March 16, 2009
Accepted:
January 27,
2009
Received:
October 7,
2008
Identification
Copyright
© 2009 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
