Three-dimensional dynamic simulation of total knee replacement motion during a step-up task.

A three-dimensional dynamic model of the tibiofemoral and patellofemoral articulations was developed to predict the motions of knee implants during a step-up activity. Patterns of muscle activity, initial joint angles and velocities, and kinematics of the hip and tinkle were measured experimentally and used as inputs to the simulation. Prosthetic knee kinematics were determined by integration of dynamic equations of motion subject to forces generated by muscles, ligaments, and contact at both the tibiofemoral and patellofemoral articulations. The modeling of contacts between implants did not rely upon explicit constraint equations; thus, changes in the number of contact points were allowed without modification to the model formulation. The simulation reproduced experimentally measured flexion-extension angle of the knee (within one standard deviation), but translations at the tibiofemoral articulations were larger during the simulated step-up task than those reported for patients with total knee replacements.