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. Author manuscript; available in PMC: 2022 May 24.
Published in final edited form as: J Biomech. 2021 Apr 15;121:110420. doi: 10.1016/j.jbiomech.2021.110420

In vivo Articular Contact Pattern of a Total Wrist Arthroplasty Design

Bardiya Akhbari 1, Amy M Morton 2, Kalpit N Shah 2, Janine Molino 2, Douglas C Moore 2, Arnold-Peter C Weiss 2,3, Scott W Wolfe 4,5, Joseph J Crisco 1,2
PMCID: PMC8130596  NIHMSID: NIHMS1697500  PMID: 33895657

Abstract

Total wrist arthroplasty (TWA) designs suffer from a relatively high complication rate when compared to other arthroplasties. Understanding the contact pattern of hip and knee replacement has improved their design and function; however, the in vivo contact pattern of TWA has not yet been examined and is thus the aim of this study. We hypothesized that the center of contact (CoC) is located at the geometric centers of the carpal component and radial component in the neutral posture and that the CoC moves along the principal arcs of curvature throughout primary anatomical motions. Wrist motion and implant kinematics of six patients with the Freedom® total wrist implant were studied during various tasks using biplanar videoradiography. The location of the CoC of the components was investigated by calculating distance fields between the articular surfaces. We found the CoC at the neutral posture was not at the geometric centers but was located 3.5mm radially on the carpal component and 1.2mm ulnarly on the radial component. From extension to flexion, the CoC moved 10.8mm from dorsal to volar side on the carpal component (p<0.0001) and 7.2mm from volar to dorsal on the radial component (p=0.0009). From radial to ulnar deviation, the CoC moved 12.4mm from radial to ulnar on the carpal component (p<0.0001), and 5.6mm from ulnar to radial on the radial component (p=0.009). The findings of this study may eventually improve TWA success by advancing future designs through a more accurate understating of their kinematic performance in vivo.

Keywords: contact, total wrist arthroplasty, pattern, wrist, distance field

1. Introduction

Identifying articular contacts in joint arthroplasty is critical for determining the biomechanical factors that limit postoperative range-of-motion and for understanding failure mechanisms and wear patterns of implant components (Gilbert et al., 2014; Steinbrück et al., 2013; Trepczynski et al., 2019). Improving implant designs to reduce the failure and complication rate is especially important for total wrist arthroplasty (TWA) designs, given their stubbornly high complication rate (Fischer et al., 2020; Melamed et al., 2016; Yeoh and Tourret, 2015). Investigations of hip replacements have identified points of increased wear (Hua et al., 2014; Kwon et al., 2012) that have led to design improvements to reduce impingement by minimizing edge loading (Hua et al., 2016). Similarly, total knee arthroplasty designs have advanced to mimic the contact patterns of a native knee joint by allowing for the rollback of the distal femur on the tibial plateau (Steinbrück et al., 2013).

With the goal of reducing complications such as loosening and periprosthetic fractures, the articular shape of TWA devices has been modified from an early ball-and-socket design to a recent toroidal or ellipsoidal design (Berber et al., 2018; Halim and Weiss, 2017). These current TWA designs have an articular shape that aligns with the two primary anatomical directions of flexion-extension and radial-ulnar deviation that the radiocarpal joint follows (Vance et al., 2012). However, most wrist motions involve a combination of the flexion-extension and radial-ulnar deviation (i.e., the dart-thrower’s motion) and occur at the mid-carpal joint (Crisco et al., 2005). It is unknown if the in vivo TWA component articulation simulates the primary directions or violates them by following an oblique path.

Abnormal and excess interface loads, high shear stress on the arthroplasty components, and bearing wear could result in polyethylene particle debris and eventual implant failure (Kandemir et al., 2020; Zhu et al., 2001). Understanding the contact patterns, the locations of the centers of contact (CoC), and their relationship to wrist motion may give us insight into potential points of abnormal stresses and possible approaches for reducing abnormal interface loads. Finite element models have shown that a toroidal design TWA has a more uniform stress distribution and less contact pressure compared to a wrist affected by rheumatoid arthritis (Bajuri et al., 2013), but may generate high stress levels on the ulnar aspect of the radial component possibly because of the geometrical configuration of the implant (Gislason et al., 2017). Grosland et al. compared the toroidal and ellipsoidal TWA designs and demonstrated that the ellipsoidal articulation was more likely to achieve a higher stability with more consistent contact areas (Grosland et al., 2004). Although these finite element models have led to a change in design from toroidal (Universal®, Integra LifeSciences) to ellipsoidal (Freedom®, Integra LifeSciences) shape articulation, an understanding of the actual contact pattern of TWA in vivo is lacking.

The aim of this study was to determine the in vivo articular contact patterns and identify the CoC of a single TWA implant design during various wrist motions and tasks. To do so, we used biplane videoradiography (BVR), an imaging technique that provides direct visualization of bone and implant motion. Based on the geometry of the articular components, we hypothesized that the CoC would be located at the geometric center of the convex surface of the carpal component and at the center of the concave surface of the radial component when the wrist is in a neutral posture. We also hypothesized that the CoC would move along the principal arcs of curvature of the carpal component during the primary anatomical motions of wrist flexion-extension and radioulnar deviation and that the CoC would remain stationary at the geometric center of the concave surface on the radial component. Because the calculations of the in vivo CoC for TWA designs with model-based BVR is novel, we evaluated the sensitivity of these calculations as a secondary objective.

2. Methods

2.1. Recruitment and Data Acquisition

Six non-rheumatoid patients (74.7 ± 5.6 yrs, 2F, 2R) with size 2 Freedom® TWA implants (Integra LifeSciences, Plainsboro, NJ) provided informed written consent and participated in this study after institutional review board approval. The standard size polyethylene cap of the carpal component was used for 4 patients, while +2mm size (larger proximal-distal dimension) was used for the other 2 patients for better restoration of carpal height. The cohort studied herein was part of a project that previously compared the biomechanics of a TWA to a healthy cohort in terms of center of rotation and alignment (Akhbari et al., 2021b, 2020).

A computed-tomography (CT) scan (Lightspeed® 16, GE Medical, Milwaukee, WI) of each wrist was acquired at a resolution of 0.39mm×0.39mm×0.625mm. Biplane videoradiography (BVR) was used to capture dynamic implant motion at 200 Hz with acquisition specifications of 75 kV/80 mA and 500μs shutter speed for both X-ray sources (XROMM, Brown University). Each study participant performed 5 tasks involving active wrist motion, including flexion-extension, radial-ulnar deviation, circumduction, simulated hammering, and simulated pitcher pouring. Each task was performed for 2 seconds, resulting in 10 seconds of total capture or 2,000 biplane radiographs per patient (mean total effective dose of radiation to each patient was approximately 0.95 mSv). The angle between the image intensifiers was ~110°, and the source-to-image distances for the X-ray sources were ~130 cm. The accuracy of BVR in capturing the wrist motion is approximately 0.7° for rotations and 0.3 mm for translations (Akhbari et al., 2019b). A more detailed description of the data acquisition parameters and tasks has been reported previously (Akhbari et al., 2020).

2.2. Model Generation and Kinematics

Three-dimensional (3D) surface models of the implants, implant-based coordinate systems (CS), and bone surface models were generated semi-automatically using a previously described methodology (Akhbari et al., 2020). Briefly, surface models of the carpal implant component, the 3rd metacarpal (MC3), and the resected radius were generated using Mimics v19 software (Materialise NV, Leuven, BE). Models of the polyethylene cap and radial component of the TWA were generated using a 3D scanner (Artec Space Spider™, Artec 3D, Luxembourg) and were superimposed on the carpal component and resected radius, respectively. The resolution (i.e., the median edge length of the triangular facets) of the polyethylene cap and radial component surface models were 0.39 and 0.46 mm, respectively. To reconstruct a pre-surgery model of the radius for visualization and coordinate system construction, the contralateral radius was used for 3 patients, and best-fit radii from a database of 120 intact radius bone models (Akhbari et al., 2019a) were used for the other 3 patients.

Coordinate systems were constructed for both the carpal component and radial component. The origin of the CS for the carpal component was placed at the center of the ellipse-shaped surface of the polyethylene cap (corresponding to the distal surface of the titanium base) with the positive y-axis directed radially and positive z-axis directed volarly (Figure 1). The stem of the radial component was shape-registered using a cylinder in Geomagic Wrap (3D Systems, Rock Hill, SC), and the longitudinal axis of the cylinder was used to define the x-axis with positive directed proximally. The CS for the radial component was located at the intersection of the x-axis and the distal articular surface, with positive y-axis directed radially and positive z-axis directed volarly (Figure 1). The geometric center of the concave surface of the radial component was 4.2mm ulnar and 3.6mm volar to the origin of the radial component’s CS. Coordinate systems for the radius and the MC3 were also constructed using standard anatomical landmarks (e.g., radius styloid, sigmoid notch) and geometrical features for kinematics description with respect to the radius (Akhbari et al, 2019a).

Figure 1.

Figure 1.

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The coordinate system (CS) of the carpal component was constructed using the minor and major axes of the ellipsoidal surface of the polyethylene cap and the central axis of the carpal stem. The radial component’s CS was constructed using the minor and major axes of its ellipsoidal surface and the central axis of the radial stem. The origins are shown with black circles. The geometric center of the radial component was 4.2 mm ulnar and 3.6 mm volar to the origin of the radial component’s coordinate system.

The implant components were tracked in the BVR images using an open-source 2D-to-3D registration software program (Autoscoper, Brown University, [https://simtk.org/projects/autoscoper]) (Akhbari et al., 2021a). The global position and orientation of the carpal component and radial component were then transformed to the MC3 and radius coordinate systems, respectively. Wrist kinematics were reported as the posture of MC3 with respect to the radius, relative to its posture in neutral position. The wrist’s neutral posture was defined by the image pose in which the wrist had minimal flexion-extension and minimal radial-ulnar deviation, selected from all captured images. Helical axes of motion parameters were used to report wrist and implant rotations. Pure flexion-extension (radial-ulnar deviation < 5% of the maximum range) and pure radial-ulnar deviation (flexion-extension < 5% of the maximum range) were defined for further contact processing. Pronation-supination (axial rotation of the carpal component relative to the radial component) was minimal (0.1±4.7°) throughout all acquired tasks.

2.3. Contact Analysis

Contact between the carpal component and radial component was calculated using wrist kinematics and component-specific distance fields (Marai et al., 2004). Distance fields were calculated for a given closed 3D surface model as a volumetric array of signed distances from the surface (i.e., the centroids of the array voxels to the triangular faces of the implant model surfaces). Known affine transformations of the array structure allowed rapid and accurate distance calculation of the proximity of any point on the opposing model to the model surface. Tri-cubic interpolation in the distance field was performed to yield sub-voxel accuracy. Using the distance fields, proximity values on the surface of the polyethylene cap and radial component were calculated for each posture (Figure 2). To obtain the contact patch between the components, these proximity values were then adjusted to the resolution of the acquisition system and our computational approach. A distance exclusion threshold (T) was used to estimate the resolution, and its sensitivity was assessed (2.4 Sensitivity Analysis).

Figure 2.

Figure 2.

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Surface-to-surface distances were calculated using the proximity value of each component after its kinematic transformation was calculated from biplanar videoradiography. Proximity values greater than 0.70 mm were excluded, and the remaining values were used to calculate the center of contact (white circles).

The CoC was calculated as the weighted-average position of the contact patch on each component. Each component’s distance field was weighted by (T – PV), where T was the optimal distance exclusion threshold and PV was the proximity value for each triangular face of the component. The weighting factor was used to reduce the influence of large proximity values in computing the CoC. Lastly, for consistency in evaluating the CoC among all patients, and because the weighted center is not precisely on the surface mesh, the weighted center was assigned to its corresponding closest point on the surface mesh.

2.4. Sensitivity Analysis

A Monte Carlo simulation that incorporated the accuracy of the BVR (0.7° and 0.3mm) was used to determine the value of T that achieved the optimal resolution. A priori, 0.41mm (i.e., 0.32+0.22+0.22=0.41mm based on translation accuracy of BVR) was selected as the optimal resolution of the system (Akhbari et al., 2019b). To find the optimal T, 10% of implant positions (n = 1,142) were chosen randomly (Ip, where p = 1:1,142), and the CoC was calculated at threshold values (T) of 0, 0.05, 0.10, …, 1.45, and 1.50mm (CCTp) . Then, the position and orientation of the carpal component (Ip) was perturbed 1,000 times within the limits of the system accuracy (< 0.7° and < 0.3mm) in all 6 degrees of freedom (Ip,m, where m = 1:1,000). The relative distance field for each Ip,m was computed, and the CoC was calculated (CCTp,m) using each threshold (T) value. The Euclidean distances of all CCTp,m to CCTp were then calculated (ETp,m), and the standard deviation of ETp,m (PT) was computed for each threshold (T). The relationship between PT and T was modelled as an exponential decay function:

PT=a∗eb∗T+c (Equation 1)

where coefficients a, b, and c were determined by curve fitting (Matlab 2018a, Mathworks, Natick, MA). Model fitness was evaluated with adjusted R2 and root-mean-squared-error (RMSE). The optimal value of T was defined when the model achieved 0.41mm resolution. The CoC relative to each component was computed and compared to verify CoC location.

2.5. Statistical Analysis

The mean and 95% confidence interval (CI) of the CoC location at the neutral posture was calculated across 6 subjects. To assess the relationship between CoC locations and the direction of wrist motion (see Appendix for the visualization), mixed models with a random intercept and random slope were used (flexion-extension and radial-ulnar deviation) in SAS version 9.4 (SAS Institute Inc., Cary, NC). A separate model was run for each CoC location and direction of motion. To assess the relative position of the CoC location with respect to the component’s CS origin, intercept-only mixed models with a random intercept were used. The maximum likelihood estimators of the models were adjusted for possible model misspecification using classical sandwich estimators. Pseudo r-squared (R2) values were calculated to assess model fit, and a p-value of 0.05 was used to determine statistical significance.

3. Results

Sensitivity analysis established 0.70 mm as the threshold to achieve the optimal resolution of the BVR system and thus defined the lower limit of CoC localization (Figure 3). The exponential decay equations

PTCarpal Component=2.0e−3.5T+0.2
PTRadial Component=1.5e−3.1T+0.2

both had R2 of 1.0 and an RMSE of 0.02 and demonstrating the validity of selecting an exponential decay model that resulted in an estimated resolution of 0.63mm and 0.70mm for CoC localization on the carpal component and the radial component, respectively. In verification, the distance between the CoC calculated relative to the carpal component and relative to the radial component was less than 0.4 mm across all implant postures.

Figure 3.

Figure 3.

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Each wrist posture was randomly perturbed 1,000 times within the range of accuracy of biplanar videoradiography (left panel), and the standard deviation of calculating the center of contact was computed at threshold values of 0 to 1.5 mm in increments of 0.05 mm for the carpal component (middle panel) and the radial component (right panel). An optimal threshold value of 0.70 mm was selected when the optimal resolution criteria of 0.41 mm (red dashed line) was met.

Across all patients and tasks, the average maximum (range) wrist flexion, extension, radial deviation, and ulnar deviation were 26.6° (10.4°–49.3°), 49.2° (36.9°–60.8°), 16.4 (11.5°–23.1°), and 18.2° (6.7°–31.1°), respectively.

At the wrist neutral posture, the carpal component was oriented on average [95% CI] at 4.9° pronation [2.4° pronation, 7.4° pronation], 0.9° flexion [6.9° extension, 8.7° flexion], and 2.8° radial deviation [11.9° radial deviation, 6.3° ulnar deviation] relative to the radial component. At the neutral posture, the CoC was located 3.5 mm radially [2.7mm, 4.4mm] and 0.5 mm dorsally [0.1mm, 0.9mm] from the carpal component’s geometric center. Similarly, the CoC was located 1.4 mm ulnar [0.7mm, 2.1mm] and 0.6 mm dorsal [0.4mm, 0.8mm] from the radial component’s geometric center.

Wrist motion from flexion to extension was significantly associated with volar-to-dorsal movement of the CoC on the carpal component, shifting at a rate of approximately 1 mm per 10° (R2=0.97, p<0.0001), as well as dorsal-to-volar movement of the CoC on the radial component, shifting at a rate of approximately 0.5 mm per 10° (R2=0.75, p=0.0009) (Figure 4 and Figure 5). Throughout wrist flexion-extension, the average CoC on the carpal component was located 3.4 mm radial to the geometric center of the surface of the carpal components (p=0.044), and on the radial component the CoC was located 1.3 mm ulnar to the geometric center of the surface of the radial component (p=0.0006). The locations of the CoC in flexion-extension demonstrated a pattern that did not follow the principal arc of curvature of the ellipsoidal shape of the polyethylene component (Figure 6).

Figure 4.

Figure 4.

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(A) The center of contact of the carpal component moved from dorsal to volar side from full wrist extension (red color) to wrist flexion (blue color), (B) while it moved from volar to dorsal side of the radial component throughout the same path.

Figure 5.

Figure 5.

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The postures of the bones (third metacarpal, resected capitate, and resected radius) and implant components (carpal component and its polyethylene cap, and radial component) at (A) maximum wrist flexion and (B) extension. Potential impingement of the components at the extreme extension can be seen in both the radiographic image and the three-dimensional models. The white circles on the components are demonstrative of the center of contact.

Figure 6.

Figure 6.

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Predicted and 95% confidence interval (CI) behavior of the centers of contact movement throughout pure flexion-extension and radial-ulnar deviation was computed based on mixed models. Flexion-extension range-of-motion is demonstrated from 60° flexion to 60° extension in 20° steps, and radial-ulnar deviation range-of-motion is demonstrated at 0°, 10°, 15°, and 20° in both radial and ulnar deviation.

From full radial deviation to full ulnar deviation, the CoC on the carpal component moved from a radial location to ulnar location at a rate of 3.1mm per 10° (R2=0.96, p<0.001), while it moved from an ulnar location to a radial location on the radial component, at a more modest rate of 1.4mm per 10° (R2=0.84, p=0.009) (Figure 7 and Figure 8). This center of contact was located at 7.4mm ulnar (p<0.0001) and 2.4mm volar relative to the radial component’s CS (p=0.0002). The locations of the CoC in radial-ulnar deviation generally followed the principal arc of curvature of the polyethylene cap (Figure 6).

Figure 7.

Figure 7.

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(A) The center of contact of the carpal component moved from its radial side to its ulnar side during wrist movement from radial deviation to ulnar deviation, (B) while it slightly moved from the ulnar side toward its radial side on the radial component.

Figure 8.

Figure 8.

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The three-dimensional models of bones and implant components at (A) maximum wrist ulnar deviation and (B) radial deviation. Complete contact between components can be seen in maximum ulnar deviation in both radiographs and three-dimensional models. The white circles on the components are demonstrative of the center of contact.

During circumduction, the CoC covered an area of 34.2 ± 13.1mm around the dorsal-radial side of the carpal component while it covered an area of 21.9 ± 8.0mm on the radial component (Figure 9).

Figure 9.

Figure 9.

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Throughout circumduction for all 6 patients (right panel; color-coded based on patients), the centers of contact on average moved around the dorsal-radial side of the carpal component (top left panel) while the centers of contact moved slightly on the radial component (bottom left panel). The average and standard deviation of movements are shown by the white circles and white dashed-ellipses, respectively.

4. Discussion

Our goal in this study was describe the location of the center of contact (CoC) of a single TWA design during in vivo wrist motion. At the neutral posture, we observed the CoC was located primarily on the radial side of the carpal component, and slightly ulnar and dorsal on the radial component, which differed from what one would expect based on the implant’s design geometry and implantation instructions. We also observed a dorsal-to-volar and radial-to-ulnar translation of the CoC on the carpal component, and volar-to-dorsal and ulnar-to-radial translation of the CoC on the radial component, as the wrist moved from full extension to flexion and from full radial deviation to ulnar deviation, respectively. Lastly, the CoC shifted only moderately (less than 10% of the articular surface area) on the radial component during circumduction, while it circled around a large portion of the dorsoradial side of the carpal component during the same motion.

Our findings are consistent with the predictions of a previous finite element model (Grosland et al., 2004), as we observed a less than 1.5mm shift in the CoC, which is a mathematical estimation of the center of pressure, on the carpal component within the first 15° of flexion-extension. We also observed a radial position of the CoC on the carpal component while Grosland et al. did not specify any radial positioning of the CoC. Another finite element study determined higher stress rate on the ulnar and dorsal aspect of the radial component, similar to our study that has shown the overall ulnar and dorsal location of the CoC on the radial component during flexion-extension and radial-ulnar deviation (Gislason et al., 2017).

Understanding the articulation pattern of the radial and carpal TWA components can help identify possible impingement or zones of increased stress on the components at different postures. Recent studies have shown that TWA allows for adequate wrist functionality for activities of daily living and that it has a good patient satisfaction rate, though it has much smaller ranges-of-motion compared to healthy wrists (Akhbari et al., 2020; Badge et al., 2016; Kennedy et al., 2018; Singh et al., 2017). Both improved range-of-motion and higher survivability of the implant could be affected if the impingement-free arc of motion is maximized (Brown and Callaghan, 2008; Cho et al., 2013; Walker et al., 2011). Based on our analysis of the in vivo flexion-extension motion, the CoC moves in opposite directions on the radial and carpal components and it is most congruent at the radial side of the carpal component. This opposing rotational and translational behavior might result in impingement and restriction of range-of-motion at certain wrist postures (top right radiographic image of Figure 5). Understanding the nature of the joint’s articulation could also improve and validate future computational models. Furthermore, current laboratory wear tests and computational models of TWA simulate wrist motion with experimental simplifications (load and motion applied) (Completo et al., 2017), which may be inaccurate (Gislason et al., 2016). Accurate and detailed data describing contact patterns should aid investigators in the development and design of more realistic laboratory wear testing protocols, as well as interpreting wear findings in retrieved implants.

While normal wrist motion occurs at both the radiocarpal and midcarpal joints (Craigen and Stanley, 1995; Rainbow et al., 2016), TWA implants simplify the wrist joint by making a single radiocarpal articulation out of a two-joint “cardan”-type articulation. Therefore, it is important to compare the TWA articulation to scaphoid-lunate articulation on the radius. However, there is a lack of consensus on the movement pattern of the CoC of the radiocarpal articulation. This could be attributed to the differences in measurement methods and their accuracies. For example, while some investigators have determined that the CoC of the scaphoid is located on the volar aspect of the radius on average (Chambers et al., 2020; Short et al., 1997; Viegas et al., 1987), others have not found any patterns of the CoC in various wrist postures (Kobayashi et al., 2018). In a cadaveric study, Viegas et. al found no significant movement of the scaphoid’s CoC on the radius in flexion but observed dorsal translation in early extension and volar translation at the extreme extension (Viegas et al., 1987). Some in vivo studies have determined that the scaphoid’s CoC is either not moving or moving dorsally on the radius from flexion to extension (Rainbow et al., 2013; Tang and Chen, 2012; Tang et al., 2009), and one study has demonstrated dorsal movement of the CoC on both the scaphoid and lunate in both mid- and extreme extension (Tang and Chen, 2012) and little movement of the CoC on the radius. During flexion, the CoC had a volar/radial movement on the radius and volar movement on the scaphoid (Rainbow et al., 2013; Tang et al., 2009). Our findings for the CoC movement on the carpal component are similar to what is reported for the scaphoid and lunate in the in vivo studies, but not what is reported for the radial component when compared to the literature for the radius. These dissimilarities could be due to soft tissue differences after joint replacement or the geometric differences between the radial component and the distal radius.

The main limitation of our study was the small cohort of 6 participants with a single implant design of polyethylene articulation on metal. Satisfactory alignment of TWA components consistent with the manufacturer’s recommendations are not always be achieved (Ocampos, 2014). Given our small sample size, it is possible that the position of the implants at the neutral posture may have affected the CoC and articulation patterns. However, based on RMSE and R2 parameters calculated from our statistical analysis (mixed models), which factors the CoC behavior for each patient separately, the articulation of the components it suggests that surgical malalignment was of limited influence. Furthermore, another potential limitation is the dependency of our system on the accuracy of tracking. For example, if the tracking accuracy increases (e.g., using the CAD model of the radial component instead of a laser-scanned model) the precision threshold along with the resolution of CoC detection would have been increased, yet the magnitude of this increase is unknown. Although we evaluated the sensitivity of our contact analysis method within the limit of accuracy of BVR, we did not validate our system using pressure sensors in cadaver models.

In this study, we computed the sensitivity of a BVR system in estimating the contact pattern of TWA components, and we demonstrated the articulation patterns of these components based on the direction of motion. Although we hypothesized that the center of contact moves along the principal arcs of curvature, our assessment showed that the centers of contact are primarily restricted to the radial side of the convex surface of the carpal component and the ulnar side of the concave surface of the radial component. Our findings may inform future design considerations for TWA, help determine protocols for wear and stress testing for TWA implants in the laboratory, and contribute to the validation of computational models.

Supplementary Material

1
Download video file (30.6MB, mp4)

Acknowledgements

The authors want to thank Erika Tavares for her help throughout biplanar videoradiography data acquisition. This study was possible with support from the National Institutes of Health P30-GM122732 (COBRE Bio-engineering Core) and a grant from the American Foundation for Surgery of the Hand (AFSH).

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Supplementary Material

Video animation of a subject performing anatomical tasks along with the contact pattern are available in the supplementary material. The dataset used in this study is publicly available on https://simtk.org/projects/twa-bvr.

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