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Arin-Bal G, Livanelioglu A, Leardini A, Belvedere C. Correlations between plantar pressure and postural balance in healthy subjects and their comparison according to gender and limb dominance: A cross-sectional descriptive study. Gait Posture 2024; 108:124-131. [PMID: 38039867 DOI: 10.1016/j.gaitpost.2023.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/07/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Lower extremity injuries rank among the most common injuries affecting young population, and numerous factors affect the outcomes of plantar pressure and balance assessment. RESEARCH QUESTION Does a correlation exist between plantar pressure and postural balance in healthy subjects and are there any difference in the results based on gender and limb dominance? METHODS This study involved thirty healthy recreationally active young adults (15 females, 15 males). Plantar pressures were analyzed using the MatScan Pressure Mat System, and postural balance was evaluated using Biodex Balance System. All assessments conducted under both static and dynamic conditions. Correlations were tested by Spearman Correlation Coefficient, and comparative tests were performed for gender and limb dominance. RESULTS Correlations were observed between plantar pressure parameters and balance scores, particularly in the dynamic conditions (p < 0.05). Gender-based differences were noted in plantar pressure parameters (p < 0.05), with females demonstrating improved balance stability scores. No significant differences were found based on limb dominance in plantar pressure and postural balance data (p > 0.05). SIGNIFICANCE This study provides valuable detailed insights into the existing literature concerning plantar pressure and postural balance assessments within the healthy population. A strong correlation was observed between plantar pressure and postural balance, and the comparisons of these assessments were affected by gender but not by limb dominance. These results could lead the way for better rehabilitation approaches by considering the correlations and differences across diverse populations.
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Affiliation(s)
- Gamze Arin-Bal
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey.
| | - Ayse Livanelioglu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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2
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Conconi M, Pompili A, Sancisi N, Durante S, Leardini A, Belvedere C. Foot kinematics as a function of ground orientation and weightbearing. J Orthop Res 2024; 42:148-163. [PMID: 37442638 DOI: 10.1002/jor.25661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/25/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
The foot is responsible for the bodyweight transfer to the ground, while adapting to different terrains and activities. Despite this fundamental role, the knowledge about the foot bone intrinsic kinematics is still limited. The aim of the study is to provide a quantitative and systematic description of the kinematics of all bones in the foot, considering the full range of dorsi/plantar flexion and pronation/supination of the foot, both in weightbearing and nonweightbearing conditions. Bone kinematics was accurately reconstructed for three specimens from a series of computed tomography scans taken in weightbearing configuration. The ground inclination was imposed through a set of wedges, varying the foot orientation both in the sagittal and coronal planes; the donor body-weight was applied or removed by a cable-rig. A total of 32 scans for each foot were acquired and segmented. Bone kinematics was expressed in terms of anatomical reference systems optimized for the foot kinematic description. Results agree with previous literature where available. However, our analysis reveals that bones such as calcaneus, navicular, intermediate cuneiform, fourth and fifth metatarsal move more during foot pronation than flexion. Weightbearing significantly increase the range of motion of almost all the bone. Cuneiform and metatarsal move more due to weightbearing than in response to ground inclination, showing their role in the load-acceptance phase. The data here reported represent a step toward a deeper understanding of the foot behavior, that may help in the definition of better treatment and medical devices, as well as new biomechanical model of the foot.
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Affiliation(s)
- Michele Conconi
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Alessandro Pompili
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Nicola Sancisi
- Department of Industrial Engineering-DIN, University of Bologna, Bologna, Italy
| | - Stefano Durante
- Area Tecnico Diagnostica Radiologica, IRCCS S. Orsola Malpighi Hospital, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Sorrentino R, Carlson KJ, Orr CM, Pietrobelli A, Figus C, Li S, Conconi M, Sancisi N, Belvedere C, Zhu M, Fiorenza L, Hublin JJ, Jashashvili T, Novak M, Patel BA, Prang TC, Williams SA, Saers JPP, Stock JT, Ryan T, Myerson M, Leardini A, DeSilva J, Marchi D, Belcastro MG, Benazzi S. Morphological and evolutionary insights into the keystone element of the human foot's medial longitudinal arch. Commun Biol 2023; 6:1061. [PMID: 37857853 PMCID: PMC10587292 DOI: 10.1038/s42003-023-05431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023] Open
Abstract
The evolution of the medial longitudinal arch (MLA) is one of the most impactful adaptations in the hominin foot that emerged with bipedalism. When and how it evolved in the human lineage is still unresolved. Complicating the issue, clinical definitions of flatfoot in living Homo sapiens have not reached a consensus. Here we digitally investigate the navicular morphology of H. sapiens (living, archaeological, and fossil), great apes, and fossil hominins and its correlation with the MLA. A distinctive navicular shape characterises living H. sapiens with adult acquired flexible flatfoot, while the congenital flexible flatfoot exhibits a 'normal' navicular shape. All H. sapiens groups differentiate from great apes independently from variations in the MLA, likely because of bipedalism. Most australopith, H. naledi, and H. floresiensis navicular shapes are closer to those of great apes, which is inconsistent with a human-like MLA and instead might suggest a certain degree of arboreality. Navicular shape of OH 8 and fossil H. sapiens falls within the normal living H. sapiens spectrum of variation of the MLA (including congenital flexible flatfoot and individuals with a well-developed MLA). At the same time, H. neanderthalensis seem to be characterised by a different expression of the MLA.
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Affiliation(s)
- Rita Sorrentino
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, 40126, Italy.
| | - Kristian J Carlson
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, WITS 2050, South Africa
| | - Caley M Orr
- Department of Cell and Developmental Biology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Department of Anthropology, University of Colorado Denver, Denver, CO, 80217, USA
| | - Annalisa Pietrobelli
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, 40126, Italy
| | - Carla Figus
- Department of Cultural Heritage, University of Bologna, Ravenna, 48121, Italy
| | - Shuyuan Li
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA
| | - Michele Conconi
- Department of Industrial Engineering, Health Sciences and Technologies, Interdepartmental Centre for Industrial Research (HST-ICIR), University of Bologna, Bologna, 40136, Italy
| | - Nicola Sancisi
- Department of Industrial Engineering, Health Sciences and Technologies, Interdepartmental Centre for Industrial Research (HST-ICIR), University of Bologna, Bologna, 40136, Italy
| | - Claudio Belvedere
- Laboratory of Movement Analysis and Functional Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mingjie Zhu
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA
| | - Luca Fiorenza
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC, 3800, Australia
| | - Jean-Jacques Hublin
- Chaire Internationale de Paléoanthropologie, CIRB (UMR 7241-U1050), Collège de France, Paris, France
- Max Planck Institute for Evolutionary Anthropology, Leipzig, 04103, Germany
| | - Tea Jashashvili
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
- Department of Geology and Paleontology, Georgian National Museum, Tbilisi, 0105, Georgia
| | - Mario Novak
- Centre for Applied Bioanthropology, Institute for Anthropological Research, Zagreb, 10000, Croatia
| | - Biren A Patel
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, 90089, USA
| | - Thomas C Prang
- Department of Anthropology, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Scott A Williams
- Evolutionary Studies Institute, University of the Witwatersrand, Johannesburg, WITS 2050, South Africa
- Center for the Study of Human Origins, Department of Anthropology, New York University, New York, 10003, USA
- Centre for the Exploration of the Deep Human Journey, University of the Witwatersrand, Johannesburg, Wits, 2050, South Africa
| | - Jaap P P Saers
- Naturalis Biodiversity Center, 2333, CR, Leiden, the Netherlands
| | - Jay T Stock
- Department of Anthropology, Western University, London, Ontario, N6A 3K7, Canada
| | - Timothy Ryan
- Department of Anthropology, The Pennsylvania State University, State College, PA, 16802, USA
| | - Mark Myerson
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA
| | - Alberto Leardini
- Laboratory of Movement Analysis and Functional Evaluation of Prostheses, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jeremy DeSilva
- Department of Anthropology, Dartmouth College, Hanover, NH, 03755, USA
| | - Damiano Marchi
- Centre for the Exploration of the Deep Human Journey, University of the Witwatersrand, Johannesburg, Wits, 2050, South Africa
- Department of Biology, University of Pisa, Pisa, 56126, Italy
| | - Maria Giovanna Belcastro
- Department of Biological, Geological and Environmental Sciences, University of Bologna, Bologna, 40126, Italy
| | - Stefano Benazzi
- Department of Cultural Heritage, University of Bologna, Ravenna, 48121, Italy
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Zaffagnini S, Dal Fabbro G, Lucidi GA, Agostinone P, Belvedere C, Leardini A, Grassi A. Personalised opening wedge high tibial osteotomy with patient-specific plates and instrumentation accurately controls coronal correction and posterior slope: Results from a prospective first case series. Knee 2023; 44:89-99. [PMID: 37562120 DOI: 10.1016/j.knee.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/08/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Patient specific devices represent a promising tool to improve accuracy and simplify high tibial osteotomy (HTO) procedures. The current study aims to assess accuracy of the correction of alignment and posterior tibial slope (PTS), and provide patient reported outcomes (PROMs) of a new personalised cutting guide and fixation plate (TOKA) system for HTO in patients with medial osteoarthritis (OA) and varus knee. METHODS 25 patients (mean age 54.4 years) with medial OA and varus knee malalignment who underwent HTO with the TOKA system were prospectively evaluated pre-operatively, 1, 3, 6 and 12-months follow-up. Standing long-leg and lateral radiographs of the knee were used to assess the hip-knee-ankle (HKA) angle and the PTS, respectively. Accuracy was defined as the difference in planned minus achieved correction. The patient reported outcomes collected were the KOOS score, EQ5D, KSS score, and VAS pain scores. All statistical analyses were performed using IBM SPSS Statistics for Windows. RESULTS The mean preoperative HKA was 170.7° (SD ± 3.2°); the mean postoperative HKA was 177.4° (SD ± 2.9°). The overall mean difference between planned and achieved correction in terms of HKA was 2.1° (SD ± 2.0°). The mean difference between planned and achieved PTS was 0.2° (SD ± 0.4°). All the assessed PROMs had a significant (p < 0.001) increase from the pre-operative value to postoperative evaluation and showed a significant (p < 0.001) improvement with follow-up time. CONCLUSIONS TOKA personalised HTO system showed accurate correction in terms of both coronal and sagittal alignment, and excellent patient reported outcomes. LEVEL OF EVIDENCE 4, prospective case series. Registration in public trial registry: registered at ClinicalTrial.gov [NCT04574570].
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Affiliation(s)
- Stefano Zaffagnini
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Italy
| | - Giacomo Dal Fabbro
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy.
| | - Gian Andrea Lucidi
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Italy
| | - Piero Agostinone
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy
| | - Claudio Belvedere
- IRCCS Istituto Ortopedico Rizzoli, Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, Bologna, Italy
| | - Alberto Leardini
- IRCCS Istituto Ortopedico Rizzoli, Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, Bologna, Italy
| | - Alberto Grassi
- IRCCS Istituto Ortopedico Rizzoli, 2nd Orthopedics and Trauma Unit, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Italy
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Leardini A, Belvedere C, de Cesar Netto C. Total Ankle Replacement: Biomechanics of the Designs, Clinical Outcomes, and Remaining Issues. Foot Ankle Clin 2023; 28:e1-e14. [PMID: 36935170 DOI: 10.1016/j.fcl.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
The present review paper aimed at discussing the current major issues in total ankle replacement, both the technical and biomechanical concepts, and the surgical and clinical concerns. Designers shall target at the same time restoration of natural ankle kinematics and congruity of the artificial surfaces throughout the range of motion. Surgeons are recommended to expand biomechanical knowledge on ankle joint replacement, and provide appropriate training and key factors to make arthroplasty a good alternative to arthrodesis. Moreover, adequate selection of patients and careful rehabilitation are critical. In the future, custom-made prosthesis components and patient-specific instrumentation are major developments for more complex cases.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy.
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA; Orthopedic Functional Imaging Research Laboratory, University of Iowa, Iowa City, IA, USA; Department of Orthopedics, Duke University, Durham, NC, USA
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Zaffagnini S, Dal Fabbro G, Belvedere C, Leardini A, Caravelli S, Lucidi GA, Agostinone P, Mosca M, Neri MP, Grassi A. Custom-Made Devices Represent a Promising Tool to Increase Correction Accuracy of High Tibial Osteotomy: A Systematic Review of the Literature and Presentation of Pilot Cases with a New 3D-Printed System. J Clin Med 2022; 11:jcm11195717. [PMID: 36233583 PMCID: PMC9571741 DOI: 10.3390/jcm11195717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The accuracy of the coronal alignment corrections using conventional high tibial osteotomy (HTO) falls short, and multiplanar deformities of the tibia require consideration of both the coronal and sagittal planes. Patient-specific instrumentations have been introduced to improve the control of the correction. Clear evidence about customized devices for HTO and their correction accuracy lacks. Methods: The databases PUBMED and EMBASE were systematically screened for human and cadaveric studies about the use of customized devices for high tibial osteotomy and their outcomes concerning correction accuracy. Furthermore, a 3D-printed customized system for valgus HTO with three pilot cases at one-year follow-up was presented. Results: 28 studies were included. The most commonly used custom-made devices for HTO were found to be cutting guides. Reported differences between the achieved and targeted correction of hip-knee-ankle angle and the posterior tibial slope were 3° or under. The three pilot cases that underwent personalized HTO with a new 3D-printed device presented satisfactory alignment and clinical outcomes at one-year follow-up. Conclusion: The available patient-specific devices described in the literature, including the one used in the preliminary cases of the current study, showed promising results in increasing the accuracy of correction in HTO procedure.
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Affiliation(s)
- Stefano Zaffagnini
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, 40126 Bologna, Italy
| | - Giacomo Dal Fabbro
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: ; Tel.: +39-051-636-6075
| | - Claudio Belvedere
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Leardini
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Silvio Caravelli
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gian Andrea Lucidi
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, 40126 Bologna, Italy
| | - Piero Agostinone
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Massimiliano Mosca
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Maria Pia Neri
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Grassi
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, 40126 Bologna, Italy
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Assirelli E, Caravaggi P, Mazzotti A, Ursini F, Leardini A, Belvedere C, Neri S. Location-Dependent Human Osteoarthritis Cartilage Response to Realistic Cyclic Loading: Ex-Vivo Analysis on Different Knee Compartments. Front Bioeng Biotechnol 2022; 10:862254. [PMID: 35782520 PMCID: PMC9240619 DOI: 10.3389/fbioe.2022.862254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Osteoarthritis (OA) is a multifactorial musculoskeletal disorder affecting mostly weight-bearing joints. Chondrocyte response to load is modulated by inflammatory mediators and factors involved in extracellular cartilage matrix (ECM) maintenance, but regulatory mechanisms are not fully clarified yet. By using a recently proposed experimental model combining biomechanical data with cartilage molecular information, basally and following ex-vivo load application, we aimed at improving the understanding of human cartilage response to cyclic mechanical compressive stimuli by including cartilage original anatomical position and OA degree as independent factors.Methods: 19 mono-compartmental Knee OA patients undergoing total knee replacement were recruited. Cartilage explants from four different femoral condyles zones and with different degeneration levels were collected. The response of cartilage samples, pooled according to OA score and anatomical position was tested ex-vivo in a bioreactor. Mechanical stimulation was obtained via a 3-MPa 1-Hz sinusoidal compressive load for 45-min to replicate average knee loading during normal walking. Samples were analysed for chondrocyte gene expression and ECM factor release.Results: Non parametric univariate and multivariate (generalized linear mixed model) analysis was performed to evaluate the effect of compression and IL-1β stimulation in relationship to the anatomical position, local disease severity and clinical parameters with a level of significance set at 0.05. We observed an anti-inflammatory effect of compression inducing a significant downmodulation of IL-6 and IL-8 levels correlated to the anatomical regions, but not to OA score. Moreover, ADAMTS5, PIICP, COMP and CS were upregulated by compression, whereas COL-2CAV was downmodulated, all in relationship to the anatomical position and to the OA degree.Conclusion: While unconfined compression testing may not be fully representative of the in-vivo biomechanical situation, this study demonstrates the importance to consider the original cartilage anatomical position for a reliable biomolecular analysis of knee OA metabolism following mechanical stimulation.
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Affiliation(s)
- Elisa Assirelli
- Laboratory of Immunorheumatology and Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- I Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Ursini
- Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Science, IRCCS Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Alberto Leardini
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Laboratory of Movement Analysis and Functional Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- *Correspondence: Claudio Belvedere,
| | - Simona Neri
- Laboratory of Immunorheumatology and Tissue Regeneration, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Ruggeri M, Gill HS, Leardini A, Zaffagnini S, MacLeod A, Ortolani M, Faccia F, Grassi A, Fabbro GD, Durante S, Belvedere C. Superimposition of ground reaction force on tibial-plateau supporting diagnostics and post-operative evaluations in high-tibial osteotomy. A novel methodology. Gait Posture 2022; 94:144-152. [PMID: 35334334 DOI: 10.1016/j.gaitpost.2022.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A fully personalised combination of Gait Analysis (GA), including Ground Reaction Force (GRF), and patient-specific knee joint morphology has not yet been reported. This can provide valuable biomechanical insight in normal and pathological conditions. Abnormal knee varus results in medial knee condylar hyper-compression and osteoarthritis, which can be prevented by restoring proper condylar load distribution via High Tibial Osteotomy (HTO). RESEARCH QUESTION This study was aimed at reporting on an original methodology, merging GA, GRF and Computer-Tomography (CT) to depict a patient-specific representation of the knee mechanical condition during locomotion. It was hypothesised that HTO results in a lateralized pattern of GRF with respect to the tibial plateau. METHODS Four patients selected for HTO received clinical, radiological and instrumental examinations, pre- and post-operatively at 6-month follow-up. GA was performed during level walking and more demanding motor tasks using a 9-camera motion-capture system, combined with two force platforms, and an established protocol. Additional skin markers were positioned around the tibial-plateau rim. Weight-bearing CT scans of the knee were collected while still wearing these markers. Proximal tibial and marker morphological models were reconstructed. The markers from CT reconstruction were then registered to the corresponding trajectories as tracked by GA data. Resulting registration matrices were used to report GRF vectors on the plane best matching the tibial-plateau model and the intersection paths were calculated. RESULTS AND SIGNIFICANCE The registration procedure was successfully executed, with a max registration error of about 3 mm. GRF intersection paths were found medially to the tibial plateau pre-op, and lateralized post-op, thus much closer to the knee centre, as expected after HTO. The exploitation of the present methodology offers personalised quantification of the original mechanical misalignment and of the effect of surgical correction which could enhance diagnostics and planning of HTO as well as other knee treatments.
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Affiliation(s)
- Miriana Ruggeri
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Harinderjit Singh Gill
- Department of Mechanical Engineering/Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alisdair MacLeod
- Department of Mechanical Engineering/Centre for Therapeutic Innovation, University of Bath, Bath, UK
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federica Faccia
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- II Clinical Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Conconi M, Pompili A, Sancisi N, Leardini A, Durante S, Belvedere C. New anatomical reference systems for the bones of the foot and ankle complex: definitions and exploitation on clinical conditions. J Foot Ankle Res 2021; 14:66. [PMID: 34930383 PMCID: PMC8686310 DOI: 10.1186/s13047-021-00504-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background A complete definition of anatomical reference systems (ARS) for all bones of the foot and ankle complex is lacking. Using a morphological approach, we propose new ARS for these bones with the aim of being highly repeatable, consistent among individuals, clinically interpretable, and also suited for a sound kinematic description. Methods Three specimens from healthy donors and three patients with flat feet were scanned in weight-bearing CT. The foot bones were segmented and ARS defined according to the proposed approach. To assess repeatability, intra class coefficients (ICC) were computed both intra- and inter-operator. Consistency was evaluated as the mean of the standard deviations of the ARS position and orientation, both within normal and flat feet. Clinical interpretability was evaluated by providing a quantification of the curvature variation in the medial-longitudinal and transverse arches and computing the Djiann-Annonier angle for normal and flat feet from these new ARS axes. To test the capability to also provide a sound description of the foot kinematics, the alignment between mean helical axes (MHA) and ARS axes was quantified. Results ICC was 0.99 both inter- and intra-operator. Rotational consistency was 4.7 ± 3.5 ° and 6.2 ± 4.4° for the normal and flat feet, respectively; translational consistency was 4.4 ± 4.0 mm and 5.4 ± 2.9 mm for the normal and flat feet, respectively. In both these cases, the consistency was better than what was achieved by using principal axes of inertia. Curvature variation in the arches were well described and the measurements of the Djiann-Annoier angles from both normal and flat feet matched corresponding clinical observations. The angle between tibio-talar MHA and ARS mediolateral axis in the talus was 12.3 ± 6.0, while the angle between talo-calcaneal MHA and ARS anteroposterior axis in the calcaneus was 17.2 ± 5.6, suggesting good capability to represent joint kinematics. Conclusions The proposed ARS definitions are robust and provide a solid base for the 3-dimensional description of posture and motion of the foot and ankle complex from medical imaging. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00504-5.
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Affiliation(s)
- Michele Conconi
- Department of Industrial Engineering - DIN, University of Bologna, Viale del Risorgimento 2, 40136, Bologna, Italy.
| | - Alessandro Pompili
- Department of Industrial Engineering - DIN, University of Bologna, Viale del Risorgimento 2, 40136, Bologna, Italy
| | - Nicola Sancisi
- Department of Industrial Engineering - DIN, University of Bologna, Viale del Risorgimento 2, 40136, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy
| | - Stefano Durante
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, Italy
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Belvedere C, Tamarri S, Ensini A, Durante S, Ortolani M, Leardini A. Can Computer-Assisted Total Knee Arthroplasty Support the Prediction of Postoperative Three-Dimensional Kinematics of the Tibiofemoral and Patellofemoral Joints at the Replaced Knee? J Knee Surg 2021; 34:1014-1025. [PMID: 32074653 DOI: 10.1055/s-0040-1701265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to analyze the extent to which postoperative patellofemoral joint (PFJ) kinematics assessed at 6-month follow-up after total knee arthroplasty (TKA) mimics the intraoperative kinematics after final component implantation. The study hypothesis, already proved in terms of tibiofemoral joint (TFJ) kinematics, is that the intraoperative assessment of PFJ kinematics after component implantation is also capable of predicting postoperative knee kinematics during activities of daily living. Twenty patients selected for TKA with patellar resurfacing were implanted using surgical navigation, including patellar component positioning via a novel computer-assisted procedure. This allowed for intraoperative TFJ and PFJ kinematic assessment after final component implantation. At 6-month follow-up, all patients were contacted for follow-up control; in addition to clinical examination, this implied postoperative kinematics assessments by three-dimensional video fluoroscopy of the replaced knee during standard activities of daily living. Several traditional PFJ, as well as TFJ, rotations and translations were calculated intra- and postoperatively and then statistically compared. Good postoperative replication of the intraoperative measurements was observed for most of PFJ variables analyzed, as well as those for TFJ. Relevant statistical analysis also supported the significant consistency between the intra- and postoperative measurements. Pertaining to the present findings on a statistical basis, intraoperative measurements performed at both TFJ and PFJ kinematics using a surgical navigation system under passive conditions, are predictive of the overall knee kinematics experienced at postoperative follow-ups by the same replaced knees in typical activities of daily living.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Tamarri
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Lullini G, Belvedere C, Ortolani M, Ruzzi S, Mazzotti A, Leardini A. Custom-Made Total Talonavicular Replacement in a Professional Rock Climber: Functional Evaluation With Gait Analysis and 3-Dimensional Medical Imaging in Weightbearing at 5 Years' Follow-Up. J Foot Ankle Surg 2021; 59:1118-1127. [PMID: 32684404 DOI: 10.1053/j.jfas.2020.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 02/03/2023]
Abstract
With the goal to restore ankle and foot function also in the long term, custom-made prostheses are becoming more frequently possible solutions for severe bone loss and avascular necrosis of the talus. A young professional rock climber was implanted with a custom-made talonavicular prosthesis, and short-term (30 months) assessment has been published. A thorough assessment at the intermediate term (60 months), with state-of-the-art gait and medical imaging analyses, is reported here. Level walking and more demanding motor tasks were analyzed with both a full-body and a multisegment foot protocol on the operated and contralateral limbs. Cone-beam computer-tomography was also used to obtain 3-dimensional (3D) position and orientation of bone models on the operated ankle. These models were also used for a 3D video fluoroscopy analysis, with the ankle in 3 joint positions at the extremes of motion. Distance map analysis was performed to check for possible changes over time of bone morphology and joint contact areas, in all 3 joint positions. Very satisfactory functional results were observed, with large and symmetric joint motion and physiological muscular recruitment even in demanding motor tasks. Distance map analyses revealed that very small morphologic and contact patterns changes occurred in the replaced ankle between 30 and 60 months. Concerns about possible wear of the cartilage in the tibial mortise are not yet supported by experimental evidence.
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Affiliation(s)
- Giada Lullini
- Laboratory Physiatrist, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Senior Biomedical Engineer Researcher, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Maurizio Ortolani
- Laboratory Physiatrist, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvia Ruzzi
- Laboratory Computer Technician, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- Executive Orthopaedic Surgeon, I Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Laboratory Director, Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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12
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Caravaggi P, Assirelli E, Ensini A, Ortolani M, Mariani E, Leardini A, Neri S, Belvedere C. Biomechanical-Based Protocol for in vitro Study of Cartilage Response to Cyclic Loading: A Proof-of-Concept in Knee Osteoarthritis. Front Bioeng Biotechnol 2021; 9:634327. [PMID: 34012954 PMCID: PMC8126668 DOI: 10.3389/fbioe.2021.634327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/08/2021] [Indexed: 12/28/2022] Open
Abstract
Osteoarthritis (OA) is an evolving disease and a major cause of pain and impaired mobility. A deeper understanding of cartilage metabolism in response to loading is critical to achieve greater insight into OA mechanisms. While physiological joint loading helps maintain cartilage integrity, reduced or excessive loading have catabolic effects. The main scope of this study is to present an original methodology potentially capable to elucidate the effect of cyclic joint loading on cartilage metabolism, to identify mechanisms involved in preventing or slowing down OA progression, and to provide preliminary data on its application. In the proposed protocol, the combination of biomechanical data and medical imaging are integrated with molecular information about chondrocyte mechanotransduction and tissue homeostasis. The protocol appears to be flexible and suitable to analyze human OA knee cartilage explants, with different degrees of degeneration, undergoing ex vivo realistic cyclic joint loading estimated via gait analysis in patients simulating mild activities of daily living. The modulation of molecules involved in cartilage homeostasis, mechanotransduction, inflammation, pain and wound healing can be analyzed in chondrocytes and culture supernatants. A thorough analysis performed with the proposed methodology, combining in vivo functional biomechanical evaluations with ex vivo molecular assessments is expected to provide new insights on the beneficial effects of physiological loading and contribute to the design and optimization of non-pharmacological treatments limiting OA progression.
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Affiliation(s)
- Paolo Caravaggi
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisa Assirelli
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- I Orthopaedic and Traumatologic Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erminia Mariani
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Medical and Surgical Sciences, Alma Mater Studiorum-Università di Bologna, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Simona Neri
- Laboratory of Immunorheumatology and Tissue Regeneration, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Ortopedico Rizzoli, Bologna, Italy
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Pagani S, Liverani E, Giavaresi G, De Luca A, Belvedere C, Fortunato A, Leardini A, Fini M, Tomesani L, Caravaggi P. Mechanical and in vitro biological properties of uniform and graded Cobalt-chrome lattice structures in orthopedic implants. J Biomed Mater Res B Appl Biomater 2021; 109:2091-2103. [PMID: 33964120 PMCID: PMC8518749 DOI: 10.1002/jbm.b.34857] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/14/2020] [Accepted: 04/24/2021] [Indexed: 12/11/2022]
Abstract
Human bones are biological examples of functionally graded lattice capable to withstand large in vivo loading and allowing optimal stress distribution. Disruption of bone integrity may require biocompatible implants capable to restore the original bone structure and properties. This study aimed at comparing mechanical properties and biological behavior in vitro of uniform (POR‐FIX) and graded (POR‐VAR) Cobalt‐chrome alloy lattice structures manufactured via Selective Laser Melting. In compression, the POR‐VAR equivalent maximum stress was about 2.5 times lower than that of the POR‐FIX. According to the DIC analysis, the graded lattice structures showed a stratified deformation associated to unit cells variation. At each timepoint, osteoblast cells were observed to colonize the surface and the first layer of both scaffolds. Cell activity was always significantly higher in the POR‐VAR (p < 0.0005). In terms of gene expression, the OPG/RANKL ratio increased significantly over time (p < 0.0005) whereas IL1β and COX2 significantly decreased (7 day vs 1 day; p < 0.0005) in both scaffolds. Both uniform‐ and graded‐porosity scaffolds provided a suitable environment for osteoblasts colonization and proliferation, but graded structures seem to represent a better solution to improve stress distribution between implant and bone of orthopedic implants.
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Affiliation(s)
- Stefania Pagani
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erica Liverani
- Department of Industrial Engineering, Università di Bologna, Bologna, Italy
| | - Gianluca Giavaresi
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Angela De Luca
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Milena Fini
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Tomesani
- Department of Industrial Engineering, Università di Bologna, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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14
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Carrara C, Belvedere C, Caravaggi P, Durante S, Leardini A. Techniques for 3D foot bone orientation angles in weight-bearing from cone-beam computed tomography. Foot Ankle Surg 2021; 27:168-174. [PMID: 32370949 DOI: 10.1016/j.fas.2020.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/04/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND For the diagnosis and treatment of foot and ankle disorders, objective quantification of the absolute and relative orientation angles is necessary. The present work aims at assessing novel techniques for 3D measures of foot bone angles from current Cone-Beam technology. METHODS A normal foot was scanned via weight-bearing CT and 3D-model of each bone was obtained. Principal Component Analysis, landmark-based and mid-diaphyseal axes were exploited to obtain bone anatomical references. Absolute and relative angles between calcaneus and first metatarsal bone were calculated both in 3D and in a simulated sagittal projections. The effects of malpositioning were also investigated via rotations of the entire foot model. RESULTS Large angle variations were found between the different definitions. For the 3D relative orientation, variations larger than 10 degrees were found. Foot malposition in axial rotation or in varus/valgus can result in errors larger than 5 and 3 degrees, respectively. CONCLUSIONS New measures of foot bone orientation are possible in 3D and in weight-bearing, removing operator variability and the effects of foot positioning.
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Affiliation(s)
- Claudio Carrara
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Belvedere C, Giacomozzi C, Carrara C, Lullini G, Caravaggi P, Berti L, Marchesini G, Baccolini L, Durante S, Leardini A. Correlations between weight-bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot. J Foot Ankle Res 2020; 13:64. [PMID: 33126903 PMCID: PMC7597032 DOI: 10.1186/s13047-020-00431-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/05/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Measurements of plantar loading reveal foot-to-floor interaction during activity, but information on bone architecture cannot be derived. Recently, cone-beam computer tomography (CBCT) has given visual access to skeletal structures in weight-bearing. The combination of the two measures has the potential to improve clinical understanding and prevention of diabetic foot ulcers. This study explores the correlations between static 3D bone alignment and dynamic plantar loading. METHODS Sixteen patients with diabetes were enrolled (group ALL): 15 type 1 with (N, 7) and without (D, 8) diabetic neuropathy, and 1 with latent autoimmune diabetes. CBCT foot scans were taken in single-leg upright posture. 3D bone models were obtained by image segmentation and aligned in a foot anatomical reference frame. Absolute inclination and relative orientation angles and heights of the bones were calculated. Pressure patterns were also acquired during barefoot level walking at self-selected speed, from which regional peak pressure and absolute and normalised pressure-time integral were worked out at hallux and at first, central and fifth metatarsals (LOAD variables) as averaged over five trials. Correlations with 3D alignments were searched also with arch index, contact time, age, BMI, years of disease and a neuropathy-related variable. RESULTS Lateral and 3D angles showed the highest percentage of significant (p < 0.05) correlations with LOAD. These were weak-to-moderate in the ALL group, moderate-to-strong in N and D. LOAD under the central metatarsals showed moderate-to-strong correlation with plantarflexion of the 2nd and 3rd phalanxes in ALL and N. LOAD at the hallux increased with plantarflexion at the 3rd phalanx in ALL, at 1st phalanx in N and at 5th phalanx in D. Arch index correlated with 1st phalanx plantarflexion in ALL and D; contact time showed strong correlation with 2nd and 3rd metatarsals and with 4th phalanx dorsiflexion in D. CONCLUSION These preliminary original measures reveal that alteration of plantar dynamic loading patterns can be accounted for peculiar structural changes of foot bones. Load under the central metatarsal heads were correlated more with inclination of the corresponding phalanxes than metatarsals. Further analyses shall detect to which extent variables play a role in the many group-specific correlations.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Giacomozzi
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità (Italian National Institute of Health), Viale Regina Elena 299, 00161, Rome, Italy.
| | - Claudio Carrara
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giada Lullini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lisa Berti
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, "Alma Mater" University, Bologna, Italy
| | - Luca Baccolini
- Department of Medical and Surgical Sciences, "Alma Mater" University, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Carrara C, Caravaggi P, Belvedere C, Leardini A. Radiographic angular measurements of the foot and ankle in weight-bearing: A literature review. Foot Ankle Surg 2020; 26:509-517. [PMID: 31402285 DOI: 10.1016/j.fas.2019.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/17/2019] [Accepted: 07/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND For the diagnosis and treatment of the foot and ankle, bone alignments have long been evaluated using planar radiographs in weight-bearing conditions and a large number of measurements have been reported. The present survey reviews the major radiographic angles that are currently present in the literature for a possible better comprehension and classification of them. METHODS PubMed and Google Scholar were used to retrieve technical and clinical papers related to these angles, and were classified based on five typologies and the three projection planes. These angles were grouped into one definition if they described similar concepts, regardless of their anatomical references and names. A corresponding original definition and diagrammatic representation are offered. RESULTS Thirty-one conceptual radiographic angles were identified across all descriptions from the literature: 18 in the sagittal plane, 9 in the transverse, and 4 in the coronal. Most angular measures represent relative bone orientations; absolute orientations, bone morphology and joint lines are less frequently used or reported. CONCLUSIONS The present survey reveals a confused scenario of angular measures, particularly in terms of anatomical references and names. It is therefore recommended to establish common relevant techniques and terminology.
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Affiliation(s)
- Claudio Carrara
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy.
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna 40136, Italy
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Palazzi E, Siegler S, Balakrishnan V, Leardini A, Caravaggi P, Belvedere C. Estimating the stabilizing function of ankle and subtalar ligaments via a morphology-specific three-dimensional dynamic model. J Biomech 2020; 98:109421. [PMID: 31653506 DOI: 10.1016/j.jbiomech.2019.109421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/05/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Knowledge of the stabilizing role of the ankle and subtalar ligaments is important for improving clinical techniques such as ligament repair and reconstruction. However, this knowledge is incomplete. The goal of this study was to expand this knowledge by investigating the stabilizing function of the ligaments using multiple morphologically subject-specific computational models. Nine models were created from the lower extremities of nine donors. Each model consisted of the articulating bones, articular cartilage, and ligaments. Simulations were conducted in ADAMS™ - a dynamic simulation program. During simulation, tibia and fibula were fixed while cyclic moments in all three anatomical planes were applied to the calcaneus one-at-a-time. The resulting displacements between the bones and the forces in each ligament were computed. Simulations were conducted with all ligaments intact and after simulated ligament serial sectioning. Each model was validated by comparing the simulation results to experimental data obtained from the specimen used to construct the model. From the results the stabilizing role of each ligament was established and the effect of ligament sectioning on Range of Motion and Overall Laxity was identified. On the lateral side, ATFL provided stabilization in supination, CFL restrained inversion, external rotation and dorsiflexion and PTFL limited dorsiflexion and external rotation. On the medial side, PTTL restrained dorsiflexion and internal rotation, ATTL limited plantarflexion and external rotation, and TCL limited dorsiflexion, eversion and external rotation. At the subtalar joint, ITCL limited plantarflexion and its posterior-lateral bundle restrained subtalar inversion. CL restrained plantarflexion/dorsiflexion, and internal and external rotation. The large inter-model variability observed in the results indicate the importance of using multiple subject-specific models rather than relying on one "representative" model.
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Affiliation(s)
- Emanuele Palazzi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Industrial Engineering, University of Bologna, Italy; Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA
| | - Sorin Siegler
- Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA.
| | | | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Peiffer M, Belvedere C, Clockaerts S, Leenders T, Leardini A, Audenaert E, Victor J, Burssens A. Three-dimensional displacement after a medializing calcaneal osteotomy in relation to the osteotomy angle and hindfoot alignment. Foot Ankle Surg 2020; 26:78-84. [PMID: 30581061 DOI: 10.1016/j.fas.2018.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/28/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND A medializing calcaneal osteotomy is frequently performed to correct adult-acquired flatfoot deformities, but there is lack of data on the associated three-dimensional variables defining the final correction. The aim of this study was to assess the correlation between the pre-operative hindfoot valgus deformity and calcaneal osteotomy angles and the post-operative calcaneal displacement. METHODS Weight-bearing CT scans obtained pre- and post-operatively were retrospectively analyzed for sixteen patients. Corresponding three-dimensional bone models were used to measure valgus deformity pre- and post-operatively, inclination of the osteotomy and displacement of the calcaneus. Linear regression was conducted to assess the relationship between these measurements. RESULTS On average, the hindfoot valgus changed from 13.1° (±4.6) pre-operatively to 5.7° (±4.3) post-operatively. A mean inferior displacement of 3.2mm (±1.3) was observed along the osteotomy with a mean inclination of 54.6° (±5.6), 80.5° (±10.7), -13.7° (±15.7) in the axial, sagittal and coronal planes, respectively. A statistically significant positive relationship (p<.05, R2=0.6) was found between the pre-operative valgus, the axial osteotomy inclination, and the inferior displacement. CONCLUSIONS This study shows that the degree of pre-operative hindfoot valgus and the axial osteotomy angle are predictive factors for the amount of post-operative inferior displacement of the calcaneus. These findings demonstrate the added value of a computer-based pre-operative planning in clinical practice. Level of evidence II Prospective comparative study.
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Affiliation(s)
- M Peiffer
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.
| | - C Belvedere
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano, 1/10, 40136 Bologna, Italy
| | - S Clockaerts
- Department of Orthopaedic Surgery, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium
| | - T Leenders
- Department of Orthopaedic Surgery, AZ Monica, Florent Pauwelslei 21, 2100 Deurne, Belgium
| | - A Leardini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prosthesis, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano, 1/10, 40136 Bologna, Italy
| | - E Audenaert
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium
| | - J Victor
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium
| | - A Burssens
- Department of Orthopaedic Surgery, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium; University Orthopaedic Center, University of Utah, 590 Wakara Way Salt Lake City, UT 84108, USA
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Leardini A, Durante S, Belvedere C, Caravaggi P, Carrara C, Berti L, Lullini G, Giacomozzi C, Durastanti G, Ortolani M, Guglielmi G, Bazzocchi A. Weight-bearing CT Technology in Musculoskeletal Pathologies of the Lower Limbs: Techniques, Initial Applications, and Preliminary Combinations with Gait-Analysis Measurements at the Istituto Ortopedico Rizzoli. Semin Musculoskelet Radiol 2019; 23:643-656. [PMID: 31745954 DOI: 10.1055/s-0039-1697939] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Musculoskeletal radiology has been mostly limited by the option between imaging under load but in two dimensions (i.e., radiographs) and three-dimensional (3D) scans but in unloaded conditions (i.e., computed tomography [CT] and magnetic resonance imaging in a supine position). Cone-beam technology is now also a way to image the extremities with 3D and weight-bearing CT. This article discusses the initial experience over a few studies in progress at an orthopaedic center. The custom design of total ankle replacements, the patellofemoral alignment after medial ligament reconstruction, the overall architecture of the foot bones in the diabetic foot, and the radiographic assessment of the rearfoot after subtalar fusion for correction of severe flat foot have all taken advantage of the 3D and weight-bearing feature of relevant CT scans. To further support these novel assessments, techniques have been developed to obtain 3D models of the bones from the scans and to merge these with state-of-the-art gait analyses.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Carrara
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Lisa Berti
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giada Lullini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Giacomozzi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Roma, Italy
| | - Gilda Durastanti
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maurizio Ortolani
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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20
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Durastanti G, Leardini A, Siegler S, Durante S, Bazzocchi A, Belvedere C. Comparison of cartilage and bone morphological models of the ankle joint derived from different medical imaging technologies. Quant Imaging Med Surg 2019; 9:1368-1382. [PMID: 31559166 DOI: 10.21037/qims.2019.08.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Accurate geometrical models of bones and cartilage are necessary in biomechanical modelling of human joints, and in planning and designing of joint replacements. Image-based subject-specific model development requires image segmentation, spatial filtering and 3-dimensional rendering. This is usually based on computed tomography (CT) for bone models, on magnetic resonance imaging (MRI) for cartilage models. This process has been reported extensively in the past, but no studies have ever compared the accuracy and quality of these models when obtained also by merging different imaging modalities. The scope of the present work is to provide this comparative analysis in order to identify optimal imaging modality and registration techniques for producing 3-dimensional bone and cartilage models of the ankle joint. Methods One cadaveric leg was instrumented with multimodal markers and scanned using five different imaging modalities: a standard, a dual-energy and a cone-beam CT (CBCT) device, and a 1.5 and 3.0 Tesla MRI devices. Bone, cartilage, and combined bone and cartilage models were produced from each of these imaging modalities, and registered in space according to matching model surfaces or to corresponding marker centres. To assess the quality in overall model reconstruction, distance map analyses were performed and the difference between model surfaces obtained from the different imaging modalities and registration techniques was measured. Results The registration between models worked better with model surface matching than corresponding marker positions, particularly with MRI. The best bone models were obtained with the CBCT. Models with cartilage were defined better with the 3.0 Tesla than the 1.5 Tesla. For the combined bone and cartilage models, the colour maps and the numerical results from distance map analysis (DMA) showed that the smallest distances and the largest homogeneity were obtained from the CBCT and the 3.0 T MRI via model surface registration. Conclusions These observations are important in producing accurate bone and cartilage models from medical imaging and relevant for applications such as designing of custom-made ankle replacements or, more in general, of implants for total as well as focal joint replacements.
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Affiliation(s)
- Gilda Durastanti
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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21
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Belvedere C, Siegler S, Fortunato A, Caravaggi P, Liverani E, Durante S, Ensini A, Konow T, Leardini A. New comprehensive procedure for custom-made total ankle replacements: Medical imaging, joint modeling, prosthesis design, and 3D printing. J Orthop Res 2019; 37:760-768. [PMID: 30537247 DOI: 10.1002/jor.24198] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 11/30/2018] [Indexed: 02/04/2023]
Abstract
Many failures in total joint replacement are associated to prosthesis-to-bone mismatch. With recent additive-manufacturing, that is, 3D-printing, custom-made prosthesis can be created by laser-melting metal powders layer-by-layer. Ankle replacement is particularly suitable for this progress because of the limited number of sizes and the poor bone stock. In this study a novel procedure is presented for subject-specific ankle replacements, including medical-imaging, joint modelling, prosthesis design, and 3D-printing. Three shank-foot specimens were CT-scanned, and corresponding 3D bone models of the tibia, fibula, talus, and calcaneus were obtained. From these models, specimen-specific implant sets were designed according to three different concepts, and 3D-printed from cobalt-chromium-molybdenum powder. Accuracy of the overall procedure was assessed via distance map comparisons between original anatomical and final metal implants. Restoration of natural ankle joint mechanics was check after implantation of each of the three sets. In a special rig, a manually-driven dorsi/plantar-flexion was applied throughout the passive arc. Additionally, at three different joint positions, joint torques were imposed in the frontal and axial anatomical planes. Mean manufacturing errors were found to be smaller than 0.08 mm. Consistent motion patterns were observed over repetitions, with the mean standard deviation smaller than 1.0 degree. In each ankle specimen, mobility, and stability at the replaced joints compared well with the original natural condition. For the first time, custom-made implants for total ankle replacements were designed, manufactured with additive technology and tested. This procedure is a first fundamental step toward the development of completely personalized prostheses. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania
| | | | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erica Liverani
- Department of Industrial Engineering, Università di Bologna, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- 1st Orthopaedic-Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tobias Konow
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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22
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Caravaggi P, Liverani E, Leardini A, Fortunato A, Belvedere C, Baruffaldi F, Fini M, Parrilli A, Mattioli‐Belmonte M, Tomesani L, Pagani S. CoCr porous scaffolds manufactured via selective laser melting in orthopedics: Topographical, mechanical, and biological characterization. J Biomed Mater Res B Appl Biomater 2019; 107:2343-2353. [DOI: 10.1002/jbm.b.34328] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/16/2018] [Accepted: 12/23/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Paolo Caravaggi
- Movement Analysis LaboratoryIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | | | - Alberto Leardini
- Movement Analysis LaboratoryIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | | | - Claudio Belvedere
- Movement Analysis LaboratoryIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Fabio Baruffaldi
- Medical Technology LaboratoryIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical StudiesIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | - Annapaola Parrilli
- Laboratory of Preclinical and Surgical StudiesIRCCS Istituto Ortopedico Rizzoli Bologna Italy
| | | | | | - Stefania Pagani
- Laboratory of Preclinical and Surgical StudiesIRCCS Istituto Ortopedico Rizzoli Bologna Italy
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23
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d'Amato M, Ensini A, Leardini A, Barbadoro P, Illuminati A, Belvedere C. Conventional versus computer-assisted surgery in total knee arthroplasty: comparison at ten years follow-up. Int Orthop 2018; 43:1355-1363. [PMID: 30196443 DOI: 10.1007/s00264-018-4114-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/13/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Computer-assisted systems (CAS) for total knee arthroplasty (TKA) were expected to result in more accurate prosthesis implantation, better patient outcomes, and longer implant survival when compared to conventional instrumentation (CI). The aim of this study was to compare two groups of patients operated using CAS or CI at ten years follow-up. METHODS One hundred twenty TKA patients, 60 using CAS and 60 using CI, were contacted after a decade for follow-up. Eligible patients received radiological examination to assess the lower-limb mechanical axis. They were also clinically assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Knee Society Score for Knee (KSS-K) and Function (KSS-F) Scoring. Kaplan-Meier survival analysis was performed to assess revisions, not for post-traumatic reasons. RESULTS In CAS and CI groups, the lower-limb mechanical axis was 1.7° ± 2.4° and 1.5° ± 2.8°, respectively; corresponding KOOS values were 82.3 ± 14.3 and 78.6 ± 14.4; KSS-K values were 85.9 ± 11.1 and 85.0 ± 9.7; KSS-F values were 82.2 ± 19.3 and 83.8 ± 18. For these assessments, the differences between the two groups were not statistically significant (p > 0.05). Two CAS (3.8%) and three CI patients (5.7%) were revised. The Kaplan-Meier analysis showed no significant differences between the two groups. CONCLUSIONS No significant differences were found at long-term follow-up in terms of radiographical-clinical outcomes and of implant survival between TKA operated using CAS or CI.
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Affiliation(s)
- Michele d'Amato
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Andrea Ensini
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Paolo Barbadoro
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Andrea Illuminati
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
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Caravaggi P, Leardini A, Belvedere C, Siegler S. A novel Cervical Spine Protection device for reducing neck injuries in contact sports: design concepts and preliminary in vivo testing. Sports Biomech 2018; 19:382-394. [PMID: 30004295 DOI: 10.1080/14763141.2018.1481222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Head and neck injuries are common in contact sports such as American football. Different mechanisms can produce such injuries, including compressive impact forces on the crown of the helmet with the neck in a flexed chin-down position. The aim of this paper was developing and testing a novel Cervical Spine Protection Device (CSPD) designed to keep the neck within its safe physiological range. The cervical spine range of motion (ROM) of ten participants was measured under four conditions: free; wearing a football gear; wearing the CSPD; and wearing the CSPD underneath the gear. The CSPD was tested in terms of passive and active restraint of head motion, and for its capability to improve endurance time of the neck extensor muscles. Wearing the CSPD resulted in a significant 40-60% reduction in ROM across the three anatomical planes, and in increased endurance of the neck extensor muscles (FREE: 114 ± 57 s; CSPD: 214 ± 95 s; p = 0.004). In quasi-static loading conditions the CSPD was capable of keeping the neck within its physiological range, thus it may be used to decrease the risk of severe injuries due to dangerous chin-down positions.
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Affiliation(s)
- Paolo Caravaggi
- Movement Analysis Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
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25
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Belvedere C, Siegler S, Ensini A, Toy J, Caravaggi P, Namani R, Princi LG, Durante S, Leardini A. Experimental evaluation of current and novel approximations of articular surfaces of the ankle joint. J Biomech 2018; 75:159-163. [PMID: 29716723 DOI: 10.1016/j.jbiomech.2018.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 01/15/2018] [Accepted: 04/14/2018] [Indexed: 11/28/2022]
Abstract
Kinematics and flexibility properties of both natural and replaced ankle joints are affected by the geometry of the articulating surfaces. Recent studies proposed an original saddle-shaped, skewed, truncated cone with laterally oriented apex, as tibiotalar contact surfaces for ankle prosthesis. The goal of this study was to compare in vitro this novel design with traditional cylindrical or medially centered conic geometries in terms of their ability to replicate the natural ankle joint mechanics. Ten lower limb cadaver specimens underwent a validated process of custom design for the replacement of the natural ankle joint. The process included medical imaging, 3D modeling and printing of implantable sets of artificial articular surfaces based on these three geometries. Kinematics and flexibility of the overall ankle complex, along with the separate ankle and subtalar joints, were measured under cyclic loading. In the neutral and in maximum plantarflexion positions, the range of motion under torques in the three anatomical planes of the three custom artificial surfaces was not significantly different from that of the natural surfaces. In maximum dorsiflexion the difference was significant for all three artificial surfaces at the ankle complex, and only for the cylindrical and medially centered conic geometries at the tibiotalar joint. Natural joint flexibility was restored by the artificial surfaces nearly in all positions. The present study provides experimental support for designing articular surfaces matching the specific morphology of the ankle to be replace, and lays the foundations of the overall process for designing and manufacturing patient-specific total ankle replacements.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
| | - Andrea Ensini
- 1st Orthopedic-Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jason Toy
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ramya Namani
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
| | | | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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26
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Belvedere C, Cadossi M, Mazzotti A, Giannini S, Leardini A. Fluoroscopic and Gait Analyses for the Functional Performance of a Custom-Made Total Talonavicular Replacement. J Foot Ankle Surg 2018. [PMID: 28633788 DOI: 10.1053/j.jfas.2017.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The present study evaluated the restoration of joint function in a special clinical case: a professional rock climber who underwent an original total talonavicular replacement with a custom-made prosthesis after a complex articular fracture. Full body gait analysis and 3-dimensional joint kinematics using single-plane fluoroscopy were performed on the same day at the 30-month follow-up examination. Gait analysis was performed using stereophotogrammetric, dynamometric, electromyographic, and baropodometric systems. Gait analysis showed good restoration of rotation, as well as moment patterns in the main lower limb and foot joints in the operated leg. At the artificial tibiotalar joint, videofluoroscopic analysis revealed a flexion capability of about 20°, together with a few degrees of motion in the frontal and transverse planes. The neighboring joints of the foot did not present with severe kinematic abnormalities. A full talonavicular replacement can be a viable and effective solution for complex ankle injury sequelae, even in patients with highly demanding functionality.
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Affiliation(s)
- Claudio Belvedere
- Engineer, Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Matteo Cadossi
- Surgeon, Second Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Antonio Mazzotti
- Medical Doctor, First Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sandro Giannini
- Professor, First Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Engineer, Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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27
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Belvedere C, Ensini A, d'Amato M, Barbadoro P, Leardini A. Three-dimensional patellar tendon fibre kinematics in navigated TKA with and without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2017; 25:3834-3843. [PMID: 27738741 DOI: 10.1007/s00167-016-4343-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/23/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Physiological elongation and orientation of patellar tendon fibres are among the scopes of total knee arthroplasty, but little is known in the three dimensions. The study aims to assess in vitro these variations at the intact and replaced knee, with and without patellar resurfacing. It was hypothesised that fibre patterns differ before and after prosthesis implantation, and between specific prosthesis designs. It was also expected that patellar resurfacing would affect relevant results. METHODS Measurements from 16 intact cadaver knees free from anatomical defects are here reported using a surgical navigation system. Data were collected at the intact joint and after implantation with cruciate-retaining or posterior-stabilised prosthesis designs, with and without patellar resurfacing. Relevant anatomical landmarks and patellar tendon attachments were digitised. Anatomical reference frames in the femur, tibia and patella were defined to measure component implantation parameters. Representative tendon fibres were defined as the straight line segments joining the two extremities. Changes in length and orientation of these fibres were calculated and reported versus flexion at the intact knee and after prosthesis implantation, both with and without patellar resurfacing. RESULTS A good intra- and inter-specimen repeatability was found at the intact and replaced knees. In both prosthesis designs, the patterns of fibre lengthening were similar to those in the intact knee, though significant differences were observed before and after patellar resurfacing. Corresponding fibre orientations in the frontal and sagittal planes showed significantly smaller ranges than those in the corresponding intact joints. More natural patterns were observed in the knees implanted with the posterior-stabilised design. Significant correlations were identified between patellar component implantation parameters and both patellar tendon fibre elongation and orientation. CONCLUSIONS Differences, however small, in patellar tendon fibre elongation and orientation were observed after total knee arthroplasty. The posterior-stabilised design provided better results, whereas patellar resurfacing affected significantly normal patellar function. In the clinical practice, the present findings can contribute to the understanding of current prosthesis designs and patellar resurfacing, recommending also enhanced care during this surgery.
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Affiliation(s)
- C Belvedere
- Movement Analysis Laboratory and Functional - Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | - A Ensini
- Movement Analysis Laboratory and Functional - Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.,2nd Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - M d'Amato
- 2nd Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - P Barbadoro
- 2nd Orthopaedic and Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Leardini
- Movement Analysis Laboratory and Functional - Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
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Leardini A, Belvedere C, Nardini F, Sancisi N, Conconi M, Parenti-Castelli V. Kinematic models of lower limb joints for musculo-skeletal modelling and optimization in gait analysis. J Biomech 2017; 62:77-86. [DOI: 10.1016/j.jbiomech.2017.04.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/22/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022]
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29
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Imbert P, Belvedere C, Leardini A. Knee laxity modifications after ACL rupture and surgical intra- and extra-articular reconstructions: intra-operative measures in reconstructed and healthy knees. Knee Surg Sports Traumatol Arthrosc 2017; 25:2725-2735. [PMID: 26037545 PMCID: PMC5570784 DOI: 10.1007/s00167-015-3653-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/18/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Quantifying the effects of anterior cruciate ligament (ACL) deficiency on knee joint laxity is fundamental for understanding the outcomes of its reconstruction techniques. The general aim of this study was to determine intra-operatively the main modifications in knee laxity before and after standard isolated intra-articular and additional extra-articular anterolateral reinforcement. Our main hypothesis was that laxity abnormalities, particularly axial rotation, can still result from these ACL reconstruction techniques. METHODS Thirty-two patients with primary ACL deficiency were analysed by a navigation system immediately before and after each of the two reconstructions. Laxity measurements in terms of knee translations and rotations were taken during the anteroposterior drawer test, with internal-external rotation at 20° and 90° of flexion, and varus-valgus and pivot-shift tests. All these laxity measures were also taken originally from the contralateral healthy knee. RESULTS With respect to the contralateral healthy knee, in the ACL-deficient knee significantly increased laxity (expressed in %) was found in the medial compared with that of the lateral compartment, respectively, 115 and 68 % in the drawer test at 20° flexion, and 55 and 46 % at 90° flexion. In the medial compartment, a significant 35 % increment was also observed for the coupled tibial anteroposterior translation during axial knee rotation at 20° of flexion. After isolated intra-articular reconstruction, normal values of anteroposterior laxity were found restored in the pivot-shift and drawer tests in the lateral compartment, but not fully in the medial compartment. After the reinforcement, laxity in the medial compartment was also found restored in the axial rotation test at 20° flexion. CONCLUSION In ACL reconstruction, with respect to the contralateral knee, intra-articular plus additional anterolateral reinforcement procedures do not restore normal joint laxity. This combined procedure over-constrained the lateral compartment, while excessive laxity still persists at the medial one. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pierre Imbert
- Department of Knee Surgery, Clinique Notre Dame De La Merci, 215, Avenue du Maréchal Lyautey, 83700, Saint Raphaël, France.
| | - Claudio Belvedere
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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Belvedere C, Leardini A, Catani F, Pianigiani S, Innocenti B. In vivo kinematics of knee replacement during daily living activities: Condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses. J Orthop Res 2017; 35:1396-1403. [PMID: 27572247 DOI: 10.1002/jor.23405] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/26/2016] [Indexed: 02/04/2023]
Abstract
In total knee replacement, the investigation on the exact contact patterns at the post-cam in implanted patients from real in vivo data during daily living activities is fundamental for validating implant design concepts and assessing relevant performances. This study is aimed at verifying the restoration of natural tibio-femoral condylar kinematics by investigating the post-cam engagement at different motor tasks. An innovative validated technique, combining three-dimensional fluoroscopic and finite element analyses, was applied to measure joint kinematics during daily living activities in 15 patients implanted with guided motion posterior-stabilized total knee replacement. Motion results showed physiological antero-posterior translations of the tibio-femoral condyles for every motor task. However, high variability was observed in the position of the calculated pivot point among different patients and different motor tasks, as well as in the range of post-cam engagement. Physiological tibio-femoral joint rotations and contacts at the condyles were found restored in the present knee replacement. Articular contact patterns experienced at the post-cam were found compatible with this original prosthesis design. The present study reports replaced knee kinematics also in terms of articular surface contacts, both at the condyles and, for the first time, at the post-cam. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1396-1403, 2017.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Fabio Catani
- Department of Orthopaedics and Traumatology, Modena Policlinic, Modena, Italy
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Belvedere C, Siegler S, Ensini A, Toy J, Caravaggi P, Namani R, Giannini G, Durante S, Leardini A. Experimental evaluation of a new morphological approximation of the articular surfaces of the ankle joint. J Biomech 2017; 53:97-104. [PMID: 28093261 DOI: 10.1016/j.jbiomech.2017.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 11/08/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
The mechanical characteristics of the ankle such as its kinematics and load transfer properties are influenced by the geometry of the articulating surfaces. A recent, image-based study found that these surfaces can be approximated by a saddle-shaped, skewed, truncated cone with its apex oriented laterally. The goal of this study was to establish a reliable experimental technique to study the relationship between the geometry of the articular surfaces of the ankle and its mobility and stability characteristics and to use this technique to determine if morphological approximations of the ankle surfaces based on recent discoveries, produce close to normal behavior. The study was performed on ten cadavers. For each specimen, a process based on medical imaging, modeling and 3D printing was used to produce two subject specific artificial implantable sets of the ankle surfaces. One set was a replica of the natural surfaces. The second approximated the ankle surfaces as an original saddle-shaped truncated cone with apex oriented laterally. Testing under cyclic loading conditions was then performed on each specimen following a previously established technique to determine its mobility and stability characteristics under three different conditions: natural surfaces; artificial surfaces replicating the natural surface morphology; and artificial approximation based on the saddle-shaped truncated cone concept. A repeated measure analysis of variance was then used to compare between the three conditions. The results show that (1): the artificial surfaces replicating natural morphology produce close to natural mobility and stability behavior thus establishing the reliability of the technique; and (2): the approximated surfaces based on saddle-shaped truncated cone concept produce mobility and stability behavior close to the ankle with natural surfaces.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA.
| | - Andrea Ensini
- 1st Orthopaedic-Traumatologic Clinic, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jason Toy
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
| | - Paolo Caravaggi
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ramya Namani
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
| | - Giulia Giannini
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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Abdel-Jaber S, Belvedere C, Mattia JSD, Leardini A, Affatato S. A new protocol for wear testing of total knee prostheses from real joint kinematic data: Towards a scenario of realistic simulations of daily living activities. J Biomech 2016; 49:2925-2931. [DOI: 10.1016/j.jbiomech.2016.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/07/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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Abdel-Jaber S, Belvedere C, Leardini A, Affatato S. Wear simulation of total knee prostheses using load and kinematics waveforms from stair climbing. J Biomech 2015; 48:3830-6. [DOI: 10.1016/j.jbiomech.2015.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/20/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
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Begon M, Leardini A, Belvedere C, Farahpour N, Allard P. Effects of frontal and sagittal thorax attitudes in gait on trunk and pelvis three-dimensional kinematics. Med Eng Phys 2015; 37:1032-6. [DOI: 10.1016/j.medengphy.2015.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/06/2015] [Accepted: 07/21/2015] [Indexed: 11/26/2022]
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Giannini S, Cadossi M, Mazzotti A, Ramponi L, Belvedere C, Leardini A. Custom-Made Total Talonavicular Replacement in a Professional Rock Climber. J Foot Ankle Surg 2015; 55:1271-1275. [PMID: 26232176 DOI: 10.1053/j.jfas.2015.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Indexed: 02/03/2023]
Abstract
Professional athletes are often eager to resume sporting activities at preinjury levels. When facing the challenge of restoring joint function after a complex articular fracture, innovative solutions must be explored. We describe the results of what we believe to be the first custom-made talonavicular prosthesis implanted in a professional rock climber who had developed post-traumatic ankle and talonavicular arthritis as sequelae of a complex talar and navicular fracture. Using computed tomography scan reconstruction of the contralateral healthy ankle and direct metal laser sintering, a custom-made talonavicular prosthesis was obtained and implanted using an anteromedial approach. The patient was clinically and radiographically evaluated every 6 months after surgery for 30 months. A 3-dimensional videofluoroscopic analysis was performed to assess the range of motion about the prosthesis. At the last follow-up visit, the functional scores were excellent (Tegner activity scale score of 9 of 10), and he had completely resumed his sporting activity. The American Orthopaedic Foot and Ankle Society score had increased from 36 to 81 points, and no signs of radiolucency were observed on the radiographs. The 3-dimensional videofluoroscopic analysis showed 15° of dorsiflexion and 4° of plantar flexion at the ankle. A customized solution is an option when the patient's expectations are not likely to be met by standard treatment, such as arthrodesis. A custom-made talonavicular prosthesis can be an effective solution for complex ankle injury sequelae in patients demanding high functionality.
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Affiliation(s)
- Sandro Giannini
- Professor, I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Matteo Cadossi
- Surgeon, I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Antonio Mazzotti
- Medical Doctor, I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy.
| | - Laura Ramponi
- Medical Doctor, I Clinic of Orthopaedic and Traumatology, Istituto Ortopedico Rizzoli, Bologna University, Bologna, Italy
| | - Claudio Belvedere
- Engineer, Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Engineer, Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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Barbadoro P, Ensini A, Leardini A, d'Amato M, Feliciangeli A, Timoncini A, Amadei F, Belvedere C, Giannini S. Tibial component alignment and risk of loosening in unicompartmental knee arthroplasty: a radiographic and radiostereometric study. Knee Surg Sports Traumatol Arthrosc 2014; 22:3157-62. [PMID: 24972998 DOI: 10.1007/s00167-014-3147-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 06/18/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Unicompartmental knee arthroplasty (UKA) has shown a higher rate of revision compared with total knee arthroplasty. The success of UKA depends on prosthesis component alignment, fixation and soft tissue integrity. The tibial cut is the crucial surgical step. The hypothesis of the present study is that tibial component malalignment is correlated with its risk of loosening in UKA. METHODS This study was performed in twenty-three patients undergoing primary cemented unicompartmental knee arthroplasties. Translations and rotations of the tibial component and the maximum total point motion (MTPM) were measured using radiostereometric analysis at 3, 6, 12 and 24 months. Standard radiological evaluations were also performed immediately before and after surgery. Varus/valgus and posterior slope of the tibial component and tibial-femoral axes were correlated with radiostereometric micro-motion. A survival analysis was also performed at an average of 5.9 years by contacting patients by phone. RESULTS Varus alignment of the tibial component was significantly correlated with MTPM, anterior tibial sinking, varus rotation and anterior and medial translations from radiostereometry. The posterior slope of the tibial component was correlated with external rotation. The survival rate at an average of 5.9 years was 89%. The two patients who underwent revision presented a tibial component varus angle of 10° for both. CONCLUSIONS There is correlation between varus orientation of the tibial component and MTPM from radiostereometry in unicompartmental knee arthroplasties. Particularly, a misalignment in varus larger than 5° could lead to risk of loosening the tibial component. LEVEL OF EVIDENCE Prognostic studies-retrospective study, Level II.
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Affiliation(s)
- P Barbadoro
- 1st Ortopaedic-Traumatologic Clinic, Istituto Ortopedico Rizzoli, University of Bologna, Via Pupilli 1, 40136, Bologna, Bo, Italy,
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Battaglia S, Belvedere C, Jaber SA, Affatato S, D'Angeli V, Leardini A. A new protocol from real joint motion data for wear simulation in total knee arthroplasty: stair climbing. Med Eng Phys 2014; 36:1605-10. [PMID: 25242732 DOI: 10.1016/j.medengphy.2014.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 08/05/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
In its normal lifespan, a knee prosthesis must bear highly demanding loading conditions, going beyond the sole activity of level walking required by ISO standard 14243. We have developed a protocol for in vitro wear simulation of stair climbing on a displacement controlled knee simulator. The flexion/extension angle, intra/extra rotation angle, and antero/posterior translation were obtained in patients by three-dimensional video-fluoroscopy. Axial load data were collected by gait analysis. Kinematics and load data revealed a good consistence across patients, in spite of the different prosthesis size. The protocol was then implemented and tested on a displacement controlled knee wear simulator, showing an accurate reproduction of stair climbing waveforms with a relative error lower than 5%.
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Affiliation(s)
- Santina Battaglia
- Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sami Abdel Jaber
- Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Saverio Affatato
- Medical Technology Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Valentina D'Angeli
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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Belvedere C, Ensini A, Leardini A, Dedda V, Feliciangeli A, Cenni F, Timoncini A, Barbadoro P, Giannini S. Tibio-femoral and patello-femoral joint kinematics during navigated total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2014; 22:1719-27. [PMID: 24408075 DOI: 10.1007/s00167-013-2825-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 12/28/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE In total knee arthroplasty, surgical navigation systems provide tibio-femoral joint (TFJ) tracking for relevant bone preparation, disregarding the patello-femoral joint (PFJ). Therefore, the important intra-operative assessment of the effect of component positioning, including the patella, on the kinematics of these two joints is not available. The objective of this study is to explore in vivo whether accurate tracking of the patella can result in a more physiological TFJ and PFJ kinematics during surgery. METHODS Ten patients underwent navigated knee replacement with patellar resurfacing. A secondary system was used to track patellar motion and PFJ kinematics using a special tracker. Patellar resection plane position and orientation were recorded using an instrumented probe. During all surgical steps, PFJ kinematics was measured in addition to TFJ kinematics. RESULTS Abnormal PFJ motion patterns were observed pre-operatively at the impaired knee. Patellar resection plane orientation on sagittal and transverse planes of 3.9° ± 9.0° and 0.4° ± 4.1° was found. A good restoration of both TFJ and PFJ kinematics was observed in all replaced knees after resurfacing, in particular the rotations in the three anatomical planes and medio-lateral patellar translation. CONCLUSIONS Patella tracking results in nearly physiological TFJ and PFJ kinematics in navigated knee arthroplasty with resurfacing. The intra-operative availability also of PFJ kinematics can support the positioning not only of the patellar component in case of resurfacing, but also of femoral and tibial components.
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Affiliation(s)
- C Belvedere
- Movement Analysis Laboratory and Functional - Clinical Evaluation of Prostheses, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy,
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Imbert P, Belvedere C, Leardini A. Human knee laxity in ACL-deficient and physiological contralateral joints: intra-operative measurements using a navigation system. Biomed Eng Online 2014; 13:86. [PMID: 24961322 PMCID: PMC4099024 DOI: 10.1186/1475-925x-13-86] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/11/2014] [Indexed: 12/02/2022] Open
Abstract
Background The comprehension of human knee laxity and of the failures of relevant surgical reconstructions of the anterior cruciate ligament (ACL) can be enhanced by the knowledge of the laximetric status of the contralateral healthy knee (CHK). Rarely this is available in patients, directly from the skeletal structures, and for a number of the standard clinical tests. The general aim of this study was to measure the extent to which laxity occurs immediately before surgery in the ACL deficient knee (ADK) with respect to CHK, in a number of standard clinical evaluation tests. Method Thirty-two patients with ACL deficiency were analyzed at ADK and at CHK by a navigation system immediately before reconstructions. Knee laxity was assessed based on digitized anatomical references during the antero-posterior drawer, Lachman, internal-external rotation, varus-valgus, and pivot-shift tests. Antero-posterior laxity was normalized based on patient-specific length of the tibial plateau. Results In the drawer test, statistical significance (p < 0.05) was found for the larger antero-posterior laxity in ADK than in CHK, on average, of 54' in the medial and 47' in the lateral compartments, when measured in normalized translations. In the Lachman test, these were about 106' and 68'. The pivot-shift test revealed a significant 70' larger antero-posterior central laxity and a 32' larger rotational laxity. No statistically relevant differences were observed in the other tests. Conclusion The first conclusion is that it is important to measure also the antero-posterior and rotational laxity of the uninjured contralateral knee in assessing the laxity of the injured knee. A second is that the Lachman test shows knee laxity better than the AP drawer, and that the pivot-shift test was the only one able to reveal rotational instability. The present original measurements and analyses contribute to the knowledge of knee joint mechanics, with possible relevant applications in biomedical and clinical research.
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Affiliation(s)
| | | | - Alberto Leardini
- Movement Analysis Laboratory, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
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Ensini A, Timoncini A, Cenni F, Belvedere C, Fusai F, Leardini A, Giannini S. Intra- and post-operative accuracy assessments of two different patient-specific instrumentation systems for total knee replacement. Knee Surg Sports Traumatol Arthrosc 2014; 22:621-9. [PMID: 24061719 DOI: 10.1007/s00167-013-2667-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/31/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this study is to assess and compare the accuracy of two different patient-specific instrumentation (PSI) systems for total knee replacement, both intra-operatively for bone preparation and post-operatively for final component alignment. METHODS Twenty-five patients were treated according to a computer tomography (CT)-based PSI system (group A) and 25 to a magnetic resonance imaging (MRI)/X-ray-based system (group B). Alignments on the three anatomical planes and resection thickness at the cutting blocks and at the resulting bone cuts were recorded intra-operatively by a standard surgical navigation system. Alignments of the prosthetic components and mechanical axis were also measured post-operatively on radiographs. These measurements at both the femur and tibia were compared with those of the corresponding pre-operative planning, considering discrepancies larger than 3° as outliers. RESULTS In both groups, the mean absolute differences between pre-operatively planned alignments and corresponding intra- and post-operative measurements ranged from a minimum of 1.2° to a maximum of 2.9° in all three anatomical planes. In both groups and in both femur and tibia, the plane with the smallest percentage of outliers was the coronal, maximum 17%. The comparison between two groups was statistically significant (p = 0.02) in the femoral sagittal plane, where group B showed smaller alignment discrepancies at the cutting blocks. CONCLUSIONS Both PSI systems showed good alignments in the coronal plane in all stages. For a few measurements, a better performance was observed in the MRI/X-ray-based system than in the CT-based system. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Andrea Ensini
- Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
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D’Angeli V, Belvedere C, Ortolani M, Giannini S, Leardini A. Load along the tibial shaft during activities of daily living. J Biomech 2014; 47:1198-205. [DOI: 10.1016/j.jbiomech.2014.01.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Cenni F, Timoncini A, Ensini A, Tamarri S, Belvedere C, D'Angeli V, Giannini S, Leardini A. Three-dimensional implant position and orientation after total knee replacement performed with patient-specific instrumentation systems. J Orthop Res 2014; 32:331-7. [PMID: 24174168 DOI: 10.1002/jor.22513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 10/04/2013] [Indexed: 02/04/2023]
Abstract
Patient-specific instrumentation systems are entering into clinical practice in total knee replacement, but validation tests have yet to determine the accuracy of replicating computer-based plans during surgery. We performed a fluoroscopic analysis to assess the final implant location with respect to the corresponding preoperative plan. Forty-four patients were analyzed after using a patient-specific system based on CT and MRI. Computer aided design implant models and models of the femur and tibia bone portions, as for the preoperative plans, were provided by the manufacturers. Two orthogonal fluoroscopic images of each knee were taken after surgery for pseudo-biplane imaging; 3D component locations with respect to the corresponding bones were estimated by a shape-matching technique. Assuming that the corresponding values at the preoperative plan were equal to zero, discrepancies were taken as an indication of accuracy for the systems. A repeatability test revealed that the technique was reliable within 1 mm and 1°. The maximum discrepancies for all the patients for the femoral component were 5.9 mm in a proximo-distal direction and 4.2° in flexion. Good matching was found between final implantations and preoperative plans with mean discrepancies smaller than 3.1 mm and 1.9°.
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Affiliation(s)
- Francesco Cenni
- Movement Analysis Laboratory-Clinical and Functional Evaluation of Prostheses, Istituto Ortopedico Rizzoli, Bologna, Italy
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Belvedere C, Tamarri S, Notarangelo DP, Ensini A, Feliciangeli A, Leardini A. Three-dimensional motion analysis of the human knee joint: comparison between intra- and post-operative measurements. Knee Surg Sports Traumatol Arthrosc 2013; 21:2375-83. [PMID: 23114867 DOI: 10.1007/s00167-012-2271-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 10/19/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare intra-operative knee joint kinematic measurements immediately after total knee replacement with those of the same patients post-operatively at 6-month follow-up. METHODS Fifteen patients who underwent total knee arthroplasty were analysed retrospectively. Eight were implanted with one prosthesis design and seven with another. The intra-operative measurements were performed by using a standard knee navigation system. This provided accurate three-dimensional positions and orientations for the femur and tibia by corresponding trackers pinned into the bones. At 6-month follow-up, the patients were analysed by standard three-dimensional video-fluoroscopy of the replaced knee during stair climbing, chair rising and step-up. Relevant three-dimensional positions and orientations were obtained by an iterative shape-matching procedure between the silhouette contours and the CAD-model projections. A number of traditional kinematic parameters were calculated from both measurements to represent the joint motion. RESULTS Good post-operative replication of the intra-operative measurements was observed for most of the variables analysed. The statistical analysis also supported the good consistency between the intra- and post-operative measurements. CONCLUSIONS Intra-operative kinematic measurements, accessible by a surgical navigation system, are predictive of the following motion performance of the replaced knees as experienced in typical activities of daily living. LEVEL OF EVIDENCE Prognostic studies--investigating natural history and evaluating the effect of a patient characteristic, Level II.
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Affiliation(s)
- C Belvedere
- Movement Analysis Laboratory, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy,
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D'Angeli V, Belvedere C, Ortolani M, Giannini S, Leardini A. Load along the femur shaft during activities of daily living. J Biomech 2013; 46:2002-10. [PMID: 23845727 DOI: 10.1016/j.jbiomech.2013.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
Abstract
A comprehensive knowledge of the loads applied during activities of daily living to the femur shaft is necessary to the design of direct attachments of relevant prostheses. A motion analysis system was used together with an established protocol with skin markers to estimate the three components of the forces and moments acting on ten equidistant points along the full femur shaft. Twenty healthy young volunteers were analyzed while performing three repetitions of the following tasks: level walking at three different speeds, straight-line and with sudden changes of direction to the right and to the left, stairs ascending and descending, squat, rising from a chair and sitting down. Average load patterns, after normalisation for body weight and height, were calculated over subjects for each point, about the three anatomical axes, and for each motor task. These patterns were found consistent over subjects, but different among the anatomical axes and tasks. In general, the moments were observed limitedly influenced by the progression speed, and higher for more proximal points. The moments were also higher in abd/adduction (8.1% body weight*height on average), nearly three times larger than those in flex/extension (2.6) during stair descending. The largest value over all moments was 164.8 N m, abd/adduction in level walking at high speed. The present results should be of value also for a most suitable level for amputation in transfemoral amputation, for in-vitro mechanical tests and for finite element models of the femur.
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Affiliation(s)
- V D'Angeli
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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Cenni F, Leardini A, Pieri M, Berti L, Belvedere C, Romagnoli M, Giannini S. Functional performance of a total ankle replacement: thorough assessment by combining gait and fluoroscopic analyses. Clin Biomech (Bristol, Avon) 2013. [PMID: 23177657 DOI: 10.1016/j.clinbiomech.2012.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A thorough assessment of patients after total ankle replacement during activity of daily living can provide complete evidence of restored function in the overall lower limbs and replaced ankle. This study analyzes how far a possible restoration of physiological mobility in the replaced ankle can also improve the function of the whole locomotor apparatus. METHODS Twenty patients implanted with an original three-part ankle prosthesis were analyzed 12 months after surgery during stair climbing and descending. Standard gait analysis and motion tracking of the components by three-dimensional fluoroscopic analysis were performed on the same day using an established protocol and technique, respectively. FINDINGS Nearly physiological ankle kinematic, kinetic and electromyography patterns were observed in the contralateral side in both motor activities, whereas these patterns were observed only during stair climbing in the operated side. Particularly, the mean ranges of flexion at the replaced ankle were 13° and 17° during stair climbing and descending, respectively. Corresponding 2.1 and 3.1mm antero/posterior meniscal-to-tibial translations were correlated with flexion between the two metal components (p<0.05). In addition, a larger tibiotalar flexion revealed by fluoroscopic analysis resulted in a physiological hip and knee moment. INTERPRETATION The local and global functional performances of these patients were satisfactory, especially during stair climbing. These might be associated to the recovery of physiological kinematics at the replaced ankle, as also shown by the consistent antero/posterior motion of the meniscal bearing, according to the original concepts of this ankle replacement design.
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Affiliation(s)
- F Cenni
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy.
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Cenni F, Pieri M, Berti L, Belvedere C, Romagnoli M, Giannini S, Leardini A. FUNCTIONAL PERFORMANCE OF REPLACED ANKLES BY COMBINING GAIT AND FLUOROSCOPIC ANALYSES. J Biomech 2012. [DOI: 10.1016/s0021-9290(12)70201-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cenni F, Leardini A, Belvedere C, Bugané F, Cremonini K, Miscione MT, Giannini S. Kinematics of the three components of a total ankle replacement: in vivo fluoroscopic analysis. Foot Ankle Int 2012. [PMID: 22735201 DOI: 10.3113/fai.2012.0290.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Careful kinematic analysis of ankle joints with newly developed prostheses should be carried out to assess the actual performance in vivo. This study analyzed the pattern of motion of the three components of a ligament-compatible ankle replacement, developed to replicate normal joint kinematics. MATERIALS AND METHODS Twelve patients treated with this design were analyzed at 6, 12, and 24 months followup. A series of images were acquired by videofluoroscopy at extremes of the range of motion, and during flexion/extension against gravity and stair-climbing/descending. Three-dimensional positions and orientations of the tibial and talar metal components and of the polyethylene mobile-bearing were obtained from the images by a standard shape-matching procedure. Motion between the three components was calculated and descriptively analyzed. RESULTS Large tibiotalar joint mobility of the replaced ankle was observed in all three anatomical planes, particularly in the sagittal. In flexion/extension against gravity, the mean range of flexion was 17.6, 17.7, and 16.2 degrees, respectively, over the three followups. The inclination angle of the mean axis of joint rotation was 3.7 degrees down and lateral in the frontal plane and 4.7 degrees posterior and lateral in the transverse plane, similar to those in the normal ankle. The corresponding antero-posterior translation of the meniscal-bearing with respect to the tibia was 3.3, 3.3, and 3.2 mm, with statistically significant correlation with joint flexion. CONCLUSION Physiological motion can be achieved in ligament-compatible ankle joint replacements. The considerable antero-posterior bearing-to-tibial motion and its coupling with flexion support the main original claims of this design.
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Affiliation(s)
- Francesco Cenni
- Istituto Ortopedico Rizzoli, Movement Analysis Laboratory, Via di Barbiano, Bologna, Italy.
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Cenni F, Leardini A, Belvedere C, Bugané F, Cremonini K, Miscione MT, Giannini S. Kinematics of the three components of a total ankle replacement: in vivo fluoroscopic analysis. Foot Ankle Int 2012; 33:290-300. [PMID: 22735201 DOI: 10.3113/fai.2012.0290] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Careful kinematic analysis of ankle joints with newly developed prostheses should be carried out to assess the actual performance in vivo. This study analyzed the pattern of motion of the three components of a ligament-compatible ankle replacement, developed to replicate normal joint kinematics. MATERIALS AND METHODS Twelve patients treated with this design were analyzed at 6, 12, and 24 months followup. A series of images were acquired by videofluoroscopy at extremes of the range of motion, and during flexion/extension against gravity and stair-climbing/descending. Three-dimensional positions and orientations of the tibial and talar metal components and of the polyethylene mobile-bearing were obtained from the images by a standard shape-matching procedure. Motion between the three components was calculated and descriptively analyzed. RESULTS Large tibiotalar joint mobility of the replaced ankle was observed in all three anatomical planes, particularly in the sagittal. In flexion/extension against gravity, the mean range of flexion was 17.6, 17.7, and 16.2 degrees, respectively, over the three followups. The inclination angle of the mean axis of joint rotation was 3.7 degrees down and lateral in the frontal plane and 4.7 degrees posterior and lateral in the transverse plane, similar to those in the normal ankle. The corresponding antero-posterior translation of the meniscal-bearing with respect to the tibia was 3.3, 3.3, and 3.2 mm, with statistically significant correlation with joint flexion. CONCLUSION Physiological motion can be achieved in ligament-compatible ankle joint replacements. The considerable antero-posterior bearing-to-tibial motion and its coupling with flexion support the main original claims of this design.
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Affiliation(s)
- Francesco Cenni
- Istituto Ortopedico Rizzoli, Movement Analysis Laboratory, Via di Barbiano, Bologna, Italy.
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Ensini A, Catani F, Biasca N, Belvedere C, Giannini S, Leardini A. Joint line is well restored when navigation surgery is performed for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20:495-502. [PMID: 21625830 DOI: 10.1007/s00167-011-1558-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The incorrect restoration of the joint line during TKA can result in joint instability, anterior knee pain, limited range of motion, and joint stiffness. The joint line level is usually measured only on pre- and post-operative radiographs. Current knee navigation systems can now potentially support intra-operatively joint line restoration by controlling the exact amount of the bone-cartilage removed and the corresponding overall thickness of the components implanted. The aim of this study was to assess how well the joint line level is restored and the tibiofemoral overstuffing prevented when standard knee surgical navigation is used carefully also with these purposes. Intra-operative measurements during navigated TKA were taken. METHODS Sixty-seven primary TKAs were followed prospectively. The variation before and after prosthesis component implantation of the joint line level, both in the femoral and tibial reference, was measured intra-operatively by an instrumented probe. Overstuffing was measured as the difference between the overall craniocaudal thickness of the femoral and tibial prosthesis components inserted and the thickness of the bone-cartilage removed. RESULTS A significant elevation in the joint line level after prosthesis implantation was found with respect to the tibial reference (1.9 ± 2.4 mm, mean ± SD), very little to the femoral reference (0.3 ± 2.1 mm), perhaps accounted for the femur-first operative technique utilized. Overstuffing was on the average of 2.2 ± 3.0 mm. CONCLUSIONS These results suggest that a knee navigation system can also support well a proper restoration of the joint line level and limit the risk of overstuffing when relevant measurements are taken carefully during operation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- A Ensini
- Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, Italy.
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Catani F, Belvedere C, Ensini A, Feliciangeli A, Giannini S, Leardini A. In-vivo knee kinematics in rotationally unconstrained total knee arthroplasty. J Orthop Res 2011; 29:1484-90. [PMID: 21452303 DOI: 10.1002/jor.21397] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 02/07/2011] [Indexed: 02/04/2023]
Abstract
Total knee replacement designs claim characteristic kinematic performance that is rarely assessed in patients. In the present study, in vivo kinematics of a new prosthesis design was measured during activities of daily living. This design is posterior stabilized for which spine-cam interaction coordinates free axial rotation throughout the flexion-extension arc by means of a single radius of curvature for the femoral condyles in the sagittal and frontal planes. Fifteen knees were implanted with this prosthesis, and 3D video-fluoroscopic analysis was performed at 6-month follow-up for three motor tasks. The average range of flexion was 70.1° (range: 60.1-80.2°) during stair-climbing, 74.7° (64.6-84.8°) during chair-rising, and 64.1° (52.9-74.3°) during step-up. The corresponding average rotation on the tibial base-plate of the lines between the medial and lateral contact points was 9.4° (4.0-22.4°), 11.4° (4.6-22.7°), and 11.3° (5.1-18.0°), respectively. The pivot point for these lines was found mostly in the central area of the base-plate. Nearly physiological range of axial rotation can be achieved at the replaced knee during activities of daily living.
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Affiliation(s)
- Fabio Catani
- Department of Orthopedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
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