Total knee arthroplasty (TKA) - the replacement of the articulating surfaces of the knee joint - is an increasingly used intervention for osteoarthritis. Younger, more active patients are undergoing TKA due to the clinical success of the implants. Surgeons must make recommendations on the suitability of post-surgery sporting activities; a balance must be struck between the health-promoting nature of the activity and the risk involved to the implant. Golf has been identified as a sport with a large number of participants that is recommended by the majority of knee surgeons. Despite golf being considered a low risk activity, there is limited scientific evidence that the loading applied to the knee-joint may be larger than assumed. Thus, the main aim of this thesis was to provide objective biomechanical data to contribute to our scientific knowledge base and to provide meaningful clinical data to enable medical practitioners to make informed decisions regarding the appropriateness of golf as an activity for post -TKA individuals. Three studies are presented in this thesis. The first investigated the suitability of a standard six-degrees-of-freedom (6DoF) marker model and tested the performance of an alternative model that included an 'optimised', modified cluster design placed on a site of low soft tissue artefact. Whilst statistically significant differences were identified between knee angles derived from each cluster design, the magnitude of the differences were small. Thus, both of the marker models were considered to provide knee-angle measurements that would be considered equivalent in a clinical setting.

Femoral impaction grafting is a technique where bone graft is impacted into the femur prior to cementing a stem in place. The technique is designed to compensate for bone stock loss in revision surgery, however it has associated problems of implant movement / subsidence and periprosthetic fractures. The hypothesis for this thesis was that the stability and remodelling of impaction grafting could be improved, either by changing the graft size or by adding a synthetic graft. To quantify the technique of impaction grafting the Exeter slap hammer was modified, enabling force readings to be measured in nine surgical cases with four different surgeons. The results found that the average force that travels through the impactor is 1.8 to 8.4 kN, which is equivalent to three to eleven times body weight. These readings were used in the subsequent studies to replicate the current technique. It was hypothesised that varying the graft size might alter the porosity, strength and remodelling of impacted graft. Three graft groups were studied Small, Large and a Graded mix. The results found that the impacted Large graft had higher porosity and lower axial stiffness than the Small and Graded Graft. A noted reduction in graft density was found after six weeks in-vivo compared with twelve, irrespective of graft type. Since density can be related to mechanical strength this led to the question: Could the inclusion of a synthetic bone graft improve the mechanical properties of remodelling graft A 50:50 mix of allograft and BoneSave was compared with allograft. No difference in stiffness was found between the groups after six and twelve weeks remodelling. These studies were carried out using small test samples either in the laboratory or in- vivo. In order to determine if synthetic graft extenders could be used clinically tests in more realistic models were undertaken. Mechanical analysis was conducted on the 50 % inclusion of two graft extenders with allograft, namely: BoneSave and Appapore-60. The results of both projects showed a positive result.

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