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Computational framework for population-based evaluation of TKR-implanted patellofemoral joint mechanics

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Abstract

Differences in patient anatomy are known to influence joint mechanics. Accordingly, intersubject anatomical variation is an important consideration when assessing the design of joint replacement implants. The objective of this study was to develop a computational workflow to perform population-based evaluations of total knee replacement implant mechanics considering variation in patient anatomy and to assess the potential for an efficient sampling strategy to support design phase screening analyses. The approach generated virtual subject anatomies using a statistical shape model of the knee and performed virtual implantation to size and align the implants. A finite-element analysis simulated a deep knee bend activity and predicted patellofemoral (PF) mechanics. The study predicted bounds of performance for kinematics and contact mechanics and investigated relationships between patient factors and outputs. For example, the patella was less flexed throughout the deep knee bend activity for patients with an alta patellar alignment. The results also showed the PF range of motions in AP and ML were generally larger with increasing femoral component size. Comparison of the 10–90% bounds between sampling strategies agreed reasonably, suggesting that Latin Hypercube sampling can be used for initial screening evaluations and followed up by more intensive Monte Carlo simulation for refined designs. The platform demonstrated a functional workflow to consider variation in joint anatomy to support robust implant design.

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Acknowledgement

This research was supported in part by the National Science Foundation (CBET-1034251), National Institutes of Health (Grant Number: 1R01EB015497-01) and DePuy Synthes, a Johnson & Johnson Company.

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Authors and Affiliations

  1. Center for Orthopaedic Biomechanics, Mechanical and Materials Engineering, University of Denver, 2155 E Wesley Ave, Denver, CO, 80208, USA

    Azhar A. Ali, Chadd W. Clary, Lowell M. Smoger, Douglas A. Dennis, Clare K. Fitzpatrick, Paul J. Rullkoetter & Peter J. Laz

  2. Colorado Joint Replacement, Denver, CO, USA

    Douglas A. Dennis

  3. Mechanical and Biomedical Engineering, Boise State University, Boise, ID, USA

    Clare K. Fitzpatrick

Authors
  1. Azhar A. Ali
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  2. Chadd W. Clary
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  3. Lowell M. Smoger
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  4. Douglas A. Dennis
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  5. Clare K. Fitzpatrick
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  6. Paul J. Rullkoetter
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  7. Peter J. Laz
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Corresponding author

Correspondence to Peter J. Laz.

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Ethical approval

For the population model, the study used cadaveric data, publically available data from the Osteoarthritis Initiative and de-identified data, and was categorized as exempt by the University of Denver Institutional Review Board. With regard to the implant size data for the clinical subjects, the study (ID: 1480194-1) was reviewed and approved by the Catholic Health Initiatives Institute for Research and Innovation Institutional Review Board (CHIRB). The implant size data were deidentified, and no patient information was transferred.

Conflict of interest

Disclosures for the authors are as follows: A.A. Ali, L.M. Smoger and C.K. Fitzpatrick have no conflicts of interest to report. P.J. Laz, C.W. Clary and P.J. Rullkoetter have received institutional support from DePuy Synthes. C.W. Clary and P.J. Rullkoetter have served as consultants for DePuy Synthes. D.A. Dennis has received royalties from DePuy Synthes and Innomed, and received honorariums and served as a consultant for DePuy Synthes and Corin. He reports owning stock or stock options in Joint Vue and receiving research or institutional support from DePuy Synthes and Porter Adventist Hospital.

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Ali, A.A., Clary, C.W., Smoger, L.M. et al. Computational framework for population-based evaluation of TKR-implanted patellofemoral joint mechanics. Biomech Model Mechanobiol 19, 1309–1317 (2020). https://doi.org/10.1007/s10237-020-01295-7

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  • DOI: https://doi.org/10.1007/s10237-020-01295-7

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