Musculoskeletal modeling of total ankle arthroplasty using force-dependent kinematics for predicting in vivo joint mechanics

2019 ◽  
Vol 234 (2) ◽  
pp. 210-222 ◽  
Author(s):  
Yanwei Zhang ◽  
Zhenxian Chen ◽  
Hongmou Zhao ◽  
Xiaojun Liang ◽  
Cheng Sun ◽  
...  
Keyword(s):  
Body Weight ◽  
Ankle Joint ◽  
Plantar Flexion ◽  
Contact Forces ◽  
Total Ankle Arthroplasty ◽  
Musculoskeletal Modeling ◽  
Patient Specific ◽  
Joint Mechanics ◽  
Ankle Arthroplasty

In vivo load and motion in the ankle joint play a key role in the understanding of the failure mechanism and function outcomes of total ankle arthroplasty. However, a thorough understanding of the biomechanics of the ankle joint in daily activities is lacking. The objective of this study was to develop a novel lower extremity musculoskeletal multibody dynamics model with total ankle arthroplasty considering the 6 degrees of freedom of the ankle joint motions and the deformable contact mechanics of the implant, based on force-dependent kinematics method. A patient who underwent total ankle arthroplasty surgery was considered. The walking gait data of the patient was measured in a gait laboratory and used as the input for the patient-specific musculoskeletal modeling. The predictions from the musculoskeletal model of total ankle arthroplasty included dorsiflexion–plantar flexion, inversion–eversion, internal–external rotation, anterior–posterior translation, inferior–superior translation, and medial–lateral translation of the tibiotalar joint, the ankle contact forces, the muscle activations, and the ligament forces. The magnitudes and tendencies of the predicted results were all within reasonable ranges, as compared with the data available in the literature. The predicted peak total ankle contact force was 6.55 body weight. In addition, the peak contact forces of the lateral and medial compartments were 4.22 body weight and 2.59 body weight, respectively. This study provides a potential new platform for the design of a better ankle prosthesis, the improvement of the operation techniques of the clinicians, and the accelerated postoperative recovery of the patients.

Predicting ground reaction and tibiotalar contact forces after total ankle arthroplasty during walking

2020 ◽  
Vol 234 (12) ◽  
pp. 1432-1444
Author(s):  
Yanwei Zhang ◽  
Zhenxian Chen ◽  
Yinghu Peng ◽  
Hongmou Zhao ◽  
Xiaojun Liang ◽  
...  
Keyword(s):  
Motion Capture ◽  
Multibody Dynamics ◽  
Contact Forces ◽  
Total Ankle Arthroplasty ◽  
Contact Model ◽  
Patient Specific ◽  
Ground Reaction Forces ◽  
Ground Contact ◽  
Ankle Arthroplasty ◽  
Reaction Forces

The motion capture and force plates data are essential inputs for musculoskeletal multibody dynamics models to predict in vivo tibiotalar contact forces. However, it could be almost impossible to obtain valid force plates data in old patients undergoing total ankle arthroplasty under some circumstances, such as smaller gait strides and inconsistent walking speeds during gait analysis. To remove the dependence of force plates, this study has established a patient-specific musculoskeletal multibody dynamics model with total ankle arthroplasty by combining a foot-ground contact model based on elastic contact elements. And the established model could predict ground reaction forces, ground reaction moments and tibiotalar contact forces simultaneously. Three patients’ motion capture and force plates data during their normal walking were used to establish the patient-specific musculoskeletal models and evaluate the predicted ground reaction forces and ground reaction moments. Reasonable accuracies were achieved for the predicted and measured ground reaction forces and ground reaction moments. The predicted tibiotalar contact forces for all patients using the foot-ground contact model had good consistency with those using force plates data. These findings suggested that the foot-ground contact model could take the place of the force plates data for predicting the tibiotalar contact forces in other total ankle arthroplasty patients, thus providing a simplified and valid platform for further study of the patient-specific prosthetic designs and clinical problems of total ankle arthroplasty in the absence of force plates data.

scholarly journals Novel Measurement Technique for Talar Height Assessment in Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0030
Author(s):  
Robert Kulwin ◽  
Steven L. Haddad
Keyword(s):  
Ankle Joint ◽  
Time Course ◽  
Weight Bearing ◽  
Functional Restoration ◽  
Total Ankle Arthroplasty ◽  
Joint Mechanics ◽  
Ankle Arthroplasty ◽  
Subtalar Fusion ◽  
Bony Landmarks ◽  
Significant Difference

Category: Ankle Arthritis; Other Introduction/Purpose: Talar and calcaneal height have been identified as important not only to the biomechanics of ankle joint function but of the adjacent joints of the hindfoot as well. Many proposed measurement systems have been introduced to the literature to assess talar height in ankle arthroplasty, but have significant shortcomings. The malleoli frequently develop osteophytes after total ankle arthroplasty. If the subtalar joint is fused or arthritic, methods relying on landmarks such as the angle of Gissane are similarly unreliable. Lastly, subsidence is often asymmetrical. Measuring from the highest point of the talar component may not be reflective of functional talar height. We propose using adjusted talocalcaneal height to assess the functional restoration of talar height. Methods: Pre and post-operative radiographs and weight bearing computed tomography (WBCT) were reviewed for 40 cases of failed total ankle arthroplasty undergoing revision. Bony landmarks were assessed for consistency over a time course of two to four years post operatively. Talocalcaneal height was measured along from the center of the tibial component of ankle arthroplasty on weight bearing lateral radiographs and on sagittal and coronal reconstructions on WBCT (fig 1). Measurements on radiographs and WBCT were compared for agreement. For implants where lateral radiographs could not be used (AgilityTM, Depuy), sagittal and coronal WBCT was used. Results: Average adjusted talocalcaneal height as measured on lateral radiographs, sagittal WBCT, coronal WBCT, and averaged values from sagittal and coronal WBCT was 68mm, 67.4mm, 68.5mm, and 68mm respectively. There was not a significant difference between the lateral radiographs and WBCT measurement methods (p= 0.30, 0.37, 0.46), and correlation was 0.99 for all methods. Measurements did not vary in cases of angular subsidence or subtalar fusion. Conclusion: Adjusted talocalcaneal height is a reproducible and reliable measurement to assess talar height. It accommodates procedures frequently performed in tandem with total ankle arthroplasty such as calcaneal osteotomy and subtalar fusion. It relies on a single, static bony landmark, and remains valid in cases of asymmetric subsidence. Lastly, it incorporates calcaneal height, which affects not only ankle joint mechanics but adjacent joint mechanics as well.

scholarly journals Influence of Tibial Component Position on Altered Kinematics Following Total Ankle Arthroplasty During Simulated Gait

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0010
Author(s):  
Guilherme Saito ◽  
Daniel Sturnick ◽  
Jonathan Deland ◽  
Scott Ellis ◽  
Constantine Demetracopoulos
Keyword(s):  
Ankle Joint ◽  
Tibial Component ◽  
Joint Kinematics ◽  
Transverse Plane ◽  
Total Ankle Arthroplasty ◽  
Component Position ◽  
Ankle Arthroplasty ◽  
Ankle Kinematics ◽  
Joint Contact

Category: Ankle Arthritis Introduction/Purpose: Correct positioning of total ankle arthroplasty (TAA) implants has been associated with superior clinical outcomes. Furthermore, biomechanical studies have demonstrated that poor alignment of the components may lead to early component wear, compromising the longevity of the prosthesis. Malpositioning of TAA implants affects ligament engagement patterns and joint contact mechanics, possibly leading to altered joint kinematics. However, the correlation between implant position and ankle joint motion is still unclear. The objective of this study was to assess the effect of tibial component position on ankle kinematics following TAA during simulated gait. Methods: Eight mid-tibia cadaveric specimens were utilized in this IRB approved study. The stance phase of gait was simulated both pre- and post-TAA in each specimen using a six-degree of freedom robotic platform. Ground reaction forces and tibial kinematic from in vivo data were replicated while physiologic tendon force profiles were applied to each extrinsic ankle tendons by linear actuators instrumented. Ankle kinematics was measured from reflective markers attached to bones via surgical pins. TAAs were completed using a common fixed-bearing total ankle system following the manufacturer recommended protocol (Salto Talaris, Integra LifeSciences). Using reconstructed CT data, 3D tibial component position relative to a standard ankle joint reference was characterized (Figure 1A). The effect of tibial component position on absolute differences in ankle kinematics (pre – post TAA) was assessed using linear regression with a level of significance set to p = 0.05. Results: Differences in ankle joint kinematics were only identified in the transverse plane, where internal talar rotation was significantly increased following TAA compared to the native condition (Figure 1B). The medial position of TAA tibial components was found to be positively associated with increased internal talar rotation (Figure 1C; β = 1.861 degrees/mm, R2 = 0.72, p = 0.008). No other measurements of tibial component position (anterior-posterior/inferior-superior position, sagittal/frontal/transverse plane angle) were found to be significantly associated with altered ankle kinematics following TAA (All β < 0.1 and p > 0.05). Conclusion: This study suggests that medial positioning of the tibial implant affects ankle kinematics. During operative procedures the tibial component is usually positioned in order to preserve bone stock of the medial and lateral malleolus. However, little attention is given to the position of the implant in relation to the center of the tibial axis. This finding could have clinical implications for techniques implemented during surgical procedures and for the development of new instrumentation systems.

In-vivo analysis of ankle joint movement for patient-specific kinematic characterization

2017 ◽  
Vol 231 (9) ◽  
pp. 831-838 ◽  
Author(s):  
Carlo Ferraresi ◽  
Carlo De Benedictis ◽  
Walter Franco ◽  
Daniela Maffiodo ◽  
Alberto Leardini
Keyword(s):  
Ankle Joint ◽  
Patient Specific ◽  
Joint Movement ◽  
In Vivo Analysis

In vivo kinematics of fixed-bearing total ankle arthroplasty

2020 ◽  
Vol 26 (4) ◽  
pp. 371-377 ◽  
Author(s):  
Gloria Casaroli ◽  
Tomaso Villa ◽  
Alberto Bianchi ◽  
Eleonora Caboni ◽  
Francesco Malerba ◽  
...  
Keyword(s):  
Total Ankle Arthroplasty ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
In Vivo Kinematics

scholarly journals Mechanical and Anatomical Axis in Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008
Author(s):  
Ali-Asgar Najefi ◽  
Andrew Goldberg
Keyword(s):  
Lower Limb ◽  
Mechanical Axis ◽  
Normal Group ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Patient Specific ◽  
Ankle Arthroplasty ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
Anatomical Axis

Category: Ankle Arthritis Introduction/Purpose: Inadequate correction of alignment in the coronal, sagittal or axial planes will inevitably lead to failure of the Total Ankle Arthroplasty (TAA). The mechanical axis of the lower limb (MAL), the mechanical axis of the tibia (MAT) and the anatomical axis of the tibia (AAT) are three recognized coronal plane measurements using plain radiography. The relationship between anatomical and mechanical axes depends on the presence of femoral or tibial deformities from trauma or inherited conditions, or previous corrective or replacement surgery. Ankle arthroplasty relies heavily on preoperative radiographs or CT scans and the purpose of this study was to assess whether MAL, MAT and AAT are the same in a cohort of patients upon which placement of TAA is considered. Methods: We analysed 75 patients operated on between 2015 and 2016 at a specialist tertiary centre for elective orthopaedic surgery. All patients had a pre-operative long leg radiograph. They were split into 2 groups. The first group had known deformity proximal to the ankle (such as previous tibial or femoral fracture, severe arthritis, or previous reconstructive surgery) and the second group had no clinically detectable deformity. The MAL, MAT and AAT were assessed and the difference between these values was calculated. Results: There were 54 patients in the normal group, and 21 patients in the deformity group. Overall, 25 patients(33%) had a difference between all three axes of less than 1 degree. In 33 patients(44%), there was a difference in one of the axes of ≥2 degrees. There was no significant difference between MAT and AAT in patients in the normal group(p=0.6). 95% of patients had a difference of <1 degree. There was a significant difference between the MAT and AAT in patients in the deformity group(p<0.01). In the normal group, 39 patients(73%) had a difference of <2 degrees between the AAT and MAL. In the deformity group, only 10 patients (48%) had a difference of <2 degrees.In fact, 24% of patients had a difference ≥3 degrees. Conclusion: Malalignment in the coronal plane in TAA may be an issue that we have not properly addressed. Up to 66% of patients without known deformity may have a TAA that is placed at least 1 degree incorrectly relative to the MAL. We recommend the use of full-length lower limb radiographs when planning a TAA in order to plan the placement of implants. The decision to perform extramedullary referencing, intramedullary referencing, or patient specific Instrumentation must be part of the pre-operative planning process.

scholarly journals 20 Degree Post Traumatic Ankle Valgus and Distal Lateral Tibial Osteonecrosis Treated with Staged Deformity Correction and Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Lawrence DiDomenico ◽  
Danielle Butto
Keyword(s):  
Ankle Joint ◽  
Deformity Correction ◽  
Total Ankle Arthroplasty ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Ankle Arthroplasty ◽  
Initial Surgery ◽  
Post Traumatic ◽  
Ankle Valgus

Category: Ankle, Ankle Arthritis Introduction/Purpose: The purpose of this review is to present a case of post-traumatic ankle valgus and distal lateral tibial osteonecrosis successfully treated with staged deltoid repair, opening wedge tibial osteotomy, fibular lengthening, syndesmotic fusion and total ankle arthroplasty. Methods: Initial surgery consisted of ankle joint arthrotomy and deltoid imbrication. The second surgery consisted of a tibial opening wedge osteotomy with autogenous cortical fibular bone graft superior to the area of osteonecrosis to correct the 20 degree ankle valgus. Fibular lengthening osteotomy and fusion of the distal syndesmosis were also performed. CT scan confirmed bony consolidation at the distal tibiofibular syndesmosis as well as union of the allograft opening wedge. The final surgery was total ankle joint replacement with bone grafting of the area of osteonecrosis. Results: After 5 years of follow up the patient has progressed out of his AFO to full weightbearing. He reports no ankle pain, improved function and range of motion and is ambulating independently with no assistive devices. Conclusion: We successfully treated a case of distal lateral tibial osteonecrosis, and a 20 degree ankle valgus with staged deformity correction and ankle replacement. Radiographs demonstrate a well seated and positioned implant. We believe that with proper alignment that total ankle arthroplasty is a safe treatment option in the face of bone infarction.

Development of a Full Flexion 3D Musculoskeletal Model of the Knee Considering Intersegmental Contact During High Knee Flexion Movements

2020 ◽  
Vol 36 (6) ◽  
pp. 444-456
Author(s):  
David C. Kingston ◽  
Stacey M. Acker
Keyword(s):  
Body Weight ◽  
Knee Flexion ◽  
Knee Extensor ◽  
Musculoskeletal Model ◽  
Contact Forces ◽  
Model Verification ◽  
In Vivo Studies ◽  
Muscle Groups ◽  
The Right

A musculoskeletal model of the right lower limb was developed to estimate 3D tibial contact forces in high knee flexion postures. This model determined the effect of intersegmental contact between thigh–calf and heel–gluteal structures on tibial contact forces. This model includes direct tracking and 3D orientation of intersegmental contact force, femoral translations from in vivo studies, wrapping of knee extensor musculature, and a novel optimization constraint for multielement muscle groups. Model verification consisted of calculating the error between estimated tibial compressive forces and direct measurements from the Grand Knee Challenge during movements to ∼120° of knee flexion as no high knee flexion data are available. Tibial compression estimates strongly fit implant data during walking (R2 = .83) and squatting (R2 = .93) with a root mean squared difference of .47 and .16 body weight, respectively. Incorporating intersegmental contact significantly reduced model estimates of peak tibial anterior–posterior shear and increased peak medial–lateral shear during the static phase of high knee flexion movements by an average of .33 and .07 body weight, respectively. This model supports prior work in that intersegmental contact is a critical parameter when estimating tibial contact forces in high knee flexion movements across a range of culturally and occupationally relevant postures.

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