62 research outputs found
Overstretching Expectations May Endanger the Success of the âMillennium Surgeryâ
Total hip arthroplasty (THA) is an extremely successful treatment strategy. Patient expectations, however, have increased; if not properly guided by surgeons, at present, patients expect next to pain-free restoration of the joint and a fast return to work and sports. While the revision rates after THA also increased in younger patients, knowledge on musculoskeletal loads still remains sparse, and the current recommendations on postoperative rehabilitation are based on expert opinions only. The aim of this study was to unravel biomechanical contact conditions in "working age" (60 years, 67.7 +/- 8.6 years) patients during activities recommended post-THA. We hypothesized that working age patients would show substantially increased hip contact loads compared to older patients. The in vivo joint contact force (F-res) and torsion torque (M-tors), reflecting the main contact load situation, experienced during activities of daily living and sports activities were measured in a unique group of 16 patients with instrumented THA. We summarized patient activities and sports recommendations after THA mentioned within the literature using PubMed (without claim of completeness). The measurements showed that younger working age patients experienced significant (p = 0.050) increased M-tors (21.52 +/- 9.11 Nm) than older retirement age patients (13.99 +/- 7.89 Nm) by walking. Bowling, as a recommended low-impact sport, was associated with F-res of up to 5436 N and M-tors of up to 108 Nm in the working age group, which were higher than the F-res (5276 N) and M-tors (71 Nm) during high-impact soccer. Based on our results, age was proven to be a discriminator in joint loading, with working age patients presenting with increased loads compared to retirement age patients, already during daily activities. The current patient recommendations have led to further increased joint loadings. If THA cannot be delayed in a patient, we propose counselling patients on a carefully considered return to sports, focusing on low-impact activities, as indicated hereby. The findings from this work illustrate the need to provide critical feedback to patient expectations when returning to work and sports activities. Patients returning to more intensive sports activities should be carefully monitored and advised to avoid as much overloading as possible
Standardized Loads Acting in Hip Implants
With the increasing success of hip joint replacements, the average age of
patients has decreased, patients have become more active and their
expectations of the implant durability have risen. Thus, pre-clinical
endurance tests on hip implants require defining realistic in vivo loads from
younger and more active patients. These loads require simplifications to be
applicable for simulator tests and numerical analyses. Here, the contact
forces in the joint were measured with instrumented hip implants in ten
subjects during nine of the most physically demanding and frequent activities
of daily living. Typical levels and directions of average and high joint loads
were extracted from the intra- and inter-individually widely varying
individual data. These data can also be used to analyse bone remodelling at
the implant-bone interface, evaluate tissue straining in finite element
studies or validate analytical loading predictions, among other uses. The
current ISO standards for endurance tests of implant stems and necks are based
on historic analytical data from the 1970s. Comparisons of these test forces
with in vivo loads unveiled that their unidirectional orientations deviate
from the time-dependent in vivo directions during walking and most other
activities. The ISO force for testing the stem is substantially too low while
the ISO force for the neck better matches typical in vivo magnitudes. Because
the magnitudes and orientations of peak forces substantially vary among the
activities, load scenarios that reflect a collection of time-dependent high
forces should be applied rather than using unidirectional forces. Based on
data from ten patients, proposals for the most demanding activities, the time
courses of the contact forces and the required cycle numbers for testing are
given here. Friction moments in the joint were measured in addition to the
contact forces. The moment data were also standardized and can be applied to
wear tests of the implant. It was shown that friction only very slightly
influences the stresses in the implant neck and shaft
Standardized loads acting in knee implants
The loads acting in knee joints must be known for improving joint replacement, surgical procedures, physiotherapy, biomechanical computer simulations, and to advise patients with osteoarthritis or fractures about what activities to avoid. Such data would also allow verification of test standards for knee implants. This work analyzes data from 8 subjects with instrumented knee implants, which allowed measuring the contact forces and moments acting in the joint. The implants were powered inductively and the loads transmitted at radio frequency. The time courses of forces and moments during walking, stair climbing, and 6 more activities were averaged for subjects with I) average body weight and average load levels and II) high body weight and high load levels. During all investigated activities except jogging, the high force levels reached 3,372â4,218N. During slow jogging, they were up to 5,165N. The peak torque around the implant stem during walking was 10.5 Nm, which was higher than during all other activities including jogging. The transverse forces and the moments varied greatly between the subjects, especially during non-cyclic activities. The high load levels measured were mostly above those defined in the wear test ISO 14243. The loads defined in the ISO test standard should be adapted to the levels reported here. The new data will allow realistic investigations and improvements of joint replacement, surgical procedures for tendon repair, treatment of fractures, and others. Computer models of the load conditions in the lower extremities will become more realistic if the new data is used as a gold standard. However, due to the extreme individual variations of some load components, even the reported average load profiles can most likely not explain every failure of an implant or a surgical procedure
Surgical cup placement affects the heating up of total joint hip replacements
The long-term success of highly effective total hip arthroplasty (THA) is mainly restricted by aseptic loosening, which is widely associated with friction between the head and cup liner. However, knowledge of the in vivo joint friction and resulting temperature increase is limited. Employing a novel combination of in vivo and in silico technologies, we analyzed the hypothesis that the intraoperatively defined implant orientation defines the individual joint roofing, friction and its associated temperature increase. A total of 38,000 in vivo activity trials from a special group of 10 subjects with instrumented THA implants with an identical material combination were analyzed and showed a significant link between implant orientation, joint kinematics, joint roofing and friction-induced temperature increase but surprisingly not with acting joint contact force magnitude. This combined in vivo and in silico analysis revealed that cup placement in relation to the stem is key to the in vivo joint friction and heating-up of THA. Thus, intraoperative placement, and not only articulating materials, should be the focus of further improvements, especially for young and more active patients
Quantifying Asymmetry in Gait: The Weighted Universal Symmetry Index to Evaluate 3D Ground Reaction Forces
Though gait asymmetry is used as a metric of functional recovery in clinical rehabilitation, there is no consensus on an ideal method for its evaluation. Various methods have been proposed to analyze single bilateral signals but are limited in scope, as they can often use only positive signals or discrete values extracted from time-scale data as input. By defining five symmetry axioms, a framework for benchmarking existing methods was established and a new method was described here for the first time: the weighted universal symmetry index (wUSI), which overcomes limitations of other methods. Both existing methods and the wUSI were mathematically compared to each other and in respect to their ability to fulfill the proposed symmetry axioms. Eligible methods that fulfilled these axioms were then applied using both discrete and continuous approaches to ground reaction force (GRF) data collected from healthy gait, both with and without artificially induced asymmetry using a single instrumented elbow crutch. The wUSI with a continuous approach was the only symmetry method capable of identifying GRF asymmetry differences in different walking conditions in all three planes of motion. When used with a continuous approach, the wUSI method was able to detect asymmetries while avoiding artificial inflation, a common problem reported in other methods. In conclusion, the wUSI is proposed as a universal method to quantify three-dimensional GRF asymmetries, which may also be expanded to other biomechanical signals
Postoperative Changes in In Vivo Measured Friction in Total Hip Joint Prosthesis during Walking
Loosening of the artificial cup and inlay is the most common reasons for total
hip replacement failures. Polyethylene wear and aseptic loosening are frequent
reasons. Furthermore, over the past few decades, the population of patients
receiving total hip replacements has become younger and more active. Hence, a
higher level of activity may include an increased risk of implant loosening as
a result of friction-induced wear. In this study, an instrumented hip implant
was used to measure the contact forces and friction moments in vivo during
walking. Subsequently, the three-dimensional coefficient of friction in vivo
was calculated over the whole gait cycle. Measurements were collected from ten
subjects at several time points between three and twelve months postoperative.
No significant change in the average resultant contact force was observed
between three and twelve months postoperative. In contrast, a significant
decrease of up to 47% was observed in the friction moment. The coefficient of
friction also decreased over postoperative time on average. These changes may
be caused by ârunning-inâ effects of the gliding components or by the improved
lubricating properties of the synovia. Because the walking velocity and
contact forces were found to be nearly constant during the observed period,
the decrease in friction moment suggests an increase in fluid viscosity. The
peak values of the contact force individually varied by 32%-44%. The friction
moment individually differed much more, by 110%-129% at three and up to 451%
at twelve months postoperative. The maximum coefficient of friction showed the
highest individual variability, about 100% at three and up to 914% at twelve
months after surgery. These individual variations in the friction parameters
were most likely due to different ârunning-inâ effects that were influenced by
the individual activity levels and synovia properties
In vivo measured joint friction in hip implants during walking after a short rest.
INTRODUCTION:It has been suspected that friction in hip implants is higher when walking is initiated after a resting period than during continuous movement. It cannot be excluded that such increased initial moments endanger the cup fixation in the acetabulum, overstress the taper connections in the implant or increase wear. To assess these risks, the contact forces, friction moments and friction coefficients in the joint were measured in vivo in ten subjects. Instrumented hip joint implants with telemetric data transmission were used to access the contact loads between the cup and head during the first steps of walking after a short rest. RESULTS:The analysis demonstrated that the contact force is not increased during the first step. The friction moment in the joint, however, is much higher during the first step than during continuous walking. The moment increases throughout the gait cycle were 32% to 143% on average and up to 621% individually. The high initial moments will probably not increase wear by much in the joint. However, comparisons with literature data on the fixation resistance of the cup against moments made clear that the stability can be endangered. This risk is highest during the first postoperative months for cementless cups with insufficient under-reaming. The high moments after a break can also put taper connections between the head and neck and neck and shaft at a higher risk. DISCUSSION:During continuous walking, the friction moments individually were extremely varied by factors of 4 to 10. Much of this difference is presumably caused by the varying lubrication properties of the synovia. These large moment variations can possibly lead to friction-induced temperature increases during walking, which are higher than the 43.1°C which have previously been observed in a group of only five subjects
Model for calculating the 3D coefficient of friction Ό.
<p>In reality, the component F<sub>z</sub> is measured negatively, and the direction of F<sub>res</sub> is thus towards the ball surface</p
Individual contact forces, friction moments and coefficients of friction.
<p>Load pattern during one gait cycle at three (left) and twelve (right) months postoperatively.</p
Postoperative changes of contact forces and friction moments.
<p>Average and standard deviations.</p
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