Dynamic Measurement of Patellofemoral Compression Forces: A Novel Method for Patient-Specific Patella Resurfacing in Total Knee Replacement
<p>Quad sense force sensor. (<b>a</b>) 6 mm neutral shim applied to the sensor paddle. Each circle corresponds to one of four quadrants containing a separate sensor (Medial, Lateral, Superior, Inferior). (<b>b</b>) Tines on the undersurface of the sensor paddle are used to attach the sensor to the resected patella to hold it in place during range of motion trials.</p> "> Figure 2
<p>Demonstration of application of quad sense force sensor. (<b>a</b>) Placement of the quad sense sensor along undersurface of everted patella. Position of the sensor paddle is marked with electrocautery or a skin marker. (<b>b</b>) View of the quad sense sensor positioning during trialing with the patella reduced. Two towel clips are used for provisional reduction and closure of the extensor mechanism during range of motion trialing.</p> "> Figure 3
<p>CAD layout of the scanned femoral and tibial components, altered to be compatible with the Medical Model Left Cadaver Leg set-up when 3D printed and utilized for the in vitro experiment.</p> "> Figure 4
<p>Surgical technique for performing initial patella cut. Patellar clamp with attached 6 mm custom cutting guide is applied to the patella, and resection is performed with a standard oscillating saw.</p> "> Figure 5
<p>Flow diagram demonstrating planned steps of the cadaveric study, including when PFJ load measurements were obtained at key timepoints during the TKR procedure.</p> "> Figure 6
<p>Technique is shown for performing an adjustment cut to the manual left TKR set at 3 mm with a 2.5° inferiorly angled orientation guide. (<b>a</b>) Patellar clamp and custom adjustment cutting guide set. (<b>b</b>) Adjustment cut performed with patellar clamp and custom guide for a 3 mm 2.5° inferiorly angled cut in place. (<b>c</b>) Resected patella is shown after adjustment cut is completed.</p> "> Figure 7
<p>Graph of dynamic time warping analysis performed for the superior sensor load measurements obtained in an in vitro experiment using a model knee. Trials performed for the 6 mm to 9 mm neutral shims were consolidated and standardized by time, demonstrating the increase in measured force observed with each incremental increase in shim size. Purple = 6 mm neutral shim, Blue = 7 mm neutral shim, Green = 8 mm neutral shim, Red = 9 mm neutral shim. X-axis denotes Time Index (total of 12 s), and Y-axis denotes Average Force (in mV).</p> "> Figure 8
<p>Graph of dynamic time warping analysis performed for the medial sensor load measurements obtained in an in vitro experiment using a model knee. Trials performed for the 6 mm 2.5° angled shims were consolidated and standardized by time, demonstrating the changes in measured force based on shim angle orientation. Red = 6 mm neutral shim, Green = 6 mm 2.5° medial angle shim, Blue = 6 mm 2.5° lateral angle shim. X-axis denotes Time Index (total of 12 s), and Y-axis denotes Average Force (in mV).</p> "> Figure 9
<p>Comparison of visual graphs generated for PFJ load obtained before and after TKR in the right knee of Specimen 1. Three peaks seen correspond to the three knee flexion-extension cycles obtained in a 12 s recording period. Green = Medial sensor; Red = Lateral; Blue = Superior; Orange = Inferior. (<b>a</b>) PFJ load measured in native (natural) right knee with 6 mm neutral shim. (<b>b</b>) PFJ load measured in right knee with trial TKR components in place with 6 mm neutral shim. * Note: X-axis delineates time (total of 12 s) in which the three flexion-extension trials were performed. Y-axis (in mV) has different scales generated: (<b>a</b>) 2000 units of load (<b>b</b>) 2400 units of load.</p> "> Figure 10
<p>Graph of dynamic time warping analysis performed comparing the native and TKR load measurement in the right knee of Specimen 1. (<b>a</b>) Graph for lateral sensor loads measured in the right knee. Blue = Native 6 mm neutral shim; Red = TKR 6 mm neutral shim. (<b>b</b>) Graph for superior sensor loads measured in the right knee. Blue = Native 6 mm neutral shim; Red = TKR 6 mm neutral shim. X-axis denotes Time Index (total of 12 s), and Y-axis denotes Average Force (in mV).</p> ">
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patellofemoral Joint Load Sensor
2.2. In Vitro Experimental Set-Up
2.3. Cadaveric Patella Load Assessment
2.4. Cadaveric Patella Adjustment Cut
2.5. Data Collection and Presentation
2.6. Dynamic Time Warping Comparison
- Data for time periods without movement (during which the knee was actively being flexed or extended) were detected and filtered out.
- Troughs in the values obtained for the combined summed load sensors were detected using a peak detection algorithm with specified prominence.
- The signal was segmented into single movement pieces, and labeled based on the different test conditions.
- Dynamic time warping was implemented to match each segmented signal in time. In doing so, this reduced the need for the surgeon performing the trial to move the knee at exactly the same speed each time by dynamically stretching or compressing the signal, to achieve optimal Euclidean distance matching.
- Time matched signals from each test were combined to provide an average and standard deviation for each point in the knee motion, including the maximal load obtained for each trial.
2.7. Statistical Analysis
3. Results
3.1. In-Vitro Sensor Experiment
3.2. Cadaveric Experiment
4. Discussions
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Quadrant | 6 mm Neutral | 7 mm Neutral | 8 mm Neutral | 9 mm Neutral | p-Value | ||||
---|---|---|---|---|---|---|---|---|---|
Pre-Cut | Post-Cut | Pre-Cut | Post-Cut | Pre-cut | Post-Cut | Pre-Cut | Post-Cut | ||
Medial: | 0.3 ± 0.1 | 0.3 ± 0.0 | 0.4 ± 0.1 | 0.4 ± 0.1 | 0.3 ± 0.0 | 0.3 ± 0.0 | 0.3 ± 0.0 | 0.3 ± 0.1 | 0.52 |
Lateral: | 79.2 ± 12.9 | 11.5 ± 2.0 | 81.8 ± 11.6 | 13.5 ± 1.2 | 83.9 ± 12.9 | 19.3 ± 1.7 | 105.7 ± 8.0 | 20.8 ± 1.9 | <0.01 * |
Superior: | 7.0 ± 1.5 | 2.7 ± 0.7 | 11.6 ± 1.6 | 5.8 ± 1.0 | 11.6 ± 1.9 | 10.4 ± 0.9 | 13.5 ± 0.6 | 14.1 ± 1.7 | <0.01 * |
Inferior: | 0.2 ± 0.0 | 0.2 ± 0.1 | 0.2 ± 0.0 | 0.2 ± 0.0 | 0.2 ± 0.0 | 0.2 ± 0.0 | 0.2 ± 0.0 | 0.2 ± 0.0 | 0.56 |
References
- Scott, C.E.H.; Howie, C.R.; MacDonald, D.; Biant, L.C. Predicting dissatisfaction following total knee replacement: A prospective study of 1217 patients. J. Bone Jt. Surg. Br. 2010, 92, 1253–1258. [Google Scholar] [CrossRef] [PubMed]
- Ben-Shlomo, Y.; Blom, A.; Boulton, C.; Brittain, R.; Clark, E.; Craig, R.; Dawson-Bowling, S.; Deere, K.; Esler, C.; Espinoza, O.; et al. The National Joint Registry 17th Annual Report; National Joint Registry: London, UK, 2020. [Google Scholar]
- Shervin, D.; Pratt, K.; Healey, T.; Nguyen, S.; Mihalko, W.M.; El-Othmani, M.M.; Saleh, K.J. Anterior knee pain following primary total knee arthroplasty. World J. Orthop. 2015, 6, 795–803. [Google Scholar] [CrossRef] [PubMed]
- Khan, M.; Osman, K.; Green, G.; Haddad, F.S. The epidemiology of failure in total knee arthroplasty: Avoiding your next revision. Bone Joint J. 2016, 98-B, 105–112. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Petersen, W.; Rembitzki, I.V.; Brüggemann, G.-P.; Ellermann, A.; Best, R.; Koppenburg, A.G.; Liebau, C. Anterior knee pain after total knee arthroplasty: A narrative review. Int. Orthop. 2013, 38, 319–328. [Google Scholar] [CrossRef] [Green Version]
- Scuderi, G.R.; Insall, J.N.; Scott, N.W. Patellofemoral pain after total knee arthroplasty. J. Am. Acad. Orthop. Surg. 1994, 2, 239–246. [Google Scholar] [CrossRef]
- Ghosh, K.M.; Merican, A.M.; Iranpour, F.; Deehan, D.J.; Amis, A.A. The effect of overstuffing the patellofemoral joint on the extensor retinaculum of the knee. Knee. Surg. Sports Traumatol. Arthrosc. 2009, 17, 1211–1216. [Google Scholar] [CrossRef]
- Fitzpatrick, C.K.; Kim, R.H.; Ali, A.A.; Smoger, L.M.; Rullkoetter, P.J. Effects of resection thickness on mechanics of resurfaced patellae. J. Biomech. 2013, 46, 1568–1575. [Google Scholar] [CrossRef]
- Kim, J.H.; Yoo, B.-W.; Kim, A.C.-W. Influence of the rotational alignment of the femoral and patellar components on patellar tilt in total knee arthroplasty. Knee Surg. Relat. Res. 2015, 27, 163–167. [Google Scholar] [CrossRef] [Green Version]
- Mannen, E.M.; Ali, A.A.; Dennis, D.A.; Haas, B.D.; Rullkoetter, P.J.; Shelburne, K.B. Influence of Component Geometry on Patellar Mechanics in Posterior-Stabilized Rotating Platform Total Knee Arthroplasty. J. Arthroplast. 2019, 34, 974–980. [Google Scholar] [CrossRef]
- Ali, A.A.; Mannen, E.M.; Rullkoetter, P.J.; Shelburne, K.B. In vivo comparison of medialized dome and anatomic patellofemoral geometries using subject-specific computational modeling. J. Orthop. Res. 2018, 36, 1910–1918. [Google Scholar] [CrossRef]
- Emami, M.; Ghahramani, M.-H.; Abdinejad, F.; Namazi, H. Q-angle: An invaluable parameter for evaluation of anterior knee pain. Arch. Iran. Med. 2007, 10, 24–26. [Google Scholar]
- Noh, J.H.; Kim, N.Y.; Song, K.I. Intraoperative patellar maltracking and postoperative radiographic patellar malalignment were more frequent in cases of complete medial collateral ligament release in cruciate-retaining total knee arthroplasty. Knee Surg. Relat. Res. 2021, 33, 9. [Google Scholar] [CrossRef] [PubMed]
- Anglin, C.; Brimacombe, J.; Hodgson, A.; Masri, B.; Greidanus, N.; Tonetti, J.; Wilson, D. Determinants of patellar tracking in total knee arthroplasty. Clin. Biomech. 2008, 23, 900–910. [Google Scholar] [CrossRef] [PubMed]
- Longo, U.G.; Ciuffreda, M.; Mannering, N.; D’Andrea, V.; Cimmino, M.; Denaro, V. Patellar Resurfacing in Total Knee Arthroplasty: Systematic Review and Meta-Analysis. J. Arthroplast. 2018, 33, 620–632. [Google Scholar] [CrossRef] [PubMed]
- Heo, S.M.; Harris, I.; Naylor, J.; Lewin, A.M. Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry. BMC Musculoskelet. Disord. 2020, 21, 602. [Google Scholar] [CrossRef] [PubMed]
- Rex, E.L.; Gaudelli, C.; Illical, E.M.; Person, J.; Arlt, K.C.T.; Wylant, B.; Anglin, C. Guiding device for the patellar cut in total knee arthroplasty: Design and validation. Bioengineering 2018, 5, 38. [Google Scholar] [CrossRef] [Green Version]
- White, P.B.; Sharma, M.; Siddiqi, A.; Satalich, J.R.; Ranawat, A.S.; Ranawat, C.S. Role of anatomical patella replacement on anterior knee pain. J. Arthroplast. 2019, 34, 887–892. [Google Scholar] [CrossRef]
- Ledger, M.; Shakespeare, D.; Scaddan, M. Accuracy of patellar resection in total knee replacement: A study using the medial pivot knee. Knee. 2005, 12, 13–19. [Google Scholar] [CrossRef]
- Xie, X. Effect of Patellar Component Thickness on Patellar Kinematics and Patellofemoral Joint Function Following Total Knee Replacement. Ph.D. Thesis, Clemson University, Clemson, SC, USA, 1 August 2014. [Google Scholar]
- Ranawat, A.S.; Ranawat, C.S.; White, P.B. Fixed Bearings versus Rotating Platforms in Total Knee Arthroplasty. J. Knee Surg. 2015, 28, 358–362. [Google Scholar] [CrossRef]
- Heesterbeek, P.; Beumers, M.; Jacobs, W.; Havinga, M.; Wymenga, A. A comparison of reproducibility of measurement techniques for patella position on axial radiographs after total knee arthroplasty. Knee 2007, 14, 411–416. [Google Scholar] [CrossRef]
- Konno, T.; Onodera, T.; Nishio, Y.; Kasahara, Y.; Iwasaki, N.; Majima, T. Correlation between knee kinematics and patellofemoral contact pressure in total knee arthroplasty. J. Arthroplast. 2014, 29, 2305–2308. [Google Scholar] [CrossRef] [PubMed]
- Clement, N.D.; Bardgett, M.; Weir, D.; Holland, J.; Gerrand, C.; Deehan, D. Three groups of dissatisfied patients exist after total knee arthroplasty: Early, persistent and late. Bone Jt. J. 2018, 100-B, 161–169. [Google Scholar] [CrossRef] [PubMed]
- Kim, S.J.; Bamne, A.; Song, Y.D.; Kang, Y.G.; Kim, A.T.K. Patients still wish for key improvements after total knee arthroplasty. Knee Surg. Relat. Res. 2015, 27, 24–33. [Google Scholar] [CrossRef] [PubMed]
- Wang, Z.; Wen, L.; Zhang, L.; Ma, D.; Dong, X.; Qu, T. Undercoverage of lateral trochlear resection is correlated with the tibiofemoral alignment parameters in kinematically aligned TKA: A retrospective clinical study. BMC Musculoskelet. Disord. 2021, 22, 196. [Google Scholar] [CrossRef]
- Plate, J.F.; Seyler, T.M.; Halvorson, J.J.; Santago, A.C.; Lang, J.E. Non-anatomical capsular closure of a standard parapatellar knee arthrotomy leads to patellar maltracking and decreased range of motion: A cadaver study. Knee Surg. Sports Traumatol. Arthrosc. 2013, 22, 543–549. [Google Scholar] [CrossRef]
Quadrant | Combined Knees | Specimen 1 | Specimen 2 |
---|---|---|---|
Medial | 9.2 ± 11.6 | 0.6 ± 0.8 | 17.8 ± 10.9 |
Lateral | 28.8 ± 13.0 | 40.6 ± 5.0 | 17.0 ± 3.9 |
Superior | 6.4 ± 5.6 | 11.5 ± 1.7 | 1.3 ± 1.4 |
Inferior | 1.0 ± 1.0 | 0.2 ± 0.0 | 1.8 ± 0.9 |
Quadrant | Native | TKR | p-Value |
---|---|---|---|
Medial | 9.2 ± 11.6 | 0.6 ± 0.6 | 0.021 * |
Lateral | 28.8 ± 13.0 | 38.5 ± 26.7 | 0.139 |
Superior | 6.4 ± 5.6 | 3.0 ± 2.9 | 0.011 * |
Inferior | 1.0 ± 1.0 | 2.0 ± 2.7 | 0.178 |
Quadrant | 6 mm Neutral | 7 mm Neutral | 8 mm Neutral | 9 mm Neutral | p-Value |
---|---|---|---|---|---|
Medial: | 0.6 ± 0.6 | 13.0 ± 22.9 | 14.1 ± 23.8 | 2.8 ± 3.6 | <0.001 * |
Lateral: | 38.5 ± 26.7 | 42.6 ± 25.6 | 47.0 ± 29.8 | 67.5 ± 40.6 | <0.001 * |
Superior: | 3.0 ± 2.9 | 7.5 ± 4.6 | 7.5 ± 5.4 | 9.6 ± 6.3 | <0.001 * |
Inferior: | 2.0 ± 2.7 | 1.6 ± 1.8 | 3.8 ± 4.3 | 3.9 ± 4.1 | 0.004 * |
Quadrant | Medial Orientation | Lateral Orientation | Superior Orientation | Inferior Orientation | p-Value |
---|---|---|---|---|---|
Medial: | 2.6 ± 3.4 | 2.5 ± 3.8 | 12.7 ± 22.2 | 8.9 ± 8.6 | <0.001 * |
Lateral: | 24.7 ± 11.1 | 26.5 ± 9.1 | 25.2 ±14.1 | 25.4 ± 15.1 | <0.001 * |
Superior: | 2.7 ± 4.0 | 2.8 ± 1.8 | 3.0 ± 2.6 | 1.6 ± 2.0 | <0.001 * |
Inferior: | 2.2 ± 3.0 | 0.8 ± 1.0 | 0.7 ± 0.7 | 1.6 ± 2.0 | <0.001 * |
Quadrant | Pre-Cut | Post-Cut | p-Value |
---|---|---|---|
Medial: | 13.3 ± 15.3 | 15.4 ± 13.0 | 0.281 |
Lateral: | 33.5 ± 15.7 | 15.7 ± 9.7 | 0.002 * |
Superior: | 7.6 ± 9.3 | 10.5 ± 2.9 | 0.249 |
Inferior: | 2.5 ± 2.2 | 4.9 ± 3.6 | 0.031 * |
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Brivio, A.; Barrett, D.; Gong, M.F.; Watson, A.; Naybour, S.; Plate, J.F. Dynamic Measurement of Patellofemoral Compression Forces: A Novel Method for Patient-Specific Patella Resurfacing in Total Knee Replacement. Appl. Sci. 2022, 12, 10584. https://doi.org/10.3390/app122010584
Brivio A, Barrett D, Gong MF, Watson A, Naybour S, Plate JF. Dynamic Measurement of Patellofemoral Compression Forces: A Novel Method for Patient-Specific Patella Resurfacing in Total Knee Replacement. Applied Sciences. 2022; 12(20):10584. https://doi.org/10.3390/app122010584
Chicago/Turabian StyleBrivio, Angela, David Barrett, Matthew F. Gong, Annabel Watson, Susie Naybour, and Johannes F. Plate. 2022. "Dynamic Measurement of Patellofemoral Compression Forces: A Novel Method for Patient-Specific Patella Resurfacing in Total Knee Replacement" Applied Sciences 12, no. 20: 10584. https://doi.org/10.3390/app122010584
APA StyleBrivio, A., Barrett, D., Gong, M. F., Watson, A., Naybour, S., & Plate, J. F. (2022). Dynamic Measurement of Patellofemoral Compression Forces: A Novel Method for Patient-Specific Patella Resurfacing in Total Knee Replacement. Applied Sciences, 12(20), 10584. https://doi.org/10.3390/app122010584