Research in Total Knee Arthroplasty Biomechanics: Closing the Gap Between Surgeons and Engineers
Abstract
Knee kinematics is a complex three-dimensional roto-translation strongly influenced by patient-specific anatomy, including the femoral condyles, tibial plateau, patellar surface, and soft tissue morphology and mechanics. As each individual exhibits unique kinematics and kinetics, understanding patient-specific joint anatomy and function—through dedicated experimental and computational methodologies—is essential to bridge the gap between surgeons and engineers in total knee arthroplasty (TKA).
Recent research using robotic simulators has advanced the accurate assessment of 3D knee kinematics, involving both rotations and translations. Particularly, these studies have begun addressing previously underexplored aspects such as patellofemoral mechanics, collateral ligament strain, and knee alignment. The integration of numerical simulations with experimental data has further enhanced biomechanical comprehension, enabling sensitivity analyses of contact forces, bone stresses, fracture risk, and ligament strain distributions.
Evidence consistently shows that knee biomechanics is highly patient-dependent. Even minor deviations in implant positioning or soft tissue modelling can induce substantial changes in joint forces—sometimes up to 60%—despite only small kinematic alterations. Therefore, close-to-reality models of the knee joint, which account for soft tissue behavior, are crucial for accurate tibiofemoral and patellofemoral interaction predictions.
Moreover, findings indicate that kinematics alone may not suffice to explain postoperative knee function; kinetics must also be considered in clinical follow-up. Patient-specific experimental and computational approaches thus emerge as promising tools to guide surgeons and engineers in optimizing TKA outcomes and restoring mobility.
Short Bio
Bernardo Innocenti is Professor of Biomechanics at the BEAMS Department of the Université Libre de Bruxelles (ULB), Belgium, since 2012. He earned his degree in Mechanical Engineering (2002) and a Ph.D. in Mechanical Design (2006), both from the University of Florence. From 2007 to 2012, he served as Lead Project Manager at the European Centre for Knee Research, Smith & Nephew, in Leuven, Belgium. At ULB, he was appointed Associate Professor in 2012 and promoted to Professor in 2020. Since 2011, he has also been a Guest Professor in the Division of Biomechanics, Department of Mechanical Engineering, KU Leuven, Belgium. Since 2022, he has served as President of the Biomedical Filière at ULB.
His main research focus is orthopaedic biomechanics, particularly the numerical and experimental analysis of the human knee joint in native, pathological, and prosthetic conditions. He is the author or co-author of more than 150 peer-reviewed journal articles, 10 book chapters, 1 book, and 3 patents.
He regularly reviews leading journals in orthopaedics and biomechanics and serves as Associate Editor for the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA), Journal of Orthopaedic Surgery and Research, and Frontiers in Biomechanics. He is also on the Editorial Boards of Muscles, Ligaments and Tendons Journal (MLTJ), Journal of Mechanics in Medicine and Biology, and Journal of Medical and Biological Engineering.
Prof. Innocenti is a member of the Council of the European Society of Biomechanics (since 2022), the founding President of the Belgian Chapter of the International Society for Computer-Assisted Orthopaedic Surgery (CAOS Belgium, 2015), and a member of the European Knee Society (2016), the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (2016), and the European Knee Associates (2018).
He has received several awards, including the Marc Coventry Award (2009) and the Richard S. Laskin Research Award (2011). Prof. Innocenti is also a consultant for several orthopaedic companies.