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The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

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Clinical Orthopaedics and Related Research®

Abstract

Background

Tibiofemoral forces are important in the design and clinical outcomes of TKA. We developed a tibial tray with force transducers and a telemetry system to directly measure tibiofemoral compressive forces in vivo. Knee forces and kinematics traditionally have been measured under laboratory conditions. Although this approach is useful for quantitative measurements and experimental studies, the extrapolation of results to clinical conditions may not always be valid.

Questions/purposes

We therefore developed wearable monitoring equipment and computer algorithms for classifying and identifying unsupervised activities outside the laboratory.

Methods

Tibial forces were measured for activities of daily living, athletic and recreational activities, and with orthotics and braces, during 4 years postoperatively. Additional measurements included video motion analysis, EMG, fluoroscopic kinematic analysis, and ground reaction force measurement. In vivo measurements were used to evaluate computer models of the knee. Finite element models were used for contact analysis and for computing knee kinematics from measured knee forces. A third-generation system was developed for continuous monitoring of knee forces and kinematics outside the laboratory using a wearable data acquisition hardware.

Results

By using measured knee forces and knee flexion angle, we were able to compute femorotibial AP translation (−12 to +4 mm), mediolateral translation (−1 to 1.5 mm), axial rotation (−3° to 12°), and adduction-abduction (−1° to +1°). The neural-network-based classification system was able to identify walking, stair-climbing, sit-to-stand, and stand-to-sit activities with 100% accuracy.

Conclusions

Our data may be used to improve existing in vitro models and wear simulators, and enhance prosthetic designs and biomaterials.

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Acknowledgments

These studies have been possible because of active collaborations with Benjamin J. Fregly, PhD, University of Florida; Thomas Andriacchi PhD, Stanford University; Scott Banks PhD, BioMotion Foundation; Harry Rubash MD, and Guoan Li PhD, Harvard Medical Center; Ritchie Gill PhD, Oxford, UK; Richard Komistek PhD, University of Tennessee; Marcus Pandy PhD, Sydney, Australia; and Urs Wyss PhD, Calgary, Canada. In addition, the following allowed us to use their facilities: the TaylorMade Performance Lab, Carlsbad, CA; the Torrey Pines Golf Course, La Jolla, CA; and the La Jolla Beach and Tennis Club, La Jolla, CA.

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Authors and Affiliations

  1. Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 11025 North Torrey Pines Road, Suite 200, La Jolla, CA, 92037, USA

    Darryl D. D’Lima MD, PhD, Shantanu Patil MD, Nicolai Steklov BS & Clifford W. Colwell Jr MD

Authors
  1. Darryl D. D’Lima MD, PhD
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  2. Shantanu Patil MD
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  3. Nicolai Steklov BS
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  4. Clifford W. Colwell Jr MD
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Corresponding author

Correspondence to Darryl D. D’Lima MD, PhD.

Additional information

One of the authors (DDD) received research support from Stryker, Zimmer, Smith & Nephew, and Tornier. One of the authors (CWC) is a consultant for Stryker.

One or more of the authors (DDD, CWC) received funding from the National Institutes of Health under the following grants: R01 EB009351 and R21 AR057561.

Each author certifies that his institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for the study was obtained.

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D’Lima, D.D., Patil, S., Steklov, N. et al. The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis. Clin Orthop Relat Res 469, 2953–2970 (2011). https://doi.org/10.1007/s11999-011-1916-9

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  • DOI: https://doi.org/10.1007/s11999-011-1916-9

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