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Woodling_Katelyn_Masters_Thesis.pdf (4.46 MB)

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Developing a Passive Range of Motion Knee Simulation to Study the Effect of Total Knee Arthroplasty Component Alignment and Knee Laxity on Passive Kinematics

Woodling, Katelyn Elizabeth
http://rave.ohiolink.edu/etdc/view?acc_num=osu1417447069

Abstract Details

2014, Master of Science, Ohio State University, Mechanical Engineering.
Total knee arthroplasty (TKA) is the gold-standard end-stage treatment for advanced stage osteoarthritis (OA). While TKA is effective at restoring some function and relieving pain from OA, many patients still experience sub-optimal outcomes after surgery. Recovery after TKA is dependent on many variables, but numerous studies have suggested that outcomes are particularly sensitive to surgical technique. In particular, one of the most important decisions that the surgeon makes in the operating room is how to place the femoral and tibial components. There is currently much debate as to how to “correctly” place the components and the direct consequences of component placement on post-operative outcome are not well understood. Generally, it has been found that malrotation of the components in TKA can lead to post-operative pain, early prosthesis failure, and abnormal knee kinematics. To better understand how component placement in TKA influences patient movement after surgery, researchers use computer simulations. Previous studies have used computer simulations of weight-bearing movements to understand how changing component alignment changes knee kinematics. However, in weight-bearing movements, the knee experiences forces from the muscles crossing the joint and from external forces, both of which can alter knee kinematics. In contrast, studying passive movements may allow us to better understand how surgical decisions and prostheses design in particular affect how the knee moves. The main tool that a surgeon has in the operating room to assess how the patient will be able to move their knee post-operatively is a passive range of motion test. However, objective measurements are commonly not taken during this procedure and the surgeon uses his hands to decide if the TKA components move “well”. For this reason, I developed and validated a subject-specific forward dynamic simulation of an intraoperative passive range of motion test. Once validated, I used this model to study the effects of component alignment (in the coronal, sagittal, and transverse planes) and the global knee laxity on knee varus/valgus angle, internal/external angle, and anterior/posterior translation throughout a passive range of motion test. With the results from these simulations, I ran two statistical analyses: 1) to predict the range of the following biomechanical variables: varus/valgus angle, internal/external angle, and anterior and posterior translation of the femur on the tibia, throughout the passive range of motion, and 2) to predict the varus/valgus angle, internal/external angle, or anterior/posterior translation at any flexion angle given the orientations of the components in 3 planes and the global knee laxity. I found that the orientation of the femoral component in the sagittal plane had the greatest overall effect on the biomechanical variables of interest. I also determined that the alignment of the femoral component in the transverse plane more greatly affected knee kinematics than tibial component alignment. Using the results of my statistical analysis we were able to make a mathematical model which could be used as a time-efficient alternative to simulation-based studies. The results of this thesis may one day aid surgeons in determining component alignments in TKA which give the most favorable patient outcomes.
Robert Siston, Dr. (Advisor)
Ajit Chaudhari, Dr. (Committee Member)
131 p.
Biomechanics; Biomedical Engineering; Biomedical Research; Mechanical Engineering
Total Knee Arthroplasty; osteoarthritis; knee kinematics; passive range of motion; component placement; surgical technique

Recommended Citations

Citations

  • Woodling, K. E. (2014). Developing a Passive Range of Motion Knee Simulation to Study the Effect of Total Knee Arthroplasty Component Alignment and Knee Laxity on Passive Kinematics [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1417447069

    APA Style (7th edition)

  • Woodling, Katelyn. Developing a Passive Range of Motion Knee Simulation to Study the Effect of Total Knee Arthroplasty Component Alignment and Knee Laxity on Passive Kinematics. 2014. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1417447069.

    MLA Style (8th edition)

  • Woodling, Katelyn. "Developing a Passive Range of Motion Knee Simulation to Study the Effect of Total Knee Arthroplasty Component Alignment and Knee Laxity on Passive Kinematics." Master's thesis, Ohio State University, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=osu1417447069

    Chicago Manual of Style (17th edition)

osu1417447069
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This open access ETD is published by The Ohio State University and OhioLINK.