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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: closed (30 April 2022) | Viewed by 13219

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Dr. Arnd Steinbrück

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Guest Editor

Orthopaedic Surgical Competence Center Augsburg (OCKA), 86152 Augsburg, Germany
Interests: hip and knee arthroplasty; arthroplasty registries; biomechanics; translational medicine; applied research

Special Issue Information

Dear Colleagues,

Arthroplasty in orthopedic and trauma surgery is rapidly developing in terms of engineering, digitalization and quality assurance. This includes the development and functional analysis of implants, biomedical techniques to supervise and facilitate arthroplasty surgeries, as well as big data analysis. Further research in arthroplasty and translational research is urgently needed to ensure continuous improvements in medical care for arthroplasty patients.

We invite you to submit your research on these topics, in the form of original research papers, mini-reviews, and perspective articles.

Dr. Arnd Steinbrück
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

hip arthroplasty
knee arthroplasty
biomechanics
engineering
arthroplasty registry
translational medicine
applied research

Published Papers (5 papers)

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Research

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14 pages, 3732 KiB

Open AccessArticle

Using Statistical Shape Models to Optimize TKA Implant Design

by Ingrid Dupraz, Arthur Bollinger, Julien Deckx, Ronja Alissa Schierjott, Michael Utz and Marnic Jacobs

Appl. Sci. 2022, 12(3), 1020; https://doi.org/10.3390/app12031020 - 19 Jan 2022

Cited by 5 | Viewed by 2101

Abstract

(1) TKA implants should well fit on each patient’s anatomy. Statistical Shape Models (SSM) statistically represent the anatomy of a given population. The aims of this study were to assess how to generate a valid SSM for implant design and provide guidelines and examples on how to use the SSMs to evaluate the anatomic fit of TKA components. (2) Methods: A Caucasian SSM was built from 120 anatomies (65 female, 55 male) and an Asian SSM was based on 112 patients (75 female, 37 male). These SSMs were used to generate a database of 20 bone models. The AP/ML dimensions of the bone models were compared to those of the input population. Design input parameters, such as the tibial contour, trochlea, and femur curvature were extracted from the SSMs. Femur and patella components were virtually implanted on the bone models. (3) Results: the dimensions of the generated bone models well represented the population. The overhang of the femoral component as well as the coverage and peak restoration of the patella component were visualized. (4) Conclusions: SSMs can be used to efficiently gain input into TKA design and evaluate the implant fit on the studied population. Full article

(This article belongs to the Special Issue New Frontiers in Arthroplasty and Translational Research)

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12 pages, 2671 KiB

Open AccessArticle

Biomechanical Assessment of Mobile-Bearing Total Knee Endoprostheses Using Musculoskeletal Simulation

by Maeruan Kebbach, Iman Soodmand, Sven Krueger, Thomas M. Grupp, Christoph Woernle and Rainer Bader

Appl. Sci. 2022, 12(1), 182; https://doi.org/10.3390/app12010182 - 24 Dec 2021

Cited by 2 | Viewed by 4771

Abstract

The purpose of this computational study was to analyze the effects of different mobile-bearing (MB) total knee replacement (TKR) designs on knee joint biomechanics. A validated musculoskeletal model of the lower right extremity implanted with a cruciate-retaining fixed-bearing TKR undergoing a squat motion was adapted for three different MB TKR design variants: (I) a commercially available TKR design allowing for tibial insert rotation about the tibial tray with end stops to limit the range of rotation, (II) the same design without end stops, and (III) a multidirectional design with an additional translational degree-of-freedom (DoF) and end stops. When modeling the MB interface, two modeling strategies of different joint topologies were deployed: (1) a six DoF joint as a baseline and (2) a combined revolute-prismatic joint (two DoF joint) with end stops in both DoF. Altered knee joint kinematics for the three MB design variants were observed. The commercially available TKR design variant I yielded a deviation in internal-external rotation of the tibial insert relative to the tray up to 5° during knee flexion. Compared to the multidirectional design variant III, the other two variants revealed less femoral anterior-posterior translation by as much as 5 mm. Concerning the modeling strategies, the two DoF joint showed less computation time by 68%, 80%, and 82% for design variants I, II, and III, respectively. However, only slight differences in the knee joint kinematics of the two modeling strategies were recorded. In conclusion, knee joint biomechanics during a squat motion differed for each of the simulated MB design variants. Specific implant design elements, such as the presence of end stops, can impact the postoperative range of knee motion with regard to modeling strategy, and the two DoF joint option tested accurately replicated the results for the simulated designs with a considerably lower computation time than the six DoF joint. The proposed musculoskeletal multibody simulation framework is capable of virtually characterizing the knee joint dynamics for different TKR designs. Full article

(This article belongs to the Special Issue New Frontiers in Arthroplasty and Translational Research)

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16 pages, 4510 KiB

Open AccessArticle

Towards a New, Pre-Clinical, Subject-Independent Test Model for Kinematic Analysis after Total Knee Arthroplasty—Influence of the Proximo-Distal Patella Position and Patellar Tendon Stiffness

by Adrian Sauer, Allan Maas, Svenja Ottawa, Alexander Giurea and Thomas M. Grupp

Appl. Sci. 2021, 11(21), 10322; https://doi.org/10.3390/app112110322 - 3 Nov 2021

Cited by 1 | Viewed by 1548

Abstract

Although simulation models are heavily used in biomechanical research and testing of TKA implants, pre-clinical tools for a holistic estimation of implant performance under dynamic loading conditions are rare. The objective of this study was the development of an efficient pre-clinical test method for analyzing knee contact mechanics and kinematics based on a dynamic FE model and to evaluate the effects of the proximo-distal patella position and the patellar tendon stiffness on the patellar kinematics. A finite element-based workflow for knee prostheses designs was developed based on standardized in vivo load data, which included the tibial forces and moments. In a new research approach, the tibial forces are used as input for the model, whereas the tibial moments were used to validate the results. For the standardized sit down, stand up, and knee bend load cycles, the calculated tibial moments show only small deviations from the reference values—especially for high flexion angles. For the knee bend cycle, the maximum absolute value of patellar flexion decreases for higher patellar tendon stiffness and more distally placed patellar components. Therefore, patella-related clinical problems caused by patella baja may also arise if the patellar tendon is too weak for high tibiofemoral flexion angles. Full article

(This article belongs to the Special Issue New Frontiers in Arthroplasty and Translational Research)

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Review

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10 pages, 1381 KiB

Open AccessReview

Outpatient Total Knee Arthroplasty: A Meta-Analysis

by Filippo Migliorini, Andrea Pintore, Lucio Cipollaro, Francesco Oliva and Nicola Maffulli

Appl. Sci. 2021, 11(20), 9376; https://doi.org/10.3390/app11209376 - 9 Oct 2021

Cited by 3 | Viewed by 2000

Abstract

Introduction: Outpatient total knee arthroplasty (TKA) is attracting growing interest. This meta-analysis compared patient reported outcome measures (PROMs), infection, readmission, revision, deep vein thrombosis (DVT), and mortality rates of outpatient versus inpatient TKA. Methods: This meta-analysis was conducted according to the 2020 PRISMA statement. In August 2021, the following databases were accessed: Pubmed, Web of Science, Google Scholar, Embase. All the clinical trials comparing outpatient versus inpatient (>2 days) TKA were considered. Studies which reported data on revision settings were not considered, nor studies which included patients discharged between one and two days. Results: Data from 159,219 TKAs were retrieved. The mean follow-up was 5.8 ± 7.6 months. The mean age was 63.7 ± 5.0 years and the mean BMI 30.3 ± 1.8 kg/m². Comparability was found in age (p = 0.4), BMI (p = 0.3), and gender (p = 0.4). The outpatient group evidenced a greater Oxford knee score (p = 0.01). The inpatient group demonstrated a greater rate of revision (p = 0.03), mortality (p = 0.003), and DVT (p = 0.005). No difference was found in the rate of readmission (p = 0.3) and infection (p = 0.4). Conclusions: With regards to the endpoints evaluated in this meta-analysis, current evidence does not support outpatient TKA. However, given the limited data available for inclusion and the overall poor quality of the included articles, no reliable conclusion can be inferred. Further high quality clinical trials with clear eligibility criteria are required. Full article

(This article belongs to the Special Issue New Frontiers in Arthroplasty and Translational Research)

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11 pages, 1200 KiB

Open AccessFeature PaperReview

Outpatient Total Hip Arthroplasty: A Meta-Analysis

by Filippo Migliorini, Lucio Cipollaro, Francesco Cuozzo, Francesco Oliva, Andrea Valerio Marino and Nicola Maffulli

Appl. Sci. 2021, 11(15), 6853; https://doi.org/10.3390/app11156853 - 26 Jul 2021

Cited by 4 | Viewed by 1891

Abstract

Introduction: Outpatient total hip arthroplasty (THA) is increasingly popular. This meta-analysis investigated the potential advantages of outpatient regimes for THA. Methods: This study followed the PRISMA guidelines. PubMed, Web of Science, Google Scholar, Embase, and Scopus databases were accessed in June 2021. All clinical studies investigating outpatient THA were considered. The outcomes of interest were pain, infection, mortality, revision, dislocation, readmission rates, and deep vein thrombosis (DVT). Results: Data from 102,839 patients were included. A total of 52% (153,168 of 102,839 patients) were women. The mean age of patients was 62.6 ± 4.6 years, the mean BMI was 29.1 ± 1.8 kg/m². Good comparability was found in age, BMI, and gender (p > 0.1). No difference was found in pain (p = 0.4), infections (p = 0.9), mortality (p = 0.9), rate of revision (p = 0.1), dislocation (p = 0.9), and readmission (p = 0.8). The outpatient group demonstrated a greater rate of DVT (OR 3.57; 95% CI 2.47 to 5.18; p < 0.0001). Conclusions: In selected patients, outpatient THA can be performed safely with optimal outcomes comparable with inpatient THA. Clear and comprehensive pre-operative planning should involve a multi-disciplinary group composed of orthopaedic surgeons, anaesthesia and rehabilitation specialists, and physiotherapists. Each centre performing outpatient THA should implement continuous homecoming welfare activity, to supervise physiotherapy and monitor anticoagulant therapy. Full article

(This article belongs to the Special Issue New Frontiers in Arthroplasty and Translational Research)

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