A Development of Force Distribution Measurement System with High Resolution for Total Knee Arthroplasty
Mohd Hanafi Mat Som*,**, Kouki Nagamune*,***, Takashi Kamiya*,
Shogo Kawaguchi*, Koji Takayama***, Tomoyuki Matsumoto***,
Ryosuke Kuroda***, and Masahiro Kurosaka***
*Graduate School of Engineering, University of Fukui, 3-9-1 Bunkyo, Fukui-shi, Fukui 910-0017, Japan
**School of Mechatronic Engineering, Universiti Malaysia Perlis, Pauh Putra Campus, Arau, Perlis 02600, Malaysia
***Graduate School of Medicine, Kobe University, 7-5-1 Kusunokicho, Chuo-ku, Hyogo, Kobe 650-0017, Japan
Soft tissue or ligament balancing in total knee arthroplasty is important for ensuring knee joint stability. Correct balancing and appropriate alignment of ligaments extend prosthesis life by preventing unnecessary force fromacting on the prosthesis during routine activities. The current implementation of total knee arthroplasty relies heavily on the subjective “feel” of the surgeon for correct prosthesis implantation onto tibiofemoral components. We developed a force distribution sensing systemto provide quantitative information to surgeons during ligament balancing. The measurement system consists of two main components: two force sensors embedded in trial insert for each condyle and signal acquisition for data processing and force visualization. Sensors were designed and developed using pressure-sensitive conductive rubber that measures changes in resistance in the event of deformation caused by external force. Corresponding voltage measured by circuits is transmitted via an RF transceiver to a computer and visualized as color gradient. Current sensors could measure maximum force of 196.13 N (20 kgf). Results from calibration and experiments on a plastic trial prosthesis indicated that the device has good potential for providing appropriate force distribution information on the knee during total knee arthroplasty procedure.
-  H. P. Delport, J. Vander Sloten, and J. Bellemans, “New possible pathways in improving outcome and patient satisfaction after TKA,” Acta Orthopædica Belgica, Vol.79, No.3, 2013.
-  S. Kurtz, K. Ong, E. Lau, F. Mowat, andM. Halpern, “Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030,” The J. of Bone & Joint Surgery, Vol.89, No.4, pp. 780-785, 2007.
-  C. Lavernia, D. J. Lee, and V. H. Hernandez, “The increasing financial burden of knee revision surgery in the United States,” Clinical orthopaedics and related research, Vol.446, pp. 221-226, 2006.
-  Y. Kadono, H. Yasunaga, H. Horiguchi, H. Hashimoto, S. Matsuda, S. Tanaka, and K. Nakamura, “Statistics for orthopedic surgery 2006–2007: data from the Japanese Diagnosis Procedure Combination database,” J. of Orthopaedic Science, Vol.15, No.2, pp. 162- 170, 2010.
-  G. Golladay, K. Gustke, L. C. Elson, and C. R. Anderson, “Intraoperative Sensors for Dynamic Feedback During Soft Tissue Balancing Preliminary Results of a Prospective Multicenter Study,” American Academy of Orthopaedic Surgeons, 2013.
-  C. A. Jones, D. C. Voaklander, D. Johnston, and M. E. Suarez-Almazor, “Health related quality of life outcomes after total hip and knee arthroplasties in a community based population.,” The J. of rheumatology, Vol.27, No.7, pp. 1745-1752, 2000.
-  J. A. Rand, R. T. Trousdale, D. M. Ilstrup, and W. S. Harmsen, “Factors affecting the durability of primary total knee prostheses,” The J. of Bone & Joint Surgery, Vol.85, No.2, pp. 259-265, 2003.
-  A. D. Beswick, V. Wylde, R. Gooberman-Hill, A. Blom, and P. Dieppe, “What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients,” BMJ Open, Vol.2, No.1, 2012.
-  T. K. Fehring, S. Odum,W. L. Griffin, J. B. Mason, and M. Nadaud, “Early failures in total knee arthroplasty,” Clinical orthopaedics and related research, Vol.392, pp. 315-318, 2001.
-  R. Siston, N. Giori, S. Goodman, and S. Delp, “Surgical navigation for total knee arthroplasty: A perspective,” J. Biomech., Vol.40, pp. 728-735, 2007.
-  D. Crottet, J. Kowal, S. Sarfert, T.Maeder, H. Bleuler, and L. Nolte, L.P. Dürselen, “Ligament balancing in TKA: Evaluation of a forcesensing device and the influence of patellar eversion and ligament release,” J. Biomech., Vol.40, pp. 1709-1715, 2007.
-  S. Babazadeh, J. D. Stoney, K. Lim, and P. F. Choong, “The relevance of ligament balancing in total knee arthroplasty: how important is it? A systematic review of the literature,” Orthopedic reviews, Vol.1, No.e26, 2009.
-  E. Aunan, T. Kibsgård, J. Clarke-Jenssen, and S. Röhrl, “A new method to measure ligament balancing in total knee arthroplasty: laxity measurements in 100 knees,” Archives of orthopaedic and trauma surgery, pp. 1-9, 2012.
-  F. Griffin, J. Insall, and G. Scuderi, “Accuracy of soft tissue balancing in total knee arthroplasty,” The J. of arthroplasty, Vol.15, No.8, pp. 970-973, 2000.
-  T. Matsumoto, H. Muratsu, S. Kubo, M. Kurosaka, and R. Kuroda, “Recent Advances in Hip and Knee Arthroplasty,” chapter 18, In-Tech, Jan. 2012.
-  T. Matsumoto, H. Muratsu, S. Kubo, T. Matsushita, M. Kurosaka, and R. Kuroda, “Soft Tissue Tension in Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty,” J. Arthroplasty, Vol.26, pp. 788-795, 2011.
-  S. Okamoto, K. Okazaki, H. Mitsuyasu, S. Matsuda, and Y. Iwamoto, “Lateral Soft Tissue Laxity Increases but Medial Laxity Does Not Contract With Varus Deformity in Total Knee Arthroplasty,” Clinical orthopaedics and related research, 2012.
-  D. Viskontas, T. Skrinskas, J. Johnson, G. King, M.Winemaker, and D. Chess, “Computer-assisted gap equalization in total knee arthroplasty,” The J. of arthroplasty, Vol.22, No.3, pp. 334-342, 2007.
-  M. Winemaker, “Perfect balance in total knee arthroplasty: the elusive compromise,” The J. of arthroplasty, Vol.17, No.1, pp. 2-10, 2002.
-  J.Wu, X. Pang, and G.Wang, “The Geometry Parameters Measurement in the Computer Aided Knee Replacement Surgery System,” InWCSE ’09, WRI World Congress on Software Engineering 2009, Vol.3, pp. 67-70, 2009.
-  B. A. Morris, D. D. D’Lima, J. Slamin, N. Kovacevic, S. W. Arms, C. P. Townsend, and C. W. ColwellJr, “e-Knee: Evolution of the Electronic Knee Prosthesis Telemetry Technology Development,” The J. of Bone & Joint Surgery, Vol.83, No.2 suppl 1, pp. S62-66, 2001.
-  T. Takahashi, Y. Wada, and H. Yamamoto, “Soft-tissue balancing with pressure distribution during total knee arthroplasty,” J. of Bone & Joint Surgery, British Volume, Vol.79, No.2, pp. 235-239, 1997.
-  A. L. Wallace, M. L. Harris, W. R. Walsh, and W. J. Bruce, “Intraoperative assessment of tibiofemoral contact stresses in total knee arthroplasty,” The J. of arthroplasty, Vol.13, No.8, pp. 923-927, 1998.
-  K. Tanaka, H. Muratsu, K. Mizuno, R. Kuroda, S. Yoshiya, and M. Kurosaka, “Soft tissue balance measurement in anterior cruciate ligament-resected knee joint: cadaveric study as a model for cruciate-retaining total knee arthroplasty,” J. of Orthopaedic Science, Vol.12, No.2, pp. 149-153, 2007.
-  M. Ohmukai, Y. Kami, and R. Matsuura, “Electrode for Force Sensor of Conductive Rubber,” J. of Sensor Technology, Vol.2, No.3, pp. 127-131, 2012.
-  P. Tsotra and K. Friedrich, “Electrical and mechanical properties of functionally graded epoxy-resin/carbon fibre composites,” Composites Part A: applied science and manufacturing, Vol.34, No.1, pp. 75-82, 2003.
-  Y.-J. Yang, M.-Y. Cheng, W.-Y. Chang, L.-C. Tsao, S.-A. Yang, W.-P. Shih, F.-Y. Chang, S.-H. Chang, and K.-C. Fan, “An integrated flexible temperature and tactile sensing array using PI-copper films,” Sensors and Actuators A: Physical, Vol.143, No.1, pp. 143-153, 2008.
-  N. Das, T. Chaki, and D. Khastgir, “Effect of processing parameters, applied pressure and temperature on the electrical resistivity of rubber-based conductive composites,” Carbon, Vol.40, No.6, pp. 807-816, 2002.
-  M. Hussain, Y. Choa, and K. Niihara, “Conductive rubber materials for pressure sensors,” J. of materials science letters, Vol.20, Vol.6, pp. 525-527, 2001.
-  F. Souza, R. Michel, and B. Soares, “A methodology for studying the dependence of electrical resistivity with pressure in conducting composites,” Polymer testing, Vol.24, No.8, pp. 998-1004, 2005.
-  M. Shimojo, A. Namiki, M. Ishikawa, R. Makino, and K. Mabuchi, “A Tactile Sensor Sheet Using Pressure Conductive Rubber With Electrical-Wires Stitched Method,” Vol.4, No.5, pp. 589-596, 2004.
-  F. Xu, Y. Ge, Y. Yu, J. Ding, T. Ju, and S. Li, “The Design of a Novel Flexible Tactile Sensor Based on Pressure-conductive Rubber,” Sensors & Transducers, Vol.124, No.1, 2011.
-  W. Mars and A. Fatemi, “Factors that affect the fatigue life of rubber: a literature survey,” Rubber Chemistry and Technology, Vol.77, No.3, pp. 391-412, 2004.
-  K. Weiß and H. Worn, “The working principle of resistive tactile sensor cells,” In Mechatronics and Automation, 2005 IEEE Int. Conf., Vol.1, pp. 471-476, 2005.
-  V. Pinskerova, P. Johal, S. Nakagawa, A. Sosna, A. Williams, W. Gedroyc, and M. Freeman, “Does the femur roll-back with flexion?,” J. of Bone & Joint Surgery, British Volume, Vol.86, No.6, pp. 925-931, 2004.
This article is published under a Creative Commons Attribution-NoDerivatives 4.0 Internationa License.