In-vivo time-dependent articular cartilage contact behavior of the tibiofemoral joint

SummaryObjectiveThe purpose of this study was to investigate the in-vivo time-dependent contact behavior of tibiofemoral cartilage of human subjects during the first 300s after applying a constant full body weight loading and determine whether there are differences in cartilage contact responses between the medial and lateral compartments.DesignSix healthy knees were investigated in this study. Each knee joint was subjected to full body weight loading and the in-vivo positions of the knee were captured by two orthogonal fluoroscopes during the first 300s after applying the load. Three-dimensional models of the knee were created from MR images and used to reproduce the in-vivo knee positions recorded by the fluoroscopes. The time-dependent contact behavior of the cartilage was represented using the peak cartilage contact deformation and the cartilage contact area as functions of time under the constant full body weight.ResultsBoth medial and lateral compartments showed a rapid increase in contact deformation and contact area during the first 20s of loading. After 50s of loading, the peak contact deformation values were 10.5±0.8% (medial) and 12.6±3.4% (lateral), and the contact areas were 223.9±14.8mm2 (medial) and 123.0±22.8mm2 (lateral). Thereafter, the peak cartilage contact deformation and contact area remained relatively constant. The respective changing rates of cartilage contact deformation were 1.4±0.9%/s (medial) and 3.1±2.5%/s (lateral); and of contact areas were 40.6±20.8mm2/s (medial) and 24.0±11.4mm2/s (lateral), at the first second of loading. Beyond 50s, both changing rates approached zero.ConclusionsThe peak cartilage contact deformation increased rapidly within the first 20s of loading and remained relatively constant after ∼50s of loading. The time-dependent response of cartilage contact behavior under constant full body weight loading was significantly different in the medial and lateral tibiofemoral compartments, with greater peak cartilage contact deformation on the lateral side and greater contact area on the medial side. These data can provide insight into normal in-vivo cartilage function and provide guidelines for the improvement of ex-vivo cartilage experiments and the validation of computational models that simulate human knee joint contact

A review of symptomatic leg length inequality following total hip arthroplasty

Leg length inequality (LLI) following total hip replacement is a complication which features increasingly in the recent literature. The definition of LLI is complicated by lack of consensus regarding radiological measurement, clinical measurement and the incomplete relationship between LLI and associated symptoms. This paper reviews 79 reports relating to LLI post hip replacement, detailing definitions and classification and highlighting patient populations prone to symptomatic LLI. While there is no universal definition of LLI, there is a broad consensus that less than 10 mm of difference on AP view plain radiographs is clinically acceptable. There are few techniques described that consistently produce a postoperative LLI of less than this magnitude. Where postoperative LLI exists, lengthening appears to cause more problems than shortening. In cases of mild LLI, non-surgical management produces adequate outcomes in the majority of cases, with functional LLI cases doing better than those with true LLI. Operative correction is effective in half of cases, even where nerve palsy is present, and remains an important option of last resort. Poor outcomes in patients with LLI may be minimised if individuals at risk are identified and counselled appropriately