Determinants of pivot kinematics in posterior stabilized total knee arthroplasty.

BACKGROUND: Restoring medial knee pivot kinematics post-total knee arthroplasty is widely recognized to enhance patient satisfaction. Our study investigates the kinematics of patients who received posterior stabilized implants via robotic-arm assisted surgery, specifically analyzing effects of implant alignment and soft tissue balance on pivot location. METHODS: Twelve high-functioning patients with unilateral posterior stabilizing knee implants underwent CT-guided robotic-arm assisted surgery. We then evaluated their knee kinematics using stereo radiography during gait, stair descent, lunge, seated knee extension and leg press. Femoral low-point condylar kinematics were used to calculate the transverse center of rotation, or pivot, using principal component analysis. Linear mixed effects regression was used to identify surgical parameters that influence pivot location across a flexion range. FINDINGS: Across all five activities a central pivot pattern emerged as the primary pivot location (40 %) followed by medial (25 %), no pivot (22 %) and lateral (14 %). Tibial medial resection depth and Tibial implant flexion-extension placement were significantly associated with shifting the pivot location laterally prior to cam-post engagement. Femoral implant external-internal implant placement, and medial compartment laxity in extension were significantly associated with shifting the pivot location laterally during the cam-post engagement, while femoral distal-lateral resection depth was associated with a medial shift. INTERPRETATION: Central and medial pivot locations are predominant in patients with posterior stabilized total knee arthroplasty, facilitated by robotic-arm assisted surgery. Despite significant associations between surgical parameters such as tibial medial resection depth and lateral compartment laxity with medial pivot, these variables explained a small portion of the variability in pivot location. This suggests that while surgical precision influences pivot kinematics, individual patient factors may play a more critical role, suggesting a need for further research into patient-specific biomechanics to optimize post-surgical outcomes.

Reproducibility in modeling and simulation of the knee: Academic, industry, and regulatory perspectives.

Stakeholders in the modeling and simulation (M&S) community organized a workshop at the 2019 Annual Meeting of the Orthopaedic Research Society (ORS) entitled "Reproducibility in Modeling and Simulation of the Knee: Academic, Industry, and Regulatory Perspectives." The goal was to discuss efforts among these stakeholders to address irreproducibility in M&S focusing on the knee joint. An academic representative from a leading orthopedic hospital in the United States described a multi-institutional, open effort funded by the National Institutes of Health to assess model reproducibility in computational knee biomechanics. A regulatory representative from the United States Food and Drug Administration indicated the necessity of standards for reproducibility to increase utility of M&S in the regulatory setting. An industry representative from a major orthopedic implant company emphasized improving reproducibility by addressing indeterminacy in personalized modeling through sensitivity analyses, thereby enhancing preclinical evaluation of joint replacement technology. Thought leaders in the M&S community stressed the importance of data sharing to minimize duplication of efforts. A survey comprised 103 attendees revealed strong support for the workshop and for increasing emphasis on computational modeling at future ORS meetings. Nearly all survey respondents (97%) considered reproducibility to be an important issue. Almost half of respondents (45%) tried and failed to reproduce the work of others. Two-thirds of respondents (67%) declared that individual laboratories are most responsible for ensuring reproducible research whereas 44% thought that journals are most responsible. Thought leaders and survey respondents emphasized that computational models must be reproducible and credible to advance knee M&S.

Anisotropic mode-dependent damage of cortical bone using the extended finite element method (XFEM).

Anisotropic damage initiation criteria were developed for extended finite element method (XFEM) prediction of crack initiation and propagation in cortical bone. This anisotropic damage model was shown to accurately predict the dependence of crack propagation patterns and fracture toughness on mode mixity and on osteon orientations, as observed experimentally. Four initiation criteria were developed to define crack trajectories relative to osteon orientations and max principal stress for single and mixed mode fracture. Alternate failure strengths for tensile and compressive loading were defined to simulate the asymmetric failure of cortical bone. The dependence of cortical bone elasticity and failure properties on osteon orientation is analogous to the dependence of composite properties on fibre orientation. Hence, three of the criteria developed in the present study were based upon the Hashin damage criteria. The fourth criterion developed was defined in terms of the max principal stress. This criterion initiated off axis crack growth perpendicular to the direction of the max principal stress. The unique set of parameters calibrated accurately predicted; (i) the relationship between fracture energy and osteon alignment, (ii) the alternate crack patterns for both varying osteon orientations and loading angle. Application of the developed anisotropic damage models to cortical bone screw pullout highlights the potential application for orthopaedic device design evaluation.