Numerical study of osteophyte effects on preoperative knee functionality in patients undergoing total knee arthroplasty

Osteophytes are routinely removed during total knee arthroplasty, yet thepreoperative planning currently relies on preoperative computed tomography (CT)scans of the patient's osteoarthritic knee, typically including osteophytic features.This complicates the surgeon's ability to anticipate the exact biomechanical effectsof osteophytes and the consequences of their removal before the operation. The aimof this study was to investigate the effect of osteophytes on ligament strains andkinematics, and ascertain whether the osteophyte volume and location determinethe extent of this effect. We segmented preoperative CT scans of 21 patients,featuring different osteophyte severity, using image‐based active appearancemodels trained to identify the osteophytic and preosteophytic bone geometriesand estimate the cartilage thickness in the segmented surfaces. The patients'morphologies were used to scale a template musculoskeletal knee model.Osteophytes induced clinically relevant changes to the knee's functional behavior,but these were variable and patient‐specific. Generally, severe osteophytic kneessignificantly strained the oblique popliteal ligament (OPL) and posterior capsule (PC)relative to the preosteophytic state. Furthermore, there was a marked effect on thelateral collateral ligament and anterolateral ligament (ALL) strains compared to mildand moderate osteophytic knees, and concurrent alterations in the tibial lateral‐medial translation and external–internal rotation. We found a strong correlationbetween the OPL, PC, and ALL strains and posterolateral condylar and tibialosteophytes, respectively. Our findings may have implications for the preoperativeplanning in total knee arthroplasty, toward reproducing the physiological kneebiomechanics as close as feasibly possible

A Patient-Specific Musculoskeletal Model of Total Knee Arthroplasty to Predict In Vivo Knee Biomechanics

Musculoskeletal(MS) models are useful to gain information on in vivo biomechanics that would be otherwise very difficult to obtain.However, before entering the clinical routine MS models must be thoroughlyvalidated. This study presents a novel MS modelling framework capable ofintegrating the patient-specific MS architecture in a very detailed way, andsimultaneously simulating body level dynamics and secondary knee kinematics.The model predictions were further validated against publicly available in vivo experimental data. The bonegeometries were segmented from CT images of a patient with an instrumentedTotal Knee Arthroplasty (TKA) from the “Grand Challenge Competition to Predict In Vivo Knee Loads” dataset. These were inputtedinto an advanced morphing technique in order to scale the MS architecture of thenew TLEM 2.0 model1 to the specific patient. A detailed 11-DOF modelof the knee joint was constructed that included ligaments and rigid contact. Aninverse kinematic and a force-dependent kinematic technique2 wereutilized to simulate one gait cycle and one right-turn trial. Tibiofemoral (TF)joint contact force predictions were evaluated against experimental TF forcesrecorded by the TKA prosthesis, and secondary knee kinematics againstexperimental fluoroscopy data. The coefficientof determination and the root-mean-square error between predicted andexperimental tibiofemoral forces were larger than 0.9 and smaller than 0.3body-weights, respectively, for both gait and right-turn trials. Secondary kneekinematics were estimated with an average Sprague and Geers’ combined error assmall as 0.06. Themodelling strategy proposed permits a high level of patient-specificpersonalization and does not require any non-physiological parameter tuning.The very good agreement between predictions and experimental in vivo data is promising for the futureintroduction of the model into clinical applications

Multi-centre evaluation of real-time multiplex PCR for detection of carbapenemase genes OXA-48, VIM, IMP, NDM and KPC

Background: Resistance to carbapenem antibiotics is emerging worldwide among Enterobacteriaceae. To prevent hospital transmission due to unnoticed carriage of carbapenemase producing micro-organisms in newly admitted patients, or follow-up of patients in an outbreak setting, a molecular screening method was developed for detection of the most prevalent carbapenemase genes; blaOXA-48, blaVIM, blaIMP, blaNDM and blaKPC.Methods: A real-time multiplex PCR assay was evaluated using a collection of 86 Gram negative isolates, including 62 carbapenemase producers. Seven different laboratories carried out this method and used the assay for detection of the carbapenemase genes on a selection of 20 isolates.Results: Both sensitivity and specificity of the multiplex PCR assay was 100%, as established by results on the strain collection and the inter-laboratory comparisons.Conclusions: In this study, we present a multiplex real-time PCR that is a robust, reliable and rapid method for the detection of the most prevalent carbapenemases blaOXA-48, blaVIM, blaIMP, blaNDM and blaKPC, and is suitable for screening of broth cultured rectal swabs and for identification of carbapenemase genes in cultures

The primary stability of a cementless PEEK femoral component is sensitive to BMI:A population-based FE study

The use of polyetheretherketone (PEEK) for cementless femoral total knee arthroplasty (TKA) components is of interest due to several potential advantages, e.g. the use in patients with metal hypersensitivity. Additionally, the stiffness of PEEK closer resembles the stiffness of bone, and therefore, peri-prosthetic stress-shielding may be avoided. When introducing a new implant material for cementless TKA designs, it is important to study its effect on the primary fixation, which is required for the long-term fixation. Finite element (FE) studies can be used to study the effect of PEEK as implant material on the primary fixation, which may be dependent on patient factors such as age, gender and body weight index (BMI). Therefore, the research objectives of this study were to investigate the effect of PEEK vs cobalt-chrome (CoCr) and patient characteristics on the primary fixation of a cementless femoral component. 280 FE models of 70 femora were created with varying implant material and gait and squat activity. Overall, the PEEK models generated larger peak micromotions than the CoCr models. Distinct differences were seen in the micromotion distributions between the PEEK and CoCr models for both the gait and squat models. The micromotions of all femoral models significantly increased with BMI. Neither gender nor age of the patients had a significant effect on the micromotions. This population study gives insights into the primary fixation of a cementless femoral component in a cohort of FE models with varying implant material and patient characteristics.</p

Biomechanical Consequences of Tibial Insert Thickness after Total Knee Arthroplasty: A Musculoskeletal Simulation Study

The thickness of the tibial polyethylene (PE) insert is a critical parameter to ensure optimal soft-tissue balancing in the intraoperative decision-making procedure of total knee arthroplasty (TKA). However, there is a paucity of information about the kinetic response to PE insert thickness variations in the tibiofemoral (TF) joint, and subsequently, the secondary effects on the patellofemoral (PF) biomechanics. Therefore, the purpose of this study was to investigate the influence of varying PE insert thickness on the ligament and TF compressive forces, as well as on the PF forces and kinematics, after a cruciate-retaining TKA. A previous patient-specific musculoskeletal model of TKA was adapted to simulate a chair-rising motion in which PE insert thickness was varied with 2 mm increments or decrements compared to the reference case (9 mm), from 5 mm up to 13 mm. Greater PE insert thickness resulted in higher ligament forces and concurrently increased the TF compressive force by 21% (13 mm), but slightly unloaded the PF joint with 7% (13 mm) while shifting the patella distally in the trochlear groove, compared to the reference case. Thinner PE inserts showed an opposite trend. Our findings suggest that the optimal PE insert thickness selection is a trade-off between the kinetic outcomes of the TF and PF joints