The effect of flexion of the femoral component in TKA: A musculoskeletal simulation study

Marco Antonio Marra, Marta Strzelczak, Sebastiaan A.W. van de Groes, Petra J.C. Heesterbeek, Dennis W. Janssen, H.F.J.M. Koopman, N.J.J. Verdonschot, A.B. Wymenga

    Research output: Contribution to conferenceAbstract

    11 Downloads (Pure)

    Abstract

    Introduction/Aim: More flexion of the femoral component (FFC) is a surgical option to better restore the femur anatomy in the sagittal plane in Total Knee Arthroplasty (TKA), and to prevent notching of the anterior femoral cortex. However, its true effects on the patellofemoral joint (PFJ) during activities of daily living (ADLs) remain unknown. We studied the effect of FFC on quadriceps and PFJ forces during ADLs. We hypothesised that more FFC has advantages for the knee extensor mechanism.
    Materials and Methods: A previous validated musculoskeletal model of cruciate-retaining TKA was used (Fig. 1) to simulate a rising-from-a-chair activity [1]. We simulated a baseline case with the original post-operative FFC (0°). We then increased the FFC by 3°, 6°, 9°, by referencing the posterior femoral condyles (Fig. 2) and repeated the simulation. Quadriceps forces, PFJ ligament forces and PFJ contact forces were calculated.
    Results: Peak quadriceps force decreased by 48 N (6.5 %BW), on average, for every 3° of FFC at 90° flexion (Fig. 3a). The peak PFJ contact force decreased by 64 N (8.7 %BW), on average, for every 3° of FFC at 90° flexion. Conversely, peak medial and lateral PFJ ligament forces increased by 23 N and 25 N, respectively, on average, for every 3° more FFC (Fig. 3c-d).
    Discussion: FFC moderately affects the PFJ mechanics. Reduced PFJ contact force with more FFC is explained by reduced quadriceps force. More FFC, thus, benefits the knee extensor mechanism, due to increased quadriceps moment arm. More FFC over-tightens both medial and lateral PFJ ligaments, due to a wider PFJ gap, although the effect on ligament forces is not dramatic.
    Conclusions: More FFC reduces the quadriceps and PFJ force to rise from and sit on a chair. This surgical option can potentially help preventing anterior femoral notching, while at the same time provide a better knee function.
    References: [1] Marra MA, Vanheule V, Fluit R, et al. A Subject-Specific Musculoskeletal Modeling Framework to Predict In Vivo Mechanics of Total Knee Arthroplasty. ASME. J Biomech Eng. 2015;137(2):020904-020904-12
    Original languageEnglish
    Number of pages1
    Publication statusPublished - 20 Apr 2017
    EventEuropean Knee Society Conference 2017 - London, United Kingdom
    Duration: 20 Apr 201721 Apr 2017
    http://eks.congresses.medicongress.com/eks-2017/welcome

    Conference

    ConferenceEuropean Knee Society Conference 2017
    Abbreviated titleEKS 2017
    CountryUnited Kingdom
    CityLondon
    Period20/04/1721/04/17
    Internet address

    Fingerprint

    Knee Replacement Arthroplasties
    Thigh
    Patellofemoral Joint
    Ligaments
    Knee
    Activities of Daily Living
    Mechanics

    Cite this

    Marra, M. A., Strzelczak, M., van de Groes, S. A. W., Heesterbeek, P. J. C., Janssen, D. W., Koopman, H. F. J. M., ... Wymenga, A. B. (2017). The effect of flexion of the femoral component in TKA: A musculoskeletal simulation study. Abstract from European Knee Society Conference 2017, London, United Kingdom.
    Marra, Marco Antonio ; Strzelczak, Marta ; van de Groes, Sebastiaan A.W. ; Heesterbeek, Petra J.C. ; Janssen, Dennis W. ; Koopman, H.F.J.M. ; Verdonschot, N.J.J. ; Wymenga, A.B. / The effect of flexion of the femoral component in TKA : A musculoskeletal simulation study. Abstract from European Knee Society Conference 2017, London, United Kingdom.1 p.
    @conference{d4d7505e76fc47d7a013b0577af57791,
    title = "The effect of flexion of the femoral component in TKA: A musculoskeletal simulation study",
    abstract = "Introduction/Aim: More flexion of the femoral component (FFC) is a surgical option to better restore the femur anatomy in the sagittal plane in Total Knee Arthroplasty (TKA), and to prevent notching of the anterior femoral cortex. However, its true effects on the patellofemoral joint (PFJ) during activities of daily living (ADLs) remain unknown. We studied the effect of FFC on quadriceps and PFJ forces during ADLs. We hypothesised that more FFC has advantages for the knee extensor mechanism.Materials and Methods: A previous validated musculoskeletal model of cruciate-retaining TKA was used (Fig. 1) to simulate a rising-from-a-chair activity [1]. We simulated a baseline case with the original post-operative FFC (0°). We then increased the FFC by 3°, 6°, 9°, by referencing the posterior femoral condyles (Fig. 2) and repeated the simulation. Quadriceps forces, PFJ ligament forces and PFJ contact forces were calculated.Results: Peak quadriceps force decreased by 48 N (6.5 {\%}BW), on average, for every 3° of FFC at 90° flexion (Fig. 3a). The peak PFJ contact force decreased by 64 N (8.7 {\%}BW), on average, for every 3° of FFC at 90° flexion. Conversely, peak medial and lateral PFJ ligament forces increased by 23 N and 25 N, respectively, on average, for every 3° more FFC (Fig. 3c-d).Discussion: FFC moderately affects the PFJ mechanics. Reduced PFJ contact force with more FFC is explained by reduced quadriceps force. More FFC, thus, benefits the knee extensor mechanism, due to increased quadriceps moment arm. More FFC over-tightens both medial and lateral PFJ ligaments, due to a wider PFJ gap, although the effect on ligament forces is not dramatic.Conclusions: More FFC reduces the quadriceps and PFJ force to rise from and sit on a chair. This surgical option can potentially help preventing anterior femoral notching, while at the same time provide a better knee function.References: [1] Marra MA, Vanheule V, Fluit R, et al. A Subject-Specific Musculoskeletal Modeling Framework to Predict In Vivo Mechanics of Total Knee Arthroplasty. ASME. J Biomech Eng. 2015;137(2):020904-020904-12",
    author = "Marra, {Marco Antonio} and Marta Strzelczak and {van de Groes}, {Sebastiaan A.W.} and Heesterbeek, {Petra J.C.} and Janssen, {Dennis W.} and H.F.J.M. Koopman and N.J.J. Verdonschot and A.B. Wymenga",
    year = "2017",
    month = "4",
    day = "20",
    language = "English",
    note = "European Knee Society Conference 2017, EKS 2017 ; Conference date: 20-04-2017 Through 21-04-2017",
    url = "http://eks.congresses.medicongress.com/eks-2017/welcome",

    }

    Marra, MA, Strzelczak, M, van de Groes, SAW, Heesterbeek, PJC, Janssen, DW, Koopman, HFJM, Verdonschot, NJJ & Wymenga, AB 2017, 'The effect of flexion of the femoral component in TKA: A musculoskeletal simulation study' European Knee Society Conference 2017, London, United Kingdom, 20/04/17 - 21/04/17, .

    The effect of flexion of the femoral component in TKA : A musculoskeletal simulation study. / Marra, Marco Antonio; Strzelczak, Marta; van de Groes, Sebastiaan A.W.; Heesterbeek, Petra J.C.; Janssen, Dennis W.; Koopman, H.F.J.M.; Verdonschot, N.J.J.; Wymenga, A.B.

    2017. Abstract from European Knee Society Conference 2017, London, United Kingdom.

    Research output: Contribution to conferenceAbstract

    TY - CONF

    T1 - The effect of flexion of the femoral component in TKA

    T2 - A musculoskeletal simulation study

    AU - Marra, Marco Antonio

    AU - Strzelczak, Marta

    AU - van de Groes, Sebastiaan A.W.

    AU - Heesterbeek, Petra J.C.

    AU - Janssen, Dennis W.

    AU - Koopman, H.F.J.M.

    AU - Verdonschot, N.J.J.

    AU - Wymenga, A.B.

    PY - 2017/4/20

    Y1 - 2017/4/20

    N2 - Introduction/Aim: More flexion of the femoral component (FFC) is a surgical option to better restore the femur anatomy in the sagittal plane in Total Knee Arthroplasty (TKA), and to prevent notching of the anterior femoral cortex. However, its true effects on the patellofemoral joint (PFJ) during activities of daily living (ADLs) remain unknown. We studied the effect of FFC on quadriceps and PFJ forces during ADLs. We hypothesised that more FFC has advantages for the knee extensor mechanism.Materials and Methods: A previous validated musculoskeletal model of cruciate-retaining TKA was used (Fig. 1) to simulate a rising-from-a-chair activity [1]. We simulated a baseline case with the original post-operative FFC (0°). We then increased the FFC by 3°, 6°, 9°, by referencing the posterior femoral condyles (Fig. 2) and repeated the simulation. Quadriceps forces, PFJ ligament forces and PFJ contact forces were calculated.Results: Peak quadriceps force decreased by 48 N (6.5 %BW), on average, for every 3° of FFC at 90° flexion (Fig. 3a). The peak PFJ contact force decreased by 64 N (8.7 %BW), on average, for every 3° of FFC at 90° flexion. Conversely, peak medial and lateral PFJ ligament forces increased by 23 N and 25 N, respectively, on average, for every 3° more FFC (Fig. 3c-d).Discussion: FFC moderately affects the PFJ mechanics. Reduced PFJ contact force with more FFC is explained by reduced quadriceps force. More FFC, thus, benefits the knee extensor mechanism, due to increased quadriceps moment arm. More FFC over-tightens both medial and lateral PFJ ligaments, due to a wider PFJ gap, although the effect on ligament forces is not dramatic.Conclusions: More FFC reduces the quadriceps and PFJ force to rise from and sit on a chair. This surgical option can potentially help preventing anterior femoral notching, while at the same time provide a better knee function.References: [1] Marra MA, Vanheule V, Fluit R, et al. A Subject-Specific Musculoskeletal Modeling Framework to Predict In Vivo Mechanics of Total Knee Arthroplasty. ASME. J Biomech Eng. 2015;137(2):020904-020904-12

    AB - Introduction/Aim: More flexion of the femoral component (FFC) is a surgical option to better restore the femur anatomy in the sagittal plane in Total Knee Arthroplasty (TKA), and to prevent notching of the anterior femoral cortex. However, its true effects on the patellofemoral joint (PFJ) during activities of daily living (ADLs) remain unknown. We studied the effect of FFC on quadriceps and PFJ forces during ADLs. We hypothesised that more FFC has advantages for the knee extensor mechanism.Materials and Methods: A previous validated musculoskeletal model of cruciate-retaining TKA was used (Fig. 1) to simulate a rising-from-a-chair activity [1]. We simulated a baseline case with the original post-operative FFC (0°). We then increased the FFC by 3°, 6°, 9°, by referencing the posterior femoral condyles (Fig. 2) and repeated the simulation. Quadriceps forces, PFJ ligament forces and PFJ contact forces were calculated.Results: Peak quadriceps force decreased by 48 N (6.5 %BW), on average, for every 3° of FFC at 90° flexion (Fig. 3a). The peak PFJ contact force decreased by 64 N (8.7 %BW), on average, for every 3° of FFC at 90° flexion. Conversely, peak medial and lateral PFJ ligament forces increased by 23 N and 25 N, respectively, on average, for every 3° more FFC (Fig. 3c-d).Discussion: FFC moderately affects the PFJ mechanics. Reduced PFJ contact force with more FFC is explained by reduced quadriceps force. More FFC, thus, benefits the knee extensor mechanism, due to increased quadriceps moment arm. More FFC over-tightens both medial and lateral PFJ ligaments, due to a wider PFJ gap, although the effect on ligament forces is not dramatic.Conclusions: More FFC reduces the quadriceps and PFJ force to rise from and sit on a chair. This surgical option can potentially help preventing anterior femoral notching, while at the same time provide a better knee function.References: [1] Marra MA, Vanheule V, Fluit R, et al. A Subject-Specific Musculoskeletal Modeling Framework to Predict In Vivo Mechanics of Total Knee Arthroplasty. ASME. J Biomech Eng. 2015;137(2):020904-020904-12

    M3 - Abstract

    ER -

    Marra MA, Strzelczak M, van de Groes SAW, Heesterbeek PJC, Janssen DW, Koopman HFJM et al. The effect of flexion of the femoral component in TKA: A musculoskeletal simulation study. 2017. Abstract from European Knee Society Conference 2017, London, United Kingdom.