Initial stability of a modular uncemented, porous-coated femoral stem: a mechanical study

A versatile modular hip system was used to evaluate the initial stability of a cementless femoral stem in anatomically consistent composite bones. Four implant bone configurations of varying proximal and distal fit/fill were tested. The implanted femurs were tested on an Instron 1331 materials testing machine in neutral loading and flexion loading; both translational micromotions and rotations of the implant relative to the bone were recorded on all three axes of motion, accounting for all 6 degrees of freedom of joint motion. Implants were then sectioned, and both endosteal canal fit and intramedullary canal fill were measured. Results indicate that (1) loading the implant in flexion by out-of-plane forces significantly increases both relative translation and rotation at the interface, (2) increasing the proximal fit reduces implant rotation about its longitudinal axis in flexion loading and (3) increasing the distal canal fit and fill increases prosthesis rotation about its longitudinal axis in flexion loading. These results indicate that the femoral stem is more unstable in out-of-plane loading, such as during stair climbing, and that increasing the proximal fit may enhance the initial rotational stability of an uncemented femoral stem.     

The axes of rotation of the knee

Knee motion is believed to occur about a variable flexion-extension (FE) axis perpendicular to the sagittal plane and a longitudinal rotation (LR) axis. The authors used a mechanical device to locate the FE and the LR axes of six fresh anatomic specimen knees. The motion of points on the LR axis produced circular, planar paths about the fixed FE axis. Magnetic resonance (MR) images in planes perpendicular to the FE axis showed a circular profile for the femoral condyles. The FE axis is constant and directed from anterosuperior on the medial side to posteroinferior on the lateral side, passing through the origins of the medial and lateral collateral ligaments and superior to the crossing point of the cruciates. The LR axis is anterior and not perpendicular to the FE axis, the anatomic planes. This offset produces the valgus and external rotation observed with extension. The implications of two fixed offset axes for knee motion on prosthetic design, braces, gait analysis, and reconstructive surgery are profound.     

The effect of femoral component position on the kinematics of total knee arthroplasty

In a laboratory study using seven fresh-frozen anatomic specimen knees, the effect of total knee arthroplasty on the three-dimensional kinematics of the patella, femur, and tibia were measured. Experiments were performed in the intact knee, after division of the anterior cruciate ligament (ACL), after total knee arthroplasty, and after 10 degrees internal rotation, 10 degrees external rotation, 5-mm medial shift, and 5-mm lateral shift of the femoral component on the femur. The presence of a high lateral ridge on the anterior surface of the femoral component effectively prevented patellar subluxation or dislocation, but displaced and tilted the patella medially. Internal rotation or medial displacement of the femoral component exaggerated this medial patellar displacement and shift. External rotation of the femoral component corrected it, except at flexion angles greater than 100 degrees, where the femur was shifted medially on the tibia and externally rotated 15 degrees. This combination produced a net 10-mm medial displacement of the patella relative to the tibia at 120 degrees knee flexion. Lateral placement of the femoral component compensated for the effect of the high lateral ridge and allowed more normal patellar tracking while allowing tibiofemoral motions similar to those seen after sectioning of the ACL. The kinematics of the patellofemoral and tibiofemoral joints were not reproduced with a total knee prosthesis that sacrifices the ACL. When using a prosthesis with a high lateral ridge, lateral placement of a femoral component prevented patellar dislocation and allowed patellar tracking patterns similar to those seen in the intact knee without further altering tibiofemoral motions.     

Ligaments and articular contact guide passive knee flexion

The aim of this study was to test the hypothesis that the coupled features of passive knee flexion are guided by articular contact and by the isometric fascicles of the ACL, PCL and MCL. A three-dimensional mathematical model of the knee was developed, in which the articular surfaces in the lateral and medial compartments and the isometric fascicles in the ACL, PCL and MCL were represented as five constraints in a one degree-of-freedom parallel spatial mechanism. Mechanism analysis techniques were used to predict the path of motion of the tibia relative to the femur. Using a set of anatomical parameters obtained from a cadaver specimen, the model predicts coupled internal rotation and ab/adduction with flexion. These predictions correspond well to measurements of the cadaver specimen's motion. The model also predicts posterior translation of contact on the tibia with flexion. Although this is a well-known feature of passive knee flexion, the model predicts more translation than has been reported from experiments in the literature. Modelling of uncertainty in the anatomical parameters demonstrated that the discrepancy between theoretical predictions and experimental measurement can be attributed to parameter sensitivity of the model. This study shows that the ligaments and articular surfaces work together to guide passive knee motion. A principal implication of the work is that both articular surface geometry and ligament geometry must be preserved or replicated by surgical reconstruction and replacement procedures to ensure normal knee kinematics and by extension, mechanics.     

Perceived orientation of axis of rotation in structure-from-motion

Perceived orientation of axis of rotation and accuracy in discriminating fixed-axis from nonfixed-axis rotations were investigated for orthographic projections of three-dimensional rotating objects. The principal findings were (a) the slant of the axis of rotation was systematically misperceived; (b) in both two-view and multiview displays, the perceived slant of the axis of rotation was well-predicted by the ratio between the deformation (a property of the first-order optic flow) and the component parallel to the image plane of the global velocity vector; (c) if this ratio was kept constant in each frame transition of the stimulus sequence (or it was varied), then the stimuli tended to be judged as fixed-axis rotations (or as nonfixed-axis rotations), regardless of whether they simulated a fixed-axis rotation or not; and (d) the tilt of the axis of rotation was perceived in two-view displays with a very small error.     

Perceived orientation of axis rotation in structure-from-motion.

Perceived orientation of axis of rotation and accuracy in discriminating fixed-axis from nonfixed-axis rotations were investigated for orthographic projections of three-dimensional rotating objects. The principal findings were (1) the slant of the axis of rotation was systematically misperceived; (2) in both two-view and multiview displays, the perceived slant of the axis of rotation was well-predicted by the ratio between the deformation (a property of the first-order optic flow) and the component parallel to the image plane of the global velocity vector; (3) if this ratio was kept constant in each frame transition of the stimulus sequence (or it was varied), then the stimuli tended to be judged as fixed-axis rotations (or as nonfixed-axis rotations), regardless of whether they simulated a fixed-axis rotation or not; and (4) the tilt of the axis of rotation was perceived in two-view displays with a very small error. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Femoral condyle geometry in the normal and varus knee

Femoral condyle geometry was evaluated in 30 normal and 30 varus knees using magnetic resonance imaging. In the sagittal view, the distal part of the medial condyle was deformed in the varus knees, but there was no significant difference in the posterior part of the medial condyle between the normal and varus knees. In the transverse view, the transepicondylar axis (a reliable rotational landmark) showed approximately 6 degrees external rotation relative to the posterior condylar axis in the varus knees and the normal knees. The results of this study suggest that no hypoplasia exists at the posterior part of the medial condyle in varus knees. In addition, the posterior condylar axis may be a reliable rotational landmark but is in relative internal rotation in varus knees when total knee arthroplasty is performed.     

Three-dimensional organization of otolith-ocular reflexes in rhesus monkeys. I. Linear acceleration responses during off-vertical axis rotation

1. The dynamic properties of otolith-ocular reflexes elicited by sinusoidal linear acceleration along the three cardinal head axes were studied during off-vertical axis rotations in rhesus monkeys. As the head rotates in space at constant velocity about an off-vertical axis, otolith-ocular reflexes are elicited in response to the sinusoidally varying linear acceleration (gravity) components along the interaural, nasooccipital, or vertical head axis. Because the frequency of these sinusoidal stimuli is proportional to the velocity of rotation, rotation at low and moderately fast speeds allows the study of the mid-and low-frequency dynamics of these otolith-ocular reflexes. 2. Animals were rotated in complete darkness in the yaw, pitch, and roll planes at velocities ranging between 7.4 and 184 degrees/s. Accordingly, otolith-ocular reflexes (manifested as sinusoidal modulations in eye position and/or slow-phase eye velocity) were quantitatively studied for stimulus frequencies ranging between 0.02 and 0.51 Hz. During yaw and roll rotation, torsional, vertical, and horizontal slow-phase eye velocity was sinusoidally modulated as a function of head position. The amplitudes of these responses were symmetric for rotations in opposite directions. In contrast, mainly vertical slow-phase eye velocity was modulated during pitch rotation. This modulation was asymmetric for rotations in opposite direction. 3. Each of these response components in a given rotation plane could be associated with an otolith-ocular response vector whose sensitivity, temporal phase, and spatial orientation were estimated on the basis of the amplitude and phase of sinusoidal modulations during both directions of rotation. Based on this analysis, which was performed either for slow-phase eye velocity alone or for total eye excursion (including both slow and fast eye movements), two distinct response patterns were observed: 1) response vectors with pronounced dynamics and spatial/temporal properties that could be characterized as the low-frequency range of "translational" otolith-ocular reflexes; and 2) response vectors associated with an eye position modulation in phase with head position ("tilt" otolith-ocular reflexes). 4. The responses associated with two otolith-ocular vectors with pronounced dynamics consisted of horizontal eye movements evoked as a function of gravity along the interaural axis and vertical eye movements elicited as a function of gravity along the vertical head axis. Both responses were characterized by a slow-phase eye velocity sensitivity that increased three- to five-fold and large phase changes of approximately 100-180 degrees between 0.02 and 0.51 Hz. These dynamic properties could suggest nontraditional temporal processing in utriculoocular and sacculoocular pathways, possibly involving spatiotemporal otolith-ocular interactions. 5. The two otolith-ocular vectors associated with eye position responses in phase with head position (tilt otolith-ocular reflexes) consisted of torsional eye movements in response to gravity along the interaural axis, and vertical eye movements in response to gravity along the nasooccipital head axis. These otolith-ocular responses did not result from an otolithic effect on slow eye movements alone. Particularly at high frequencies (i.e., high speed rotations), saccades were responsible for most of the modulation of torsional and vertical eye position, which was relatively large (on average +/- 8-10 degrees/g) and remained independent of frequency. Such reflex dynamics can be simulated by a direct coupling of primary otolith afferent inputs to the oculomotor plant. (ABSTRACT TRUNCATED)     

A repeatable alignment method and local coordinate description for knee joint testing and kinematic measurement

A method for aligning cadaver knee specimens to a mechanical testing rig and determining local anatomical coordinate systems using landmarks identifiable on plane X-rays is introduced. Three sequential rotational alignments arc used to position the femur and tibia relative to the coordinate system of the testing mechanism. To validate this methodology five independent observers aligned the same knee specimen. The maximum error in the alignment orientations of the tibia and femur was 2.2 from the mean. These small misalignments produced variations of up to 4.7 in tibio-femoral rotations measured during knee flexion. Kinematic measurements of 15 specimens aligned using this procedure indicate that knee alignment is reproducible and physiologically relevant.     

The effects of graft rotation on attachment site separation distances in anterior cruciate ligament reconstruction

We created a model to see if twisting the graft in an anterior cruciate ligament reconstruction affected the distance separating the femoral and tibial attachments of the perimeter fibers of a patellar tendon graft. Graft bone plugs were simulated by two 12.5-mm diameter Delrin cylinders. Holes, 1 mm in diameter, were placed at the four corners of a centralized rectangle measuring 5 by 10 mm. Graft ligament fibers were represented by color-coded sutures passed through the holes in the modeled bone plugs. This graft model was fixed in tunnels reamed under arthroscopic guidance at the anterior cruciate ligament attachment sites of the femur and tibia in six fresh-frozen knee specimens. Spring gauges were used to measure indirectly the changes in distance of separation during knee flexion between the femoral and tibial attachments relative to a zero defined at 90 degrees of knee flexion. The tibial cylinder was rotated at 45 degrees increments from 90 degrees external to 180 degrees internal rotation relative to the femoral cylinder and measurements were repeated after each incremental rotation. External rotation resulted in a statistically significant higher mean separation distance (4.5 mm) for peripheral graft attachments than internal rotation (2.8 mm) (P = 0.05).     

Renal expression of parathyroid hormone-related protein (PTHrP) and PTH/PTHrP receptor in a rat model of tubulointerstitial damage

The effect of a meniscal bearing on knee laxity in anterior cruciate ligament-sacrificing total knee arthroplasty was evaluated in 7 cadaver knees using a knee testing device that measured knee flexion angle as well as laxity to medial-lateral, anterior-posterior [AP], and rotational loads. A standard fixed tibial component and mobile tibial components (AP sliding, rotationally sliding, and AP and rotationally sliding) were used to evaluate AP, rotational, and varus-valgus stability and maximal flexion and extension with the neutrally positioned and malrotated tibial tray. The AP movable components increased AP laxity, and the fixed component decreased rotational laxity significantly when compared with the normal knees. The rotationally movable components did not change knee laxities significantly even when the tibial tray was malrotated. No significant difference among the components was detected when the maximal flexion and extension angles were compared in the neutrally positioned tibial tray. Malrotation of the tibial tray decreased the maximal extension angle in the fixed component. This study showed that the rotationally movable component can achieve near-normal laxity regardless of tibial tray rotation, but AP mobility of the bearing produces AP laxity that could lead to implant failure.     

Load mechanics of the wrist

During the last decade, we have been studying load mechanics under a variety of conditions using pressure-sensitive film and, more recently, three-dimensional reconstructions and motion analysis. In all of these studies using pressure-sensitive film, the simulated pathologic or traumatic conditions that were tested showed that all areas in which an increase in contact area or pressure occurred, localized to one area of one joint, coincided with areas in which degenerative changes occurred in the simulated clinical situation. The areas in which there was a decrease or no change in contact area or pressure coincided with areas that were spared from degenerative changes in simulated clinical situations. More recent work has demonstrated that normal carpal kinematics during wrist flexion and extension do not have an instantaneous screw axis that is fixed in or limited to the capitate. These findings change the understanding previously based on studies suggesting that the center of rotation was fixed in the capitate. It was noted that during global wrist motion the radiolunate joint contributes more motion and flexion than the capitolunate joint, but the capitolunate joint contributes more motion and extension than the radiolunate joint. It also was demonstrated that translational motion is a normal component of carpal kinematics.     

Mental rotation of objects retrieved from memory: A functional MRI study of spatial processing.

This functional MRI study examined how people mentally rotate a 3-dimensional object (an alarm clock) that is retrieved from memory and rotated according to a sequence of auditory instructions. We manipulated the geometric properties of the rotation, such as having successive rotation steps around a single axis versus alternating between 2 axes. The latter condition produced much more activation in several areas. Also, the activation in several areas increased with the number of rotation steps. During successive rotations around a single axis, the activation was similar for rotations in the picture plane and rotations in depth. The parietal (but not extrastriate) activation was similar to mental rotation of a visually presented object. The findings indicate that a large-scale cortical network computes different types of spatial information by dynamically drawing on each of its components to a differential, situation-specific degree. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of the perception of rotational motion: Orientation of the motion to the object and to the environment.

The results of two experiments suggest that strong constraints on the ability to imagine rotations extend to the perception of rotations. Participants viewed stereographic perspective views of rotating squares, regular polyhedra, and a variety of polyhedral generalized cones, and attempted to indicate the orientation of the axis and planes of rotation in terms of one of the 13 canonical directions in 3D space. When the axis and planes of a rotation were aligned with principal directions of the environment, participants could indicate the orientation of the motion well. When a rotation was oblique to the environment, the orientation of the object to the motion made a very large difference to performance. Participants were fast and accurate when the object was a generalized cone about the axis of rotation or was elongated along the axis. Variation of the amount of rotation and reflection symmetry of the object about the axis of rotation was not powerful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Representational momentum for rotations in depth: Effects of shading and axis.

Representational momentum is a positive memory distortion for an object's final position following the presentation of an implied event (J. J. Freyd, 1987). Positive memory distortions occur when observers accept test positions beyond the final presented position, or forward along the implied trajectory, as the same more readily than positions behind the final position. Four experiments explored implied events depicting rotations about various depth axes in shaded and silhouette conditions. Positive memory distortions were observed for all depth rotations under certain shading conditions, with some differences in the size of the distortion between axes. No directional effects (e.g., right vs. left) were observed. The overall positive memory distortions observed for depth rotations contrasted with the negative distortions previously observed for translation motion in depth (T. L. Hubbard, 1995b). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Placental restriction alters adrenal medullary development in the midgestation sheep fetus

This is a retrospective study of 10 patients with combined cruciate ligament and posterolateral instability who underwent surgical reconstruction between 1991 and 1994. All knees had at least 20 degrees increased external rotation at 30 degrees of knee flexion and from 1+ to 3+ varus instability. Five knees with posterior cruciate ligament ruptures had at least a 2+ Lachman test result. (One knee had both anterior and posterior cruciate ligament injuries). In all cases the lateral collateral ligament was reconstructed with a bone-patellar tendon-bone allograft secured with interference screws. Fixation tunnels were placed in the fibular head and at the isometric point on the femur. The cruciate ligaments were reconstructed with autograft or allograft material. The average follow-up was 28 months. Excessive external rotation at 30 degrees of flexion was corrected in all but one knee. Six patients had no varus laxity, and four patients had 1+ varus laxity at 30 degrees of flexion. The posterior drawer test result decreased, on average, to 1+, and the Lachman test result decreased to between 0 and 1+. The average Tegner score was 4.6, with five patients returning to their preinjury level of activity and four returning to one level lower. These results indicate that this is a promising new procedure for patients with instability resulting from lateral ligament injuries of the knee.     

The anterior cruciate ligament in controlling axial rotation. An evaluation of its effect

Changes in axial tibial rotation after anterior cruciate ligament sectioning were evaluated in 14 fresh human knee joints. Simulation of vertical stance in a quadriceps-stabilized knee was performed. Internal and external rotational torques were applied before and after anterior cruciate ligament sectioning. Pivot shift tests were done in the intact and anterior cruciate ligament sectioned knee. Results of pivot shift tests were all negative before sectioning and positive after isolated sectioning. No significant change in axial rotation occurred between the intact and sectioned knee for external rotation (P = 0.24) or internal rotation (P = 0.12). Presence of a load at the femoral housing in both the intact and ligament-sectioned knees caused a significant change in external rotation (P < 0.0001). No significant change was noted in internal rotation between loaded and unloaded states (P = 0.70). Total tibial rotation in the intact knee was noted to vary between 31 degrees at 0 degree of flexion and 42 degrees at 60 degrees of flexion. These results suggest that the anterior cruciate ligament does not play a significant role in limiting axial rotation and that rotational instability is not a major factor after isolated anterior cruciate ligament rupture.     

Aiming error under transformed spatial mappings suggests a structure for visual-motor maps.

Transformed spatial mappings were used to perturb normal visual–motor processes and reveal the structure of internal spatial representations used by the motor control system. In a 2-D discrete aiming task performed under rotated visual–motor mappings, the pattern of spatial movement error was the same for all Ss: peak error between 90° and 135° of rotation and low error for 180° rotation. A two-component spatial representation, based on oriented bidirectional movement axes plus direction of travel along such axes, is hypothesized. Observed reversals of movement direction under rotations greater than 90° are consistent with the hypothesized structure. Aiming error under reflections, unlike rotations, depended on direction of movement relative to the axis of reflection (H. A. Cunningham and M. Pavel, in press). RT and movement time effects were observed, but a speed-accuracy tradeoff was found only for rotations for which the direction-reversal strategy could be used. Finally, adaptation to rotation operates at all target locations equally but does not alter the relative difficulty of different rotations. Structural properties of the representation are invariant under learning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study

The role of the posterolateral and cruciate ligaments in restraining knee motion was studied in 11 human cadaveric knees. The posterolateral ligaments sectioned included the lateral collateral and arcuate ligaments, the popliteofibular ligament, and the popliteal tendon attachment to the tibia. Combined sectioning of the anterior cruciate and posterolateral ligaments resulted in maximal increases in primary anterior and posterior translations at 30 degrees of knee flexion. Primary varus, primary internal, and coupled external rotation also increased and were maximal at 30 degrees of knee flexion. Combined sectioning of the posterior cruciate and posterolateral ligaments resulted in increased primary posterior translation, primary varus and external rotation, and coupled external rotation at all angles of knee flexion. Examination of the knee at 30 degrees and 90 degrees of knee flexion can discriminate between combined posterior cruciate ligament and posterolateral injury and isolated posterolateral injury. The standard external rotation test performed at 30 degrees of knee flexion may not be routinely reliable for detecting combined anterior cruciate and posterolateral ligament injury. However, measurements of primary anterior-posterior translation, primary varus rotation, and coupled external rotation may be used to detect combined anterior cruciate and posterolateral ligament injury.     

Investigation of the usefulness of CYFRA 21-1 as a tumor marker in squamous cell carcinomas of the head and neck

Compressive contact stress between the patella and the anterior femur and between the quadriceps tendon and anterior femur was measured before and after total knee arthroplasty in 5 cadaver knee specimens using a digital electronic sensor. Contact stresses were measured in the normal knee and after total knee arthroplasty with an unresurfaced patella, a dome-shaped patella, and a conforming patella. Patellofemoral contact stresses did not change significantly after total knee arthroplasty when the patella was not resurfaced, but they increased significantly after the patella was resurfaced with both the dome-shaped and the conforming components. The conforming patella had the highest contact stresses because it tilted at flexion angles greater than 90 degrees and applied load to a small area on the superior portion of the patellar component. The conforming patella markedly decreased tendofemoral contact force because the thicker superior pole of the patella tented the quadriceps tendon at flexion angles greater than 120 degrees. This further increased patellofemoral contact force in deep knee flexion.