• Korean Journal of Computational Design and Engineering
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• v.16 no.5
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• pp.315-322
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• 2011

The goal of total knee replacement (TKR) surgery is to replace patient's knee joint with artificial implants in order to restore normal knee joint functions. Since mismatched knee implants often cause a critical balancing problem and short durability, designing a well-fitted implant to a patient's knee joint is essential to improve surgical outcomes. We developed a software system that three-dimensionally (3D) simulates TKR surgery based upon 3D knee models reconstructed from computed tomography (CT) imaging. The main task of the system was to extract precise 3D anatomical parameters of a patient's knee that were directly used to determine a custom fit implant and to virtually perform TKR surgery. The virtual surgery was simulated by amputating a 3D knee model and positioning the determined implant components on the amputated knee. The test result shows that it is applicable to derive surgical parameters, determine individualized implant components, rehearse the whole surgical procedure, and train medical staff or students for actual TKR surgery. The feasibility and verification of the proposed system is described with examples.

• Proceedings of the Korean Society of Precision Engineering Conference
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• 2007.06a
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• pp.207-208
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• 2007

• Proceedings of the KSME Conference
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• 2008.11a
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• pp.1473-1474
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• 2008

In the total knee arthroplasty (TKA), kinematic benefic of a mobile-bearing total knee prosthesis is still arguing. Main reasons for implant failure are loosening and polyethylene wear and should be solved with new designs with mob ile bearings. The kinematics of the knee prosthesis also affects the implant failure. Recently, a second generation of p rostheses with a mobile-bearing was developed. The current study aimed to assess the kinematic path of the 2nd generation mobile knee prosthesis compared to the normal knees. Using 3D/2D registration method, CT-derived 3D knee models were fitted to sequential 2D X-ray images during knee flexion. 3D kinematics of the femur and the tibia were analyzed. The 2nd generation mobile-bearing TKA prosthesis (e.motion, Aesculap, Germany) knees showed less external rotation and knee flexion range compared to the normal knee, but the trend of external rotation was similar each other.

• Journal of Yeungnam Medical Science
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• v.21 no.1
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• pp.1-11
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• 2004

Total knee arthroplasty has become a common procedure for treatment of severe osteoarthritis, rheumatoid arthritis and post-traumatic arthritis. In the past, failure of total knee arthroplasty was commonly attributable to aseptic loosening, often associated with component malalignment, soft tissue imbalance. With improved surgical instrumentation and soft tissue balancing techiniques, failure secondary to mechanical loosening has been minimal. But surgeons are still dissatisfied with implant malalignment. Correct tibiofemoral alignment seems to be particularly important since it is generally agreed that axial deviation and imprecise implantation may lead to loosening of the implant component. Navigation systems and robotic techniques could potentially solve problems of imprecision in traditional total knee arthroplasty. It is expected that the success rate and longevity of total knee arthroplasty will be improved during the twenty first century.

• Journal of Biomedical Engineering Research
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• v.28 no.1
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• pp.108-116
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• 2007

Recently, it has been reported that the posterior stabilized implant, which is clinically used for the total knee replacement (TKR), may have failure risk such as wear or fracture by the contact pressure and stress on the tibial post. The purpose of this study is to investigate the influence of the mal alignment of the posterior stabilized implant on the tibial post by estimating the distributions of contact pressure and von-Mises stress on a tibial post and to analyze the failure risk of the tibial post. Finite element models of a knee joint and an implant were developed from 1mm slices of CT images and 3D CAD software, respectively. The contact pressure and the von-Mises stress applying on the implant were analyzed by the finite element analysis in the neutral alignment as well as the 8 malalignment cases (3 and 5 degrees of valgus and varus angulations, and 2 and 4 degrees of anterior and posterior tilts). Loading condition at the 40% of one whole gait cycle such as 2000N of compressive load, 25N of anterior-posterior load, and 6.5Nm of torque was applied to the TKR models. Both the maximum contact pressure and the maximum von-Mises stress were concentrated on the anterior-medial region of the tibial post regardless of the malalignment, and their magnitudes increased as the degree of the malalignment increased. From present result, it is shown that the malalignment of the implant can influence on the failure risk of the tibial post.

• Journal of Biomedical Engineering Research
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• v.24 no.4
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• pp.363-367
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• 2003

Contact area and pressure are important factors which directly influence a life of knee implants. Since implant's mechanical functions should be experimentally evaluated for clinical use, many studies using a knee simulator and a pressure sensor system have been conducted. However it has not been reported that the contact pressure's distribution of a knee implant motion was estimated in real-time during a gate cycle. Therefore. the objective of this study was to analyze the contact pressure distribution for the motion of a joint using the knee simulator and I-scan sensor system. For this purpose, we developed a force-controlled dynamic knee simulator to evaluate the mechanical performance of artificial knee joint. This simulator includes a function of a soft tissue and has a 4-degree-of-freedom to represent an axial compressive load and a flexion angle. As axial compressive force and a flexion angle of the femoral component can be controlled by PC program. The pressure is also measured from I-scan system and simulator to visualize the pressure distribution on the joint contact surfaces under loading condition during walking cycle. The compressive loading curve was the major cause for the contact pressure distribution and its center move in a cycle as to a flexion angie. In conclusion, this system can be used to evaluate to the geometric interaction of femoral and tibial design due to a measured mechanical function such as a contact pressure, contact area and a motion of a loading center.

• Archives of Plastic Surgery
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• v.45 no.3
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• pp.280-283
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• 2018

Knee revision arthroplasty following peri-prosthetic joint infections is a formidable challenge. Patients are at a high risk of recurrent infection, and the soft tissue over the revised implant is often of questionable quality. Flap reconstruction has improved the salvage rates of infected arthroplasties, and should be considered in all cases of revision arthroplasty. We present a challenging case requiring staged reconstruction with two free latissimus dorsi flaps after the initial use of a medial gastrocnemius flap.

• Journal of the Computational Structural Engineering Institute of Korea
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• v.31 no.1
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• pp.23-29
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• 2018

In knee implants, contact pressure has a significant effect on wear. In this study, finite element analysis is performed using the knee implant model developed in the previous research. The contact pressures for a total of 10 knee implant materials combinations were analyzed using the combinations actually used in research and industry. In order to calculate the contact pressure, The load was applied when the flection angle of knee was $30^{\circ}$, $45^{\circ}$ and $60^{\circ}$. The result of contact pressure revealed the smallest contact pressure in the titanium alloy-UHMWPE combination. In the case of UHMWPE, contact pressure did not change much with any material used in the femur. Compared the combination with the largest contact pressure and the smallest contact pressure, the difference was 0.77%. On the other hand, Carbon / PEEK composites showed 5.3% difference when the contact pressure was the largest and the smallest. It can be seen that when the Carbon / PEEK composite material is used as the bearing part, the material of the femoral part affects the wear. This study will contribute to the prediction of knee implant wear and minimization of wear.

• Journal of radiological science and technology
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• v.41 no.5
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• pp.413-419
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• 2018

Magnetic Resonance Imaging for patients with metallic implant has poor image quality, and signal loss and artifacts including distortion can occur. The purpose of this study is to carry out a comparative evaluation on high receive bandwidth(hiBW), O-MAR, O-MAR XD to reduce artifacts in knee implant. To take MRI, 3.0T scanner and dual-source radiofrequency transmission were used. O-MAR XD technique's strong option showed a significant difference (p<0.001) with O-MAR XD technique's weak option, O-MAR and hiBW excluding the medium option. O-MAR XD's medium option had a significant difference (p<0.01) with O-MAR XD's weak, O-MAR and hiBW. O-MAR XD technique's weak option had a significant difference (p<0.01) with O-MAR XD's strong and medium options, O-MAR and hiBW. O-MAR technique had a significant difference (p<0.001) with strong, medium, weak options of O-MAR XD technique except for hiBW. HiBW had a significant difference (p<0.001) with strong, medium and weak options of O-MAR XD technique except for O-MAR. The results showed that O-MAR XD technique was more useful for MRI scan for patients with knee replacement surgery than traditional techniques such as hiBW or O-MAR, and susceptibility artifacts decreased more when O-MAR XD technique's strong or medium option was applied. Based on the results above, it is considered that it will be possible to acquire images whose susceptibility artifacts were highly decreased by using O-MAR XD technique's strong or medium option when conducting MRI for artificial knee joint and it will be helpful for checking and monitoring patients with knee joint replacement.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.124-135
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• 2017

Background In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA. Methods A systematic search and meta-analysis were performed to identify patients with TKA who underwent either pedicled muscle or fasciocutaneous flap coverage of periprosthetic knee defects. Studies evaluating implant/limb salvage rates, ambulatory function, complications, and donor-site morbidity were included in the comparative analysis. Results A total of 18 articles, corresponding to 172 flaps (119 muscle flaps and 53 fasciocutaneous flaps) were reviewed. Rates of implant salvage (88.8% vs. 90.1%, P=0.05) and limb salvage (89.8% vs. 100%, P=0.14) were comparable in each cohort. While overall complication rates were similar (47.3% vs. 44%, P=0.78), the rates of persistent infection (16.4% vs. 0%, P=0.14) and recurrent infection (9.1% vs. 4%, P=0.94) tended to be higher in the muscle flap cohort. Notably, functional outcomes and ambulation rates were sparingly reported. Conclusions Rates of limb and prosthetic salvage were comparable following muscle or fasciocutaneous flap coverage of compromised TKA. The functional morbidity associated with muscle flap harvest, however, may support the use of fasciocutaneous flaps for coverage of these defects, particularly in young patients and/or high-performance athletes.