Evaluation and validation of 2D biomechanical models of the knee for radiograph-based preoperative planning in total knee arthroplasty

Autoři: Malte Asseln aff001;  Jörg Eschweiler aff002;  Adam Trepczynski aff003;  Philipp Damm aff003;  Klaus Radermacher aff001
Působiště autorů: Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany aff001;  Department of Orthopaedics, Aachen University Clinic, RWTH Aachen University, Aachen, Germany aff002;  Julius Wolff Institute, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0227272


Thorough preoperative planning in total knee arthroplasty is essential to reduce implant failure by proper implant sizing and alignment. The “gold standard” in conventional preoperative planning is based on anterior-posterior long-leg radiographs. However, the coronal component alignment is still an open discussion in literature, since studies have reported contradictory outcomes on survivorship, indicating that optimal individual alignment goals still need to be defined. Two-dimensional biomechanical models of the knee have the potential to predict joint forces and, therefore, objectify therapy planning. Previously published two-dimensional biomechanical models were evaluated and validated for the first time in this study by comparison of model predictions to corresponding in vivo measurements obtained from telemetric implants for a one- and two-leg stance. Model input parameters were acquired from weight-bearing anterior-posterior long-leg radiographs and statistical assumptions for patient-specific model adaptation. The overall time from initialization to load prediction was in the range of 7–8 minutes per patient for all models. However, no model could accurately predict the correct trend of knee joint forces over patients. Two dimensional biomechanical models of the knee have the potential to improve preoperative planning in total knee arthroplasty by providing additional individual biomechanical information to the surgeon. Although integration into the clinical workflow might be performed with acceptable costs, the models’ accuracy is insufficient for the moment. Future work is needed for model optimization and more sophisticated modelling approaches.

Klíčová slova:

Body weight – Hip – Knee joints – Knees – Ligaments – Medical implants – Skeletal joints – Total knee arthroplasty


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