Realistic loads for testing hip implants.

The aim here was to define realistic load conditions for hip implants, based on in vivo contact force measurements, and to see whether current ISO standards indeed simulate real loads. The load scenarios obtained are based on in vivo hip contact forces measured in 4 patients during different activities and on activity records from 31 patients. The load scenarios can be adapted to various test purposes by applying average or high peak loads, high-impact activities or additional low-impact activities, and by simulating normal or very active patients. The most strenuous activities are walking (average peak forces 1800 N, high peak forces 3900 N), going up stairs (average peak forces 1900 N, high peak forces 4200 N) and stumbling (high peak forces 11,000 N). Torsional moments are 50% higher for going up stairs than for walking. Ten million loading cycles simulate an implantation time of 3.9 years in active patients. The in vitro fatigue properties of cementless implant fixations are exceeded during stumbling. At least for heavyweight and very active subjects, the real load conditions are more critical than those defined by the ISO standards for fatigue tests.

Loading of the knee joint during activities of daily living measured in vivo in five subjects.

Detailed knowledge about loading of the knee joint is essential for preclinical testing of implants, validation of musculoskeletal models and biomechanical understanding of the knee joint. The contact forces and moments acting on the tibial component were therefore measured in 5 subjects in vivo by an instrumented knee implant during various activities of daily living. Average peak resultant forces, in percent of body weight, were highest during stair descending (346% BW), followed by stair ascending (316% BW), level walking (261% BW), one legged stance (259% BW), knee bending (253% BW), standing up (246% BW), sitting down (225% BW) and two legged stance (107% BW). Peak shear forces were about 10-20 times smaller than the axial force. Resultant forces acted almost vertically on the tibial plateau even during high flexion. Highest moments acted in the frontal plane with a typical peak to peak range -2.91% BWm (adduction moment) to 1.61% BWm (abduction moment) throughout all activities. Peak flexion/extension moments ranged between -0.44% BWm (extension moment) and 3.16% BWm (flexion moment). Peak external/internal torques lay between -1.1% BWm (internal torque) and 0.53% BWm (external torque). The knee joint is highly loaded during daily life. In general, resultant contact forces during dynamic activities were lower than the ones predicted by many mathematical models, but lay in a similar range as measured in vivo by others. Some of the observed load components were much higher than those currently applied when testing knee implants.

Design and calibration of load sensing orthopaedic implants.

Contact forces and moments act on orthopaedic implants such as joint replacements. The three forces and three moment components can be measured by six internal strain gauges and wireless telemetric data transmission. The accuracy of instrumented implants is restricted by their small size, varying modes of load transfer, and the accuracy of calibration. Aims of this study were to test with finite element studies design features to improve the accuracy, to develop simple but accurate calibration arrangements, and to select the best mathematical method for calculating the calibration constants. Several instrumented implants, and commercial and test transducers were calibrated using different loading setups and mathematical methods. It was found that the arrangement of flexible elements such as bellows or notches between the areas of load transfer and the central sensor locations is most effective to improve the accuracy. Increasing the rigidity of the implant areas, which are fixed in bones or articulate against joint surfaces, is less effective. Simple but accurate calibration of the six force and moment components can be achieved by applying eccentric forces instead of central forces and pure moments. Three different methods for calculating the measuring constants proved to be equally well suited. Employing these improvements makes it possible to keep the average measuring errors of many instrumented implants below 1-2% of the calibration ranges, including cross talk. Additional errors caused by noise of the transmitted signals can be reduced by filtering if this is permitted by the sampling rate and the required frequency content of the loads.

[Loads acting on orthopaedic implants. Measurements and practical applications]. / Die Belastung orthopädischer Implantate. Messungen und praktische Anwendungen.

The loads measured at instrumented joint replacements and other orthopaedic implants allow the optimization of their stability, wear properties, fixation stability and kinematic properties prior to clinical applications. The data obtained also indicate which activities cause very high loads and should be avoided by the patients in order not to endanger the long-term success of the implant. In addition, physiotherapy after joint arthroplasty and fractures can be further improved on the basis of these data. The technical principles for such measurements are summarized and examples for the design of load measuring instrumented implants are presented. The most important results are presented based on the measurements taken at the hip and shoulder joints, internal spinal fixation devices, vertebral body replacements and knee joints. Using this data, many practical conclusions are drawn. Due to the huge amount of data obtained from the hip, most practical advise can be provided to patients with replacement or disorders involving this joint.