A Critical Analysis of TKR In Vitro Wear Tests Considering Predicted Knee Joint Loads.

Detailed knowledge about loading of the knee joint is essential for preclinical testing of total knee replacement. Direct measurement of joint reaction forces is generally not feasible in a clinical setting; non-invasive methods based on musculoskeletal modelling should therefore be considered as a valid alternative to the standards guidelines. The aim of this paper is to investigate the possibility of using knee joint forces calculated through musculoskeletal modelling software for developing an in vitro wear assessment protocol by using a knee wear simulator. In particular, in this work we preliminarily show a comparison of the predicted knee joint forces (in silico) during the gait with those obtained from the ISO 14243-1/3 and with those measured in vivo by other authors. Subsequently, we compare the wear results obtained from a knee wear joint simulator loaded by calculated forces in correspondence to the "normal gait" kinematics with those obtained in correspondence to the loads imposed by the ISO. The obtained results show that even if the predicted load profiles are not totally in good agreement with the loads deriving from ISO standards and from in vivo measurements, they can be useful for in vitro wear tests, since the results obtained from the simulator in terms of wear are in agreement with the literature data.