Probabilistic Finite Element Prediction of the Active Lower Limb Model

The scope of this paper is to explore the input parameters of a Finite Element (FE) model of an active lower limb that are most influential in determining the size and the shape of the performance envelope of the kinematics and peak contact pressure of the knee tibial insert introduced during a Total Knee Replacement (TKR) surgery. The active lower limb FE model simulates the stair ascent and it provides a more complicated setup than the isolated TKR model which includes the femoral component and the tibial insert. It includes bones, TKR implant, soft tissues and applied forces. Two probabilistic methods are used together with the FE model to generate the performance envelopes and to explore the key parameters: the Monte Carlo Simulation Technique (MCST) and the Response Surface Method (RSM). It is investigated how the uncertainties in a reduced set of 22 input variables of the FE model affect the kinematics and peak contact pressure of the knee tibial insert. The kinematics is reported in the Grood and Suntay system, where all motion is relative to the femoral component of the TKR. Reported tibial component kinematics are tibio-femoral flexion angle, anterior-posterior and medial-lateral displacement, internal-external and varus-valgus rotation (i.e. abduction-adduction), while the reported patella kinematics are patella-femoral flexion angle, medial-lateral shift and medial-lateral tilt. Tibio-femoral and patella-femoral contact pressures are also of interest. Following a sensitivity analysis, a reduced set of input variables is derived, which represent the set of key parameters which influence the performance envelopes. The findings of this work are paramount to the orthopedic surgeons who may want to know the key parameters that can influence the performance of the TKR for a given human activity.

Physical Modelling of Hip Joint Forces in Stair Climbing

A test device has been developed and validated to simulate physiologic loading of the hip during stair climbing. Forces about the hip joint were measured in static simulations of stair climbing using simulated extensor, abductor and adductor muscle groups to support the joint. Femoral flexion angle (to model step length and height) and applied hip flexion moment (to model trunk lean) were varied to examine the effects of different loading conditions on the hip. In stair climbing the maximum total joint force was six times body weight at 34° of femoral flexion and 60 N m of hip flexion moment. Joint forces increased with hip flexion moment and varied little with femoral flexion angle, except for the posteriorly directed force. This component, which twists implants about the femoral shaft, increased with femoral flexion angle but changed little with hip flexion moment.

Position, Orientation and Component Interaction in Dislocation of the Total Hip Prosthesis

The position, orientation in space and interaction of prosthetic components was determined in 15 patients with known episodes of dislocation after total hip replacement. The same calculations were performed in a reference group of 44 patients without dislocation. In the group with dislocations, there was a significantly decreased femoral anteversion, and a decreased femoral flexion permitted by the prosthetic components. There were no further significant differences of clinical relevance between the groups concerning all other examined parameters of component position, orientation and interaction. It is concluded that the decreased range of flexion, caused by impingement of the prosthetic components with ensuing leverage effect is one cause of dislocation.