Musculoskeletal multibody dynamics investigation of posterior-stabilized total knee prosthesis_Journal of Biomedical Engineering

Authors：

CHEN Zhenxian ¹ ,  ZHANG Zhifeng ² , GAO Yongchang ¹ , ZHANG Jing ¹ , GUO Lei ¹ , JIN Zhongmin ³

1. School of Construction Machinery, Chang'an University, Xi’an 710064, P. R. China;
2. Department of Arthroplasty Surgery, the Second Aﬃliated Hospital of Inner Mongolia Medical University, Hohhot 010030, P. R. China;
3. School of Mechanical Engineering, Southwest Jiaotong University, Chengdu 610031, P. R. China;

Corresponding author：

ZHANG Zhifeng, Email: longxianglvzhe@163.com

Keywords：

Total knee arthroplasty; Posterior-stabilized total knee prosthesis; Post-cam mechanism; Musculoskeletal multibody dynamics; Contact force; Joint motion

DOI：

10.7507/1001-5515.202203023

Video：

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Posterior-stabilized total knee prostheses have been widely used in orthopedic clinical treatment of knee osteoarthritis, but the patients and surgeons are still troubled by the complications, for example severe wear and fracture of the post, as well as prosthetic loosening. Understanding the in vivo biomechanics of knee prostheses will aid in the decrease of postoperative prosthetic revision and patient dissatisfaction. Therefore, six different designs of posterior-stabilized total knee prostheses were used to establish the musculoskeletal multibody dynamics models of total knee arthroplasty respectively, and the biomechanical differences of six posterior-stabilized total knee prostheses were investigated under three simulated physiological activities: walking, right turn and squatting. The results showed that the post contact forces of PFC Sigma and Scorpio NGR prostheses were larger during walking, turning right, and squatting, which may increase the risk of the fracture and wear as well as the early loosening. The post design of Gemini SL prosthesis was more conductive to the knee internal-external rotation and avoided the edge contact and wear. The lower conformity design in sagittal plane and the later post-cam engagement resulted in the larger anterior-posterior translation. This study provides a theoretical support for guiding surgeon selection, improving posterior-stabilized prosthetic design and reducing the prosthetic failure.

Citation： CHEN Zhenxian, ZHANG Zhifeng, GAO Yongchang, ZHANG Jing, GUO Lei, JIN Zhongmin. Musculoskeletal multibody dynamics investigation of posterior-stabilized total knee prosthesis. Journal of Biomedical Engineering, 2022, 39(4): 651-659. doi: 10.7507/1001-5515.202203023 Copy

1.	Heckmann N D, Steck T, Sporer S M, et al. Conforming polyethylene inserts in total knee arthroplasty: beyond the posterior-stabilized and cruciate-retaining debate. J Am Acad Orthop Surg, 2021, 29(22): 1097-1104.
2.	Fitzpatrick C K, Clary C W, Cyr A J, et al. Mechanics of post-cam engagement during simulated dynamic activity. J Orthop Res, 2013, 31(9): 1438-1446.
3.	Arnout N, Vanlommel L, Vanlommel J, et al. Post-cam mechanics and tibiofemoral kinematics: a dynamic in vitro analysis of eight posterior-stabilized total knee designs. Knee Surg Sports Traumatol Arthrosc, 2015, 23(11): 3343-3353.
4.	Bourdon C E, Broberg J S, McCalden R W, et al. Comparison of long-term kinematics and wear of total knee arthroplasty implant designs. J Mech Behav Biomed Mater, 2021, 124(104845): 1-7.
5.	Verra W C, van den Boom L G H, Jacobs W C H, et al. Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty. Acta Orthop, 2015, 86(2): 195-201.
6.	Watanabe T, Koga H, Horie M, et al. Post-cam design and contact stress on tibial posts in posterior-stabilized total knee prostheses: comparison between a rounded and a squared design. J Arthroplasty, 2017, 32(12): 3757-3762.
7.	Lachiewicz P F. How to treat a tibial post fracture in total knee arthroplasty? A systematic review. Clin Orthop Relat Res, 2011, 469(6): 1709-1715.
8.	Gray H A, Guan S, Young T J, et al. Comparison of posterior-stabilized, cruciate-retaining, and medial-stabilized knee implant motion during gait. J Orthop Res, 2020, 38(8): 1753-1768.
9.	Abdel M P, Morrey M E, Jensen M R, et al. Increased long-term survival of posterior cruciate-retaining versus posterior cruciate-stabilizing total knee replacements. J Bone Joint Surg Am, 2011, 93(22): 2072-2078.
10.	Vertullo C J, Lewis P L, Lorimer M, et al. The effect on long-term survivorship of surgeon preference for posterior-stabilized or minimally stabilized total knee replacement: an analysis of 63,416 prostheses from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am, 2017, 99(13): 1129-1139.
11.	Belvedere C, Leardini A, Catani F, et al. In vivo kinematics of knee replacement during daily living activities: condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses. J Orthop Res, 2017, 35(7): 1396-1403.
12.	Watanabe T, Muneta T, Koga H, et al. In-vivo kinematics of high-flex posterior-stabilized total knee prosthesis designed for Asian populations. Int Orthop, 2016, 40(11): 2295-2302.
13.	Fallahiarezoodar A, Abdul Kadir M R, Alizadeh M, et al. Geometric variable designs of cam/post mechanisms influence the kinematics of knee implants. Knee Surg Sports Traumatol Arthrosc, 2014, 22(12): 3019-3027.
14.	Tsumori Y, Yoshiya S, Kurosaka M, et al. Analysis of weight-bearing kinematics of posterior-stabilized total knee arthroplasty with novel helical post-cam design. J Arthroplasty, 2011, 26(8): 1556-1561.
15.	Kim M S, Kim J H, Koh I J, et al. Is high-flexion total knee arthroplasty a valid concept? Bilateral comparison with standard total knee arthroplasty. J Arthroplasty, 2016, 31(4): 802-808.
16.	Shimizu N, Tomita T, Yamazaki T, et al. The effect of weight-bearing condition on kinematics of a high-flexion, posterior-stabilized knee prosthesis. J Arthroplasty, 2011, 26(7): 1031-1037.
17.	石小军, 林江莉, 沈彬, 等. 固定平台后稳定型假体全膝关节置换术后的运动学研究. 中华骨科杂志, 2013, 33(3): 259-265.
18.	Huang C H, Liau J J, Huang C H, et al. Influence of post-cam design on stresses on posterior-stabilized tibial posts. Clin Orthop Relat Res, 2006, 450: 150-156.
19.	郭建峤, 王言冰, 田强, 等. 人体骨肌的多柔体系统动力学研究进展. 力学进展, 2022, 52: 1.
20.	Shetty G, Khairkar S. Loading on Attune® fixed-bearing cruciate-substituting total knee implant in knee malalignment during activities of daily living: a finite element analysis. J Orthop, 2021, 26: 36-41.
21.	Mizu-Uchi H, Colwell C W, Flores-Hernandez C, et al. Patient-specific computer model of dynamic squatting after total knee arthroplasty. J Arthroplasty, 2015, 30(5): 870-874.
22.	Smith C R, Vignos M F, Lenhart R L, et al. The influence of component alignment and ligament properties on tibiofemoral contact forces in total knee replacement. J Biomech Eng, 2016, 138(2): 021017.
23.	Kia M, Stylianou A P, Guess T M. Evaluation of a musculoskeletal model with prosthetic knee through six experimental gait trials. Med Eng Phys, 2014, 36(3): 335-344.
24.	Kebbach M, Darowski M, Krueger S, et al. Musculoskeletal multibody simulation analysis on the impact of patellar component design and positioning on joint dynamics after unconstrained total knee arthroplasty. Materials (Basel), 2020, 13(10): 2365.
25.	Marra M A, Vanheule V, Fluit R, et al. A subject-specific musculoskeletal modeling framework to predict in vivo mechanics of total knee arthroplasty. J Biomech Eng, 2015, 137(2): 020904.
26.	Chen Z, Zhang Z, Wang L, et al. Evaluation of a subject-specific musculoskeletal modelling framework for load prediction in total knee arthroplasty. Med Eng Phys, 2016, 38(8): 708-716.
27.	李宏伟, 刘峰. 个体化全膝关节置换骨肌多体动力学模型的适用性评估. 机械设计与制造工程, 2021, 50(5): 6-10.
28.	崔伟玲, 陈维毅, 王长江, 等. 基于nmsBuilder和OpenSim建立个性化骨肌模型及其验证. 医用生物力学, 2019, 34(6): 608-614.
29.	刘佳耕, 闫松华, 曾纪洲, 等. 全膝关节置换前后患者下肢骨肌模型步态模拟与分析. 医用生物力学, 2020, 35(3): 347-355.
30.	Horsman K, Koopman H, Van der Helm F, et al. Morphological muscle and joint parameters for musculoskeletal modelling of the lower extremity. Clin Biomech, 2007, 22(2): 239-247.
31.	Ali N, Andersen M S, Rasmussen J, et al. The application of musculoskeletal modeling to investigate gender bias in non-contact ACL injury rate during single-leg landings. Comput Methods Biomech Biomed Engin, 2014, 17(14): 1602-1616.
32.	Holmberg L J, Klarbring A. Muscle decomposition and recruitment criteria influence muscle force estimates. Multibody Syst Dyn, 2012, 28(3): 283-289.
33.	Chen Z, Zhang X, Ardestani M M, et al. Prediction of in vivo joint mechanics of an artificial knee implant using rigid multi-body dynamics with elastic contacts. Proc Inst Mech Eng H, 2014, 228(6): 564-575.
34.	Blankevoort L, Kuiper J, Huiskes R, et al. Articular contact in a three-dimensional model of the knee. J Biomech, 1991, 24(11): 1019-1031.
35.	Akasaki Y, Matsuda S, Shimoto T, et al. Contact stress analysis of the conforming post-cam mechanism in posterior-stabilized total knee arthroplasty. J Arthroplasty, 2008, 23(5): 736-743.
36.	Koh Y G, Son J, Kwon O R, et al. Tibiofemoral conformity variation offers changed kinematics and wear performance of customized posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1213-1223.
37.	Lin K-J, Huang C-H, Liu Y-L, et al. Influence of post-cam design of posterior stabilized knee prosthesis on tibiofemoral motion during high knee flexion. Clin Biomech, 2011, 26(8): 847-852.
38.	Hamai S, Okazaki K, Shimoto T, et al. Continuous sagittal radiological evaluation of stair-climbing in cruciate-retaining and posterior-stabilized total knee arthroplasties using image-matching techniques. J Arthroplasty, 2015, 30(5): 864-869.
39.	Schutz P, Postolka B, Gerber H, et al. Knee implant kinematics are task-dependent. J R Soc Interface, 2019, 16(151): 20180678.

1. Heckmann N D, Steck T, Sporer S M, et al. Conforming polyethylene inserts in total knee arthroplasty: beyond the posterior-stabilized and cruciate-retaining debate. J Am Acad Orthop Surg, 2021, 29(22): 1097-1104.
2. Fitzpatrick C K, Clary C W, Cyr A J, et al. Mechanics of post-cam engagement during simulated dynamic activity. J Orthop Res, 2013, 31(9): 1438-1446.
3. Arnout N, Vanlommel L, Vanlommel J, et al. Post-cam mechanics and tibiofemoral kinematics: a dynamic in vitro analysis of eight posterior-stabilized total knee designs. Knee Surg Sports Traumatol Arthrosc, 2015, 23(11): 3343-3353.
4. Bourdon C E, Broberg J S, McCalden R W, et al. Comparison of long-term kinematics and wear of total knee arthroplasty implant designs. J Mech Behav Biomed Mater, 2021, 124(104845): 1-7.
5. Verra W C, van den Boom L G H, Jacobs W C H, et al. Similar outcome after retention or sacrifice of the posterior cruciate ligament in total knee arthroplasty. Acta Orthop, 2015, 86(2): 195-201.
6. Watanabe T, Koga H, Horie M, et al. Post-cam design and contact stress on tibial posts in posterior-stabilized total knee prostheses: comparison between a rounded and a squared design. J Arthroplasty, 2017, 32(12): 3757-3762.
7. Lachiewicz P F. How to treat a tibial post fracture in total knee arthroplasty? A systematic review. Clin Orthop Relat Res, 2011, 469(6): 1709-1715.
8. Gray H A, Guan S, Young T J, et al. Comparison of posterior-stabilized, cruciate-retaining, and medial-stabilized knee implant motion during gait. J Orthop Res, 2020, 38(8): 1753-1768.
9. Abdel M P, Morrey M E, Jensen M R, et al. Increased long-term survival of posterior cruciate-retaining versus posterior cruciate-stabilizing total knee replacements. J Bone Joint Surg Am, 2011, 93(22): 2072-2078.
10. Vertullo C J, Lewis P L, Lorimer M, et al. The effect on long-term survivorship of surgeon preference for posterior-stabilized or minimally stabilized total knee replacement: an analysis of 63,416 prostheses from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am, 2017, 99(13): 1129-1139.
11. Belvedere C, Leardini A, Catani F, et al. In vivo kinematics of knee replacement during daily living activities: condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses. J Orthop Res, 2017, 35(7): 1396-1403.
12. Watanabe T, Muneta T, Koga H, et al. In-vivo kinematics of high-flex posterior-stabilized total knee prosthesis designed for Asian populations. Int Orthop, 2016, 40(11): 2295-2302.
13. Fallahiarezoodar A, Abdul Kadir M R, Alizadeh M, et al. Geometric variable designs of cam/post mechanisms influence the kinematics of knee implants. Knee Surg Sports Traumatol Arthrosc, 2014, 22(12): 3019-3027.
14. Tsumori Y, Yoshiya S, Kurosaka M, et al. Analysis of weight-bearing kinematics of posterior-stabilized total knee arthroplasty with novel helical post-cam design. J Arthroplasty, 2011, 26(8): 1556-1561.
15. Kim M S, Kim J H, Koh I J, et al. Is high-flexion total knee arthroplasty a valid concept? Bilateral comparison with standard total knee arthroplasty. J Arthroplasty, 2016, 31(4): 802-808.
16. Shimizu N, Tomita T, Yamazaki T, et al. The effect of weight-bearing condition on kinematics of a high-flexion, posterior-stabilized knee prosthesis. J Arthroplasty, 2011, 26(7): 1031-1037.
17. 石小军, 林江莉, 沈彬, 等. 固定平台后稳定型假体全膝关节置换术后的运动学研究. 中华骨科杂志, 2013, 33(3): 259-265.
18. Huang C H, Liau J J, Huang C H, et al. Influence of post-cam design on stresses on posterior-stabilized tibial posts. Clin Orthop Relat Res, 2006, 450: 150-156.
19. 郭建峤, 王言冰, 田强, 等. 人体骨肌的多柔体系统动力学研究进展. 力学进展, 2022, 52: 1.
20. Shetty G, Khairkar S. Loading on Attune® fixed-bearing cruciate-substituting total knee implant in knee malalignment during activities of daily living: a finite element analysis. J Orthop, 2021, 26: 36-41.
21. Mizu-Uchi H, Colwell C W, Flores-Hernandez C, et al. Patient-specific computer model of dynamic squatting after total knee arthroplasty. J Arthroplasty, 2015, 30(5): 870-874.
22. Smith C R, Vignos M F, Lenhart R L, et al. The influence of component alignment and ligament properties on tibiofemoral contact forces in total knee replacement. J Biomech Eng, 2016, 138(2): 021017.
23. Kia M, Stylianou A P, Guess T M. Evaluation of a musculoskeletal model with prosthetic knee through six experimental gait trials. Med Eng Phys, 2014, 36(3): 335-344.
24. Kebbach M, Darowski M, Krueger S, et al. Musculoskeletal multibody simulation analysis on the impact of patellar component design and positioning on joint dynamics after unconstrained total knee arthroplasty. Materials (Basel), 2020, 13(10): 2365.
25. Marra M A, Vanheule V, Fluit R, et al. A subject-specific musculoskeletal modeling framework to predict in vivo mechanics of total knee arthroplasty. J Biomech Eng, 2015, 137(2): 020904.
26. Chen Z, Zhang Z, Wang L, et al. Evaluation of a subject-specific musculoskeletal modelling framework for load prediction in total knee arthroplasty. Med Eng Phys, 2016, 38(8): 708-716.
27. 李宏伟, 刘峰. 个体化全膝关节置换骨肌多体动力学模型的适用性评估. 机械设计与制造工程, 2021, 50(5): 6-10.
28. 崔伟玲, 陈维毅, 王长江, 等. 基于nmsBuilder和OpenSim建立个性化骨肌模型及其验证. 医用生物力学, 2019, 34(6): 608-614.
29. 刘佳耕, 闫松华, 曾纪洲, 等. 全膝关节置换前后患者下肢骨肌模型步态模拟与分析. 医用生物力学, 2020, 35(3): 347-355.
30. Horsman K, Koopman H, Van der Helm F, et al. Morphological muscle and joint parameters for musculoskeletal modelling of the lower extremity. Clin Biomech, 2007, 22(2): 239-247.
31. Ali N, Andersen M S, Rasmussen J, et al. The application of musculoskeletal modeling to investigate gender bias in non-contact ACL injury rate during single-leg landings. Comput Methods Biomech Biomed Engin, 2014, 17(14): 1602-1616.
32. Holmberg L J, Klarbring A. Muscle decomposition and recruitment criteria influence muscle force estimates. Multibody Syst Dyn, 2012, 28(3): 283-289.
33. Chen Z, Zhang X, Ardestani M M, et al. Prediction of in vivo joint mechanics of an artificial knee implant using rigid multi-body dynamics with elastic contacts. Proc Inst Mech Eng H, 2014, 228(6): 564-575.
34. Blankevoort L, Kuiper J, Huiskes R, et al. Articular contact in a three-dimensional model of the knee. J Biomech, 1991, 24(11): 1019-1031.
35. Akasaki Y, Matsuda S, Shimoto T, et al. Contact stress analysis of the conforming post-cam mechanism in posterior-stabilized total knee arthroplasty. J Arthroplasty, 2008, 23(5): 736-743.
36. Koh Y G, Son J, Kwon O R, et al. Tibiofemoral conformity variation offers changed kinematics and wear performance of customized posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1213-1223.
37. Lin K-J, Huang C-H, Liu Y-L, et al. Influence of post-cam design of posterior stabilized knee prosthesis on tibiofemoral motion during high knee flexion. Clin Biomech, 2011, 26(8): 847-852.
38. Hamai S, Okazaki K, Shimoto T, et al. Continuous sagittal radiological evaluation of stair-climbing in cruciate-retaining and posterior-stabilized total knee arthroplasties using image-matching techniques. J Arthroplasty, 2015, 30(5): 864-869.
39. Schutz P, Postolka B, Gerber H, et al. Knee implant kinematics are task-dependent. J R Soc Interface, 2019, 16(151): 20180678.

Journal of Biomedical Engineering

Musculoskeletal multibody dynamics investigation of posterior-stabilized total knee prosthesis

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