Statistical Modeling of Lower Limb Kinetics During Deep Squat and Forward Lunge.

PURPOSE: Modern statistics and higher computational power have opened novel possibilities to complex data analysis. While gait has been the utmost described motion in quantitative human motion analysis, descriptions of more challenging movements like the squat or lunge are currently lacking in the literature. The hip and knee joints are exposed to high forces and cause high morbidity and costs. Pre-surgical kinetic data acquisition on a patient-specific anatomy is also scarce in the literature. Studying the normal inter-patient kinetic variability may lead to other comparable studies to initiate more personalized therapies within the orthopedics. METHODS: Trials are performed by 50 healthy young males who were not overweight and approximately of the same age and activity level. Spatial marker trajectories and ground reaction force registrations are imported into the Anybody Modeling System based on subject-specific geometry and the state-of-the-art TLEM 2.0 dataset. Hip and knee joint reaction forces were obtained by a simulation with an inverse dynamics approach. With these forces, a statistical model that accounts for inter-subject variability was created. For this, we applied a principal component analysis in order to enable variance decomposition. This way, noise can be rejected and we still contemplate all waveform data, instead of using deduced spatiotemporal parameters like peak flexion or stride length as done in many gait analyses. In addition, this current paper is, to the authors' knowledge, the first to investigate the generalization of a kinetic model data toward the population. RESULTS: Average knee reaction forces range up to 7.16 times body weight for the forwarded leg during lunge. Conversely, during squat, the load is evenly distributed. For both motions, a reliable and compact statistical model was created. In the lunge model, the first 12 modes accounts for 95.26% of inter-individual population variance. For the maximal-depth squat, this was 95.69% for the first 14 modes. Model accuracies will increase when including more principal components. CONCLUSION: Our model design was proved to be compact, accurate, and reliable. For models aimed at populations covering descriptive studies, the sample size must be at least 50.

Computer simulating a clinical trial of a load-bearing implant: an example of an intramedullary prosthesis.

Computational modelling is becoming ever more important for obtaining regulatory approval for new medical devices. An accepted approach is to infer performance in a population from an analysis conducted for an idealised or 'average' patient; we present here a method for predicting the performance of an orthopaedic implant when released into a population--effectively simulating a clinical trial. Specifically we hypothesise that an analysis based on a method for predicting the performance in a population will lead to different conclusions than an analysis based on an idealised or 'average' patient. To test this hypothesis we use a finite element model of an intramedullary implant in a bone whose size and remodelling activity is different for each individual in the population. We compare the performance of a low Young's modulus implant (E=20 GPa) to one with a higher Young's modulus (200 GPa). Cyclic loading is applied and failure is assumed when the migration of the implant relative to the bone exceeds a threshold magnitude. The analysis for an idealised of 'average' patient predicts that the lower modulus device survives longer whereas the analysis simulating a clinical trial predicts no statistically-significant tendency (p=0.77) for the low modulus device to perform better. It is concluded that population-based simulations of implant performance-simulating a clinical trial-present a very valuable opportunity for more realistic computational pre-clinical testing of medical devices.

A method to reconstruct patient-specific proximal femur surface models from planar pre-operative radiographs.

Three-dimensional reconstruction from volumetric medical images (e.g. CT, MRI) is a well-established technology used in patient-specific modelling. However, there are many cases where only 2D (planar) images may be available, e.g. if radiation dose must be limited or if retrospective data is being used from periods when 3D data was not available. This study aims to address such cases by proposing an automated method to create 3D surface models from planar radiographs. The method consists of (i) contour extraction from the radiograph using an Active Contour (Snake) algorithm, (ii) selection of a closest matching 3D model from a library of generic models, and (iii) warping the selected generic model to improve correlation with the extracted contour. This method proved to be fully automated, rapid and robust on a given set of radiographs. Measured mean surface distance error values were low when comparing models reconstructed from matching pairs of CT scans and planar X-rays (2.57-3.74mm) and within ranges of similar studies. Benefits of the method are that it requires a single radiographic image to perform the surface reconstruction task and it is fully automated. Mechanical simulations of loaded bone with different levels of reconstruction accuracy showed that an error in predicted strain fields grows proportionally to the error level in geometric precision. In conclusion, models generated by the proposed technique are deemed acceptable to perform realistic patient-specific simulations when 3D data sources are unavailable.