Jason P.

Department of Mechanical and Materials Engineering, Computational Biomechanics Laboratory, University of Denver, 2390 South York, Denver, CO 80208

Chadd W. Clary Lorin P. Maletsky
Department of Mechanical Engineering, University of Kansas, 1530 W 15th Street, Lawrence, KS 66045

Verification of Predicted Knee Replacement Kinematics During Simulated Gait in the Kansas Knee Simulator
Evaluating total knee replacement kinematics and contact pressure distributions is an important element of preclinical assessment of implant designs. Although physical testing is essential in the evaluation process, validated computational models can augment these experiments and efficiently evaluate perturbations of the design or surgical variables. The objective of the present study was to perform an initial kinematic verification of a dynamic finite element model of the Kansas knee simulator by comparing predicted tibioand patellofemoral kinematics with experimental measurements during force-controlled gait simulation. A current semiconstrained, cruciate-retaining, fixed-bearing implant mounted in aluminum fixtures was utilized. An explicit finite element model of the simulator was developed from measured physical properties of the machine, and loading conditions were created from the measured experimental feedback data. The explicit finite element model allows both rigid body and fully deformable solutions to be chosen based on the application of interest. Six degrees-of-freedom kinematics were compared for both tibio- and patellofemoral joints during gait loading, with an average root mean square (rms) translational error of 1.1 mm and rotational rms error of 1.3 deg. Model sensitivity to interface friction and damping present in the experimental joints was also evaluated and served as a secondary goal of this paper. Modifying the metal-polyethylene coefficient of friction from 0.1 to 0.01 varied the patellar flexion-extension and tibiofemoral anterior-posterior predictions by 7 deg and 2 mm, respectively, while other kinematic outputs were largely insensitive. DOI: 10.1115/1.4001678 Keywords: TKR, finite element model, kinematics, knee mechanics, contact mechanics

Mark Taylor
Bioengineering Sciences Research Group, University of Southampton, Southampton SO17 1BJ, UK

Anthony J. Petrella
DePuy, a Johnson & Johnson Company, 700 Orthopaedic Drive, Warsaw, IN 46581

Paul J. Rullkoetter1
Department of Mechanical and Materials Engineering, Computational Biomechanics Laboratory, University of Denver, 2390 South York, Denver, CO 80208 e-mail: prullkoe@du.edu



Characterizing kinematics and contact stresses in total knee replacements can lend insight into potential clinical performance. Experimental knee simulators have been developed to quantify the total knee replacement kinematics as well as the resulting polyethylene wear. Physical knee wear simulators have generally included multiple stations with tibial and femoral replacement components 1,2 . In addition, single station hip- and ankle-loaded test frames have been developed and typically include both tibio- and patellofemoral articulations 3–6 . Although these simulators are used for evaluation of implant mechanics, parametric evaluation of the implant geometry, alignment, or loading conditions is generally too time consuming and expensive to fit within the design phase of development. Investigating variations in the implant geometry is especially costly due to the requirement of producing physical prototypes. Given the time constraints, implant designers have integrated validated computational models as a viable alternative because of the ease with which geometry, relative alignment, or loading variables can be modified. Many models of the total knee replacement
1 Corresponding author. Contributed by the Bioengineering Division of ASME for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING. Manuscript received September 25, 2006; final manuscript received April 6, 2010; accepted manuscript posted April 28, 2010; published online July 1, 2010. Assoc. Editor: Avinash Patwardhan.

articulation have been formulated using finite element or rigid body dynamics methods 7–11 . Recently, explicit finite element models of the total knee replacement that simultaneously predict joint kinematics and contact mechanics have been developed and verified by direct comparison with kinematics data from forcecontrolled joint simulators 12,13 . In these explicit finite element analyses, tibiofemoral kinematics, and contact pressure and area were predicted during gait loading, and anterior-posterior A-P translation and internal-external I-E rotation were in good agreement with experimental measurements. The explicit finite element models are unique in that a fully deformable or rigid body representation of the implant may be used. It was previously shown that for gait loading, rigid body analyses predicted relative kinematics and contact pressures that were good estimates of fully deformable analyses, and required only a fraction of the time approximately 6 min compared with 6–8 h 13 . However, if internal stresses/strains are desired, a fully deformable representation must be analyzed. In addition to the tibiofemoral modeling, verification of isolated patellofemoral kinematics was performed using experimental data from the hipand ankle-loaded Purdue knee simulator 13 . In these prior models 13 , each articulation was developed and verified independently, and thus, there was no verification of the predicted kinematics during simultaneous tibio- and patellofemoral loadings. As the tibio- and patellofemoral mechanics are interdependent 14–19 , simultaneous kinematic prediction is critical AUGUST 2010, Vol. 132 / 081010-1

Journal of Biomechanical Engineering

Copyright © 2010 by ASME

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and the required quadriceps force was measured at the tibial tuberosity attachment. adduct or abduct.42. Loading between cycles was very consistent with variations for each experimental cycle within 1% of the average. the articular surface of the implant was lubricated with petroleum jelly.and patellofemoral kinematics were measured using an Optotrak system Northern Digital. and neutrally aligned with the tibial component in the anterior-posterior and medial-lateral directions. The domed patellar component was mounted flush with the Kevlar strap used in the extensor mechanism and adjusted to lie in the center of the trochlear groove at the start of the experiments. Waterloo. Redistribution subject to ASME license or copyright.” and a medial-lateral force and tibial torque about a vertical axis at the “ankle” Fig. 1 . Applied loads and flexion angle are represented by arrows. For this study. 0–60% gait cycle represents stance phase „0% equals heal strike… and 60–100% gait cycle represents the swing phase. a Johnson & Johnson company. perpendicular to the long axis. quadriceps load. Thus. internal-external torque. 10 experimental cycles were run and averaged to obtain the input profiles for the finite element model. The experimental system is briefly described here. for accurate evaluation of the total knee replacement components. 2 .and ankle-loaded Kansas knee simulator KKS . the total knee replacement components were mounted in aluminum fixtures to ensure a known. Physical dimensions. The hip joint allows flexion-extension and inferiorsuperior motions. a Kevlar® band . This mechanical arrangement allows the ankle joint to flex and extend.and patellofemoral kinematics during simulated gait loading using a dynamic finite element model of the hip. The femoral component was aligned with 0 deg external. while the linear sled can translate in the medial-lateral direction and allow varus-valgus rotation at the knee. The Optotrak system utilizes infrared emitting diodes IRED to track the rigid body motion of the femur. The KKS is a servohydraulic system that uses actuators to impart a vertical force at the “hip. more detailed information may be found in Ref. In total.asme.org/terms/Terms_Use. and tibia for the Transactions of the ASME Downloaded 27 Jul 2011 to 147. Warsaw. 132. Fixtured brackets were machined to mount the implant. Tibio. with the first and last cycles not included. The same is true for all figures with percent gait cycle on the abscissa. The quadriceps actuator was operated in displacement control to duplicate a specified hip flexion angle profile Fig. and 0 deg internal-external and varus-valgus rotations as referenced from the flat distal surface of the insert and axes of symmetry.Fig. Before each test.1 Experimental Kinematic Analysis. Experimental kinematic analysis was performed using the KKS with a current fixedbearing. For displacement degrees of freedom.46. The fixtured analysis was chosen to isolate the constraint provided by the implant and to evaluate the finite element model representation without the uncertainty introduced by testing implanted cadavers. The quadriceps actuator is aligned to recreate an ap081010-2 / Vol. the goal of the present study was to perform an initial comparison of the predicted and experimental tibio. and adduction-abduction force. and varusvalgus rotations as referenced from the flat interior bone cut surfaces . semiconstrained posterior cruciate-retaining PCR total knee replacement PFC® Sigma size 3. 2 Methods 2. For this testing. The secondary objective of this study was to evaluate the sensitivity of the model predictions to the metal-polyethylene coefficient of friction and representation of damping in the physical joints of the experimental configuration. and centers of mass were measured from the simulator.230.cfm . A quadriceps actuator mounted on the femur balances the applied vertical load through the patellar tendon in the experiment. and is constrained in all other degrees of freedom. This study serves as an important step in the validation process of developing predictive computational tools for the evaluation of implant performance. IN during gait simulation. Distance from the ankle complex to the joint line is approximately 400 mm and from the joint line to the hip is 470 mm. Boundary conditions include the axial load. actuator loading profiles were utilized to recreate level gait 20 . Ontario. The tibial component was aligned with 0 deg posterior tilt. carefully controlled loading environment. 6 . 1 Experimental Kansas knee simulator „left… and finite element representation with implant mesh „right…. masses. Canada . hip flexion angle. The ankle complex on the simulator is a universal joint mounted on a linear sled. the tibial component geometric center was placed in the center of the long axis of the aluminum fixture representing the tibia. DePuy. and rotate internally or externally. see http://www. mass moments of inertia. patella. AUGUST 2010 propriate q-angle 7 deg . 2 Applied loading and flexion angle as a function of the gait cycle. flexion. Fig. Force and displacement feedback data for each actuator was recorded throughout the testing to obtain accurate input profiles for the corresponding finite element models.

Three-dimensional. Journal of Biomechanical Engineering Fig.3 Computational Kinematic Analysis. axial load.1. A three-cylindric model of knee motion was utilized to describe the six degrees-of-freedom DOF relative kinematics of the tibioand patellofemoral articulations 21 . The ankle joint accommodates flexionextension. All other femoral degrees of freedom were constrained.46. To allow for comparison of the experimental and model kinematics. with ranges of less than 2.08. see http://www. and internal-external rotations.230. the embedded coordinate frames were placed in identical positions with respect to the components. the coefficient was increased in “coarse” of 0. and quadriceps load. Rigid body analysis with an optimized pressure-overclosure relationship was used in this study 22 . tibial torque.cfm .01 N s/mm was subsequently evaluated to obtain the final nominal damping value. Translational and rotational joint element combinations were used to model the machine ankle and hip joints.09 deg and 0. RI from computeraided design CAD models of the implant and the measured physical properties of the simulator Fig. The finite element model of the KKS was developed in ABAQUS™/Explicit Abaqus. Output kinematics were averaged for the middle 8 cycles. Element edge lengths were approximately 1.and patellofemoral kinematics were not substantially affected. and insert were represented using nodes. A subsequent sensitivity study demonstrated that the I-E prediction during this 15% of the cycle was sensitive to damping at the ankle. 2. For the deformable analyses. rigid analysis shown .org/terms/Terms_Use. contact forces are defined as a function of the penetration of the master surface into the slave surface.000 three-dimensional. medial-lateral. 3 Results 3. while the adductionabduction load and torque were applied at the ankle.asme. Patellofemoral rotations include flexion-extension. both tibio. while deformable analyses were performed to verify rigid body kinematic predictions.7 mm for the patella button. Using the coarse grid results. Previous mesh density studies verified convergence for contact pressure and stress results 13 . Inc. masses. eight-noded brick finite elements were used to represent the polyethylene tibial insert and patellar button. and describe the relative motions as three rotations and three translations. Providence. 3.test cycles. As a result.53 N s/mm at the ankle eliminated the oscillation during the swing phase and are shown AUGUST 2010.and patellofemoral . The measured lengths. The quadriceps tendon and patellar ligament were attached to the anterior side of the patellar button and approximated the stiffness of the Kevlar® band used. 3 . Model-predicted and experimental tibiofemoral flexions achieved a rms error of less than 0. Contact pressure and area were also monitored throughout the finite element simulations. the hip sled was allowed to translate in the inferior-superior direction and rotate in flexion-extension. adduction-abduction load. To evaluate the sensitivity of the model to friction at the metal-polyethylene interface. and the experimental results represent 8 averaged cycles. the coefficient of friction was varied from 0. a nonlinear elastic-plastic material model was used for the elements representing the polyethylene tibial insert and patellar button 23 . rigid triangular elements. The finite element model was run using boundary conditions to replicate the experimental loading.45 deg for either rigid or deformable representations Fig. with 16.14 mm realized between cycles. these parameters are difficult to obtain. Patellar translations were described simply as the inferiorsuperior. internal-external tilt. The femoral component was modeled using approximately 21. and inertial properties of the experimental simulator were included in the finite element model. implement the model of knee motion.000 elements for the patellar button. femur. Although friction and damping are present in the complex experimental joints.42. the root mean square error was calculated for each degree of freedom.. A post-processing script was used to interface with the output databases of the finite element models. and is attached to a linear connector that allows medial-lateral translation. The axial load and hip flexion angle were applied at the hip. Predicted I-E tibiofemoral rotation with no damping in the model included a small oscillation between approximately 65% and 80% of the gait cycle when damping in the ankle joint was neglected . and the model was run initially without representation of these losses. 132 / 081010-3 Downloaded 27 Jul 2011 to 147. Embedded coordinate frames in the patellar button. adduction-abduction. 3. In order to accurately compare the kinematics between the model and experiment. Approximately 8000 elements were used to model the inserts. The extensor mechanism was modeled with a combination of connector elements. with insignificant variations standard deviations of 0. 2. The quadriceps actuator was modeled with a connector element to impart a force along its axis and simulate the action of the hydraulic actuator used in the experiment.1 Tibiofemoral Kinematics. As this degree of freedom is essentially controlled by the applied hip flexion angle. measured machine feedback was used for all inputs to the finite element model. and patellar spin. but no experimental data were available for comparison. Vol. and the experimental geometry not essential for the analysis was simplified. 3 Model and experimental tibiofemoral flexion „+…-extension „F-E… and varus „+…-valgus „V-V… rotations as a function of the gait cycle. which occurs about the long axis of the patella. Both experimental and predicted varus-valgus rotation of the knee resulting from the applied adduction-abduction force at the ankle were very small. which was described about the tibiofemoral flexion axis 24 .3 mm for the insert and 0.2 Finite Element Model of the Kansas Knee Simulator. 1 . The results represent a coefficient of friction of 0. Transformation data between each rigid body were then transformed into clinically relevant coordinate frames and described using a three-cylindric model of the joint motion 21 . a finer increment of 0.1 deg each Fig. In order to nominally damp this degree of freedom. Example results from an addition of nominal damping of 0. Small medial-lateral oscillation was observed at the ankle joint in these initial kinematic analyses. As in the experiment. and resulted in a range of knee flexion of approximately 60 deg Fig. and their positions were monitored throughout the gait cycle. Contact was modeled using a penalty-based method with a weight factor. this comparison is essentially a verification of the implementation of the anatomical coordinate frames and description of joint motion. a sensitivity study was performed to understand the sensitivity of the model to damping present at the medial-lateral sled. Redistribution subject to ASME license or copyright.05 N s/mm increments until the oscillation subsided. including the hip flexion angle. which occurs about a floating axis perpendicular to both the flexion and patellar long axes. but that the other tibio. rigid analysis shown . Hip flexion-extension was controlled. and anterior-posterior motions of the patella in the femoral anatomical frame.01 to 0. and subsequently.

Patellofemoral flexionextension proved to be sensitive to friction Figs.94 mm rigid body model using a coefficient of friction of 0. The experimental data achieved a range of 10. Model results for the tibiofemoral A-P motion were within 2 mm of the experimental data throughout the simulations for either rigid or deformable representations Fig.230. For the range tested.5 deg when compared with the experiment and a range of 12. the model underpredicted the experimental data during the swing phase. while the finite element model predictions ranged from 26 deg to 34 deg.2 mm for the range of friction evaluated. AUGUST 2010 Transactions of the ASME Downloaded 27 Jul 2011 to 147. 7 Experimental and model-predicted patellofemoral flexion „-…-extension as a function of the gait cycle using selected coefficient of friction values 081010-4 / Vol. The model and experimental tilt and spin were both less than 10 deg Fig.cfm . The tibiofemoral A-P data should not be thought of as the position of relative tibiofemoral contact. 3.4 mm and. The rms error values comparing the predicted and experimental data ranged from 0.42. Peak patellofemoral flexion occurred at the maximum flexion achieved by the model and experiment. all results are with a coefficient of friction of 0. Although the trend was captured for the internal tilt profile. 6 and 7 .2 Patellofemoral Kinematics.08 had a rms error of less than 0.01 to 0.8 mm. and varus spin.5 deg.44 mm when comparing the deformable and rigid body data. Data include rigid body analyses with zero and nominal ankle dampings. while the experimental I-E range was 14.Fig. the coefficient of friction for metal-polyethylene interaction did not affect the predicted tibiofemoral rotations results substantially. 132. 5 .5 mm rigid body model using a coefficient of friction of 0. 6 . the model-predicted ranges increased from 11 mm to 13 mm.2 deg. 5 Tibiofemoral anterior „-…-posterior „A-P… experimental and model-predicted displacement as a function of the gait cycle. Fig.08… Fig. The deformable analysis had a rms error of 1.08 „tibio. but as tibiofemoral motion along a floating axis perpendicular to both the femoral flexion axis and long axis of the tibia 21 .6 mm to 3. Very close agreement between the rigid body and deformable analyses allow the results to be representative of either analysis for the presented coefficient values. and represents a posterior motion of the femur with respect to the tibia femoral rollback . 4 . internal tilt. of 0. as the friction coefficient increased. The deformable analysis resulted in a range of 12 mm and a rms error.org/terms/Terms_Use. the peak patellofemoral flexion varied by nearly 7 deg A range of approximately 27 deg was measured in the experiment. The peak rotations of around 10 deg for all data sets represent an internal rotation of the tibia with respect to the femur. and were somewhat sensitive to the coefficient of friction.asme. The single deformable analysis performed with a coefficient of friction of 0. 4 Experimental and predicted tibiofemoral internal „+…-external „I-E… rotation as a function of the gait cycle.1 . Comparing the results between the rigid and deformable results shows differences primarily at the peak rotation peak rms error of up to 1. the maximum errors only increased from 1. Maximum A-P motion occurred at the deepest flexion achieved by the model and experiment. Fig. Redistribution subject to ASME license or copyright. Fig. For the range of the coefficient of friction studied. with respect to the experimental data. see http://www.and patellofemoral….2 deg.08…. While the A-P motion was sensitive to the tibiofemoral friction coefficient.46.4 deg . resulting in a rms error of 2. Plotted data include rigid body analysis with various friction values. as well as a deformable analysis with nominal ankle damping „all results are with a coefficient of friction of 0. and a deformable analysis with a coefficient of friction= 0. 6 Model and experimental patellofemoral rotations as a function of the gait cycle „+ rotations are extension.

including only damping at the ankle sled. which occurred near the highest internal-external torque and adduction-abduction force applications. 4 Discussion During the design phase of implant development. anterior. The fixtured analysis under controlled loading conditions was intentionally chosen to assess the ability of the computational methods to predict the interface motion.46. The range of medial-lateral shift was 6. and patella. The frictional characteristics at the interface were approximated with simple Coulomb friction. Ranges of approximately 13.4 deg. parametric evaluation of the geometric variables. the Kevlar band of the extensor mechanism was. The coefficient of friction had little effect on the tilt and spin rotational kinematic data. femur. demonstrating that the nonlinear pressure-overclosure rigid body estimations of joint mechanics reflect the results of a fully deformable model 22 . Although not as uncertain as determining landmark data on cadaveric specimens. This was likely in part due to the increase in friction. 8 Experimental and model-predicted patellofemoral translations as a function of the gait cycle „+ translations are superior.29 mm 25 . Vol. A potentially more significant source of error is the digitization of the anatomical landmarks used to develop the anatomical coordinate frames on the tibia. or loading conditions.cfm .67 deg.0 mm. and lateral… The predicted patellar spin captured the trend of the experimental data. for computational efficiency. 132 / 081010-5 Downloaded 27 Jul 2011 to 147.05 deg and a 95% repeatability limit of 0. the trends and relative magnitudes of the experiment were adequately captured with a simplified setup. Substantial uncertainty is present in modeling these parameters and results in large variability in the kinematic predictions.74 mm. Due to the complexity of measuring and including friction and damping parameters. 8 .5 mm for both experimental and model data were realized for the posterior translation of the patella. center of mass calculations were performed on CAD models of the geometry. In this study. good agreement was found between the experimental and model-predicted kinematics for both rigid body and deformable representations. The tibiofemoral anteriorposterior motion component increased with a higher friction coefficient. implant alignment. Verified computational tools can make an invaluable contribution during the design phase due to the efficiency in studying the effects of variable perturbations. Redistribution subject to ASME license or copyright. Model verification with cadaveric studies should only be undertaken once this study is completed. such as at the machine joints and bearings.0 mm. The ability to select either deformable or rigid body analysis is important to maximize analysis efficiency. The current study is in support of the previous verification.5 mm for the experimental data. a 10 deg rotation showed a bias of 0. In addition. with a rms error of 1. The coefficient of friction between the patella and the femur had only a small effect less than 1 mm on these translational results. comprehensive evaluation is not feasible due to the time required. thus creating greater posterior femoral relative translation greater femoral rollback . In general. A 10-mm translation showed a bias of 0. Although physical simulators are required to verify or validate the prototype designs. and subsequent probabilistic studies may be completed including uncertainty in the ligamentous properties and pretension. and to avoid the uncertainty present in the modeling of cadaveric specimens. Translational degrees of freedom averaged approximately 1 mm of the rms error. see http://www.86 mm Fig. For the current loading conditions. Journal of Biomechanical Engineering Maximum rotations and translations occurred in the experiment and the model at the deepest flexion the knee achieved with the only exception being tibiofemoral internal-external rotation. Given the conservative estimate of a stable time increment. Rms error for rotational degrees of freedom averaged near 2 deg. with a rms error of 1. creating an increased relative rolling component while decreasing the relative sliding. While some of these parameters will undoubtedly affect the numerical predictions. The range of inferior-superior translation of the patella with respect to the femur was approximately 34 mm for both experimental and model data.Fig. represented using several spring elements. While machine part masses were determined from the manufactured parts. the model included only losses at the joints necessary to minimize an oscillation seen in the predicted I-E motion near peak flexion. while the model predicted a range of 5. error in establishing the anatomical frames creates significant variability in reported kinematics 26 . the rigid body analysis was a good approximation of the kinematics predicted with a fully deformable analysis. and the resulting rms error was 0. and their effect on joint kinematics and contact stresses. specifically the unknown ligament pretensions and properties.42. resulting in a rms error of less than 1.asme.org/terms/Terms_Use. All peak translations occurred at the maximum flexion achieved by the model and the experiment. but the other degrees of freedom were generally not sensitive to friction. obscuring the assessment of the model to predict the interface kinematics. All experiment translational and rotational trends were captured with the model. Patellar flexion and tibiofemoral anterior-posterior motions were shown to be sensitive to the interface friction. and six degrees-offreedom motion was described and compared with finite element model predictions. There are a number of sources of potential error in comparing the experimental and predicted motions. experimental kinematic analysis was performed with a semiconstrained.03 mm and a 95% repeatability limit of 0. fixed-bearing implant. the deformable model run time was nearly a day on a AUGUST 2010.230. are of great interest to optimize the potential performance. For a typical setup with the Optotrak system used in the motion capture.

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