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Iriuchishima T, Goto B. Radiographic evaluation of anterior tibial translation in the prone position after total knee arthroplasty: comparison of BCS-TKA and PS-TKA. Musculoskelet Surg 2024:10.1007/s12306-024-00849-7. [PMID: 39026045 DOI: 10.1007/s12306-024-00849-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/14/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the anterior tibial translation (ATT) in the prone position after total knee arthroplasty (TKA). METHODS Fifty subjects (50 knees) undergoing bi-cruciate substituting (BCS)-TKA (Journey II: Smith and Nephew) and age-gender matching 50 subjects (50 knees) undergoing posterior stabilizing (PS)-TKA, were included in this study. Approximately, six months after surgery, and when the subjects had recovered their range of knee motion, following the Mae's method, accurate lateral radiographic imaging of the knee was performed with full knee extension in both supine and prone positions. The maximal protrusion length of the femoral posterior component, posterior to the extension line parallel to the tibial shaft from the edge of the posterior tibial plateau, was measured on lateral radiographs. The difference in length between the prone and supine positions was regarded as the prone-ATT. The posterior protrusion length of the femoral component, and the prone-ATT were compared between BCS and PS-TKA. RESULTS The posterior protrusion length of the femoral component in the supine position was BCS-TKA 4.3 ± 1.9 mm, and PS-TKA 8.7 ± 2.3 mm. The length in the prone position was BCS-TKA 4.8 ± 2.3 mm, and PS-TKA 10.7 ± 2.2 m. Posterior protrusion length of the femoral component was significantly larger in both positions in PS-TKA when compared with BCS-TKA. In PS-TKA, posterior protrusion length of the femoral condyle was significantly larger in the prone position when compared to the supine position. No significant difference was observed in BCS-TKA. Prone-ATT was significantly larger in PS-TKA (2 ± 1.9 mm) when compared to BCS-TKA (0.7 ± 2 mm). CONCLUSION Even in a position corresponding to daily movement such as the prone position, ATT was significantly larger in PS-TKA, when compared to BCS-TKA.
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Affiliation(s)
| | - Bunsei Goto
- Department of Orthopedic Surgery, Kamimoku Spa Hospital, Minakami, Japan
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Koettnitz J, Tigges J, Migliorini F, Peterlein CD, Götze C. Analysis of gender differences with traditional posterior stabilized versus kinematic designs in total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:7153-7158. [PMID: 37552326 PMCID: PMC10635979 DOI: 10.1007/s00402-023-05008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is a good treatment for end-stage knee osteoarthritis (KOA). Approximately 60% of the patients are females, and 40% are males. This study analyzed pre- and postoperative angle differences in the range of motion (ROM), and the occurrence of complications with traditional posterior stabilization versus kinematic TKA in relation to gender. METHODS Data from 434 patients with primary cemented total knee arthroplasty from 2018 to 2021 were collected. Alpha and beta angles were determined pre- and postsurgery. The ROM was collected pre- and postoperatively and during follow-up. Additionally, perioperative complications, revision rate, and blood transfusion management were investigated. RESULTS The pre- and postoperative alpha-angle between men and women was significantly different, as was the level of alpha-angle correction between men and women (p = 0.001; p = 0.003). Same-gender differences in pre- to postoperative alpha-angles between traditional and kinematic TKA were shown (women (w): p = 0.001; men (m); p = 0.042). High postoperative alpha angles led to less ROM in traditional TKA for women (p = 0.008). No significant gender differences in ROM, perioperative complications, or revision surgery and transfusion rates were found. CONCLUSION Despite high gender differences in pre- and postoperative angles, only female patients with traditional arthroplasty and high postoperative alpha angles showed less ROM in the follow-up. This leads to the assumption that gender-related pre- and postoperative angle differences, and the degree of angle correction, do not influence the ROM or perioperative occurrence of complications. Both designs present safe procedures for both genders with a wide spectrum of axis deformities.
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Affiliation(s)
- Julian Koettnitz
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of Ruhr-University-Bochum, Am Kokturkanal, 32545, Bad Oeynhausen, Germany.
| | - Jara Tigges
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of Ruhr-University-Bochum, Am Kokturkanal, 32545, Bad Oeynhausen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, 52064, Aachen, Germany
| | - Christian D Peterlein
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of Ruhr-University-Bochum, Am Kokturkanal, 32545, Bad Oeynhausen, Germany
| | - Christian Götze
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of Ruhr-University-Bochum, Am Kokturkanal, 32545, Bad Oeynhausen, Germany
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Fujita M, Matsumoto T, Nakano N, Ishida K, Kuroda Y, Maeda T, Hayashi S, Kuroda R. Rotational mismatch between femoral and tibial components should be avoided in JOURNEY II bi-cruciate stabilized total knee arthroplasty. Knee 2022; 38:69-75. [PMID: 35930895 DOI: 10.1016/j.knee.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/25/2022] [Accepted: 07/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND JOURNEY II bi-cruciate stabilized (BCS) knee system, a guided motion total knee arthroplasty (TKA), has been reported to reproduce physiological knee kinematic motion with good clinical outcomes. However, this guided system may be sensitive to the femorotibial rotational alignment. METHOD Forty-four patients (50 knees) who underwent JOURNEY II BCS TKA were included in this retrospective study. The 2011 Knee Society Score (KSS) and range of motion were assessed pre-operatively and one year postoperatively. The femoral component rotational angle relative to the surgical epicondylar axis and the tibial component rotational angle relative to Akagi's line were measured postoperatively. The absolute difference between the femoral and tibial component rotational angles was defined as femorotibial component rotational mismatch. The correlation between the parameters of these rotational alignments and postoperative clinical outcomes was evaluated. Additionally, receiver operating characteristic curve analysis was performed to determine the optimal cut-off point of the femorotibial component rotational mismatch. RESULTS Mean femoral and tibial component rotational angles were 0.4° (internal rotation) and 0.7° (external rotation), respectively. The rotational mismatch of the femorotibial component was 3.2°. There were negative correlations between femorotibial rotational mismatch and clinical outcomes, including objective knee indicators, patient satisfaction, functional activities, and total 2011 KSS. The area under the curve of the femorotibial component rotational mismatch was 0.768 and the cut-off value identified by the Youden index was 2.8°. CONCLUSIONS Excessive rotational mismatch between the femoral and tibial components can negatively influence the clinical outcomes of JOURNEY II BCS TKA.
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Affiliation(s)
- Masahiro Fujita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihisa Maeda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Kage T, Inui H, Tomita T, Yamazaki T, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Takagi K, Sameshima S, Tanaka S. The Association between In Vivo Knee Kinematics and Patient-Reported Outcomes during Squatting in Bicruciate-Stabilized Total Knee Arthroplasty. J Knee Surg 2022; 35:1342-1348. [PMID: 33545725 DOI: 10.1055/s-0041-1723763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bicruciate-stabilized total knee arthroplasty (BCS TKA) has been developed to improve TKA kinematic performance. However, the relationship between in vivo kinematics and patient-reported outcomes (PROs) has not been well described. This study was performed to clarify the relationship between in vivo kinematics and PROs in a cohort of patients undergoing BCS TKA. Forty knees were evaluated using a two-dimensional to three-dimensional registration technique obtained from sagittal plane fluoroscopy. In vivo kinematics including anteroposterior (AP) translation and tibiofemoral rotation were evaluated. Knee Society scores (KSSs) and Knee injury and Osteoarthritis Outcome Scores (KOOSs) were assessed before and after surgery. Relationships between tibiofemoral kinematics assessed with the knee in different positions of knee flexion and PROs were evaluated using Spearman's correlation analysis. The study demonstrated a significant negative correlation (r = - 0.33) between medial AP translation from minimum flexion to 30 degrees flexion and postoperative KOOS activities of daily living subscale. A significant positive correlation (r = 0.51) was found between the femoral external rotation from minimum flexion to 30 degrees flexion and improvement of the KOOS pain subscale. No correlation was found between the lateral AP translation and PROs. Achieving medial AP and femoral external rotation stability in early flexion may be important in optimizing postoperative PROs.
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Affiliation(s)
- Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, Fukaya, Saitama, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Takagi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Klemt C, Bounajem G, Tirumala V, Xiong L, Oganesyan R, Kwon YM. Posterior Tibial Slope Increases Anterior Cruciate Ligament Stress in Bi-Cruciate Retaining Total Knee Arthroplasty: In Vivo Kinematic Analysis. J Knee Surg 2022; 35:788-797. [PMID: 33111270 DOI: 10.1055/s-0040-1718602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The study design involved here is experimental in nature. The resection of the anterior cruciate ligament (ACL) during conventional total knee arthroplasty (TKA) has been considered a potential factor leading to abnormal in vivo knee kinematics. Bi-cruciate retaining (BCR) TKA designs allow the preservation of the ACL with the potential to restore native knee kinematics. This study aimed to investigate the effect of posterior tibial slope (PTS) on stress experienced by the ACL during weight bearing sit-to-stand (STS) and single-leg deep lunge. The ACL elongation patterns were measured in 30 unilateral BCR TKA patients during weight-bearing STS and single-leg deep lunge using a validated dual fluoroscopic tracking technique. The minimum normalized stress within the anteromedial (AM) and posterolateral (PL) bundle of the ACL during weight-bearing STS and single-leg deep lunge was found at a PTS of 3.7 degrees. The maximum AM and PL bundle stresses were observed at a PTS of 8.5 and 9.3 degrees, respectively during STS and at 8.4, and 9.1 degrees, respectively during single-leg deep lunge. There was a significant positive correlation between PTS and stress observed within the AM and PL bundle of the ACL during weight-bearing STS (R 2 = 0.37; p < 0.01; R2 = 0.36; p = 0.01) and single-leg deep lunge (R 2 = 0.42; p < 0.01; R 2 = 0.40; p < 0.01). The study demonstrates that PTS of operated BCR TKA knees has a significant impact on the stress experienced by the preserved ACL during weight-bearing STS and single-leg deep lunge. This suggests that avoiding excessive PTS may be one of the surgical implant alignment factors to consider during surgery to minimize increased loading of the preserved ACL.
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Affiliation(s)
- Christian Klemt
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Georges Bounajem
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Venkatsaiakhil Tirumala
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Liang Xiong
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruben Oganesyan
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Garner AJ, Dandridge OW, Amis AA, Cobb JP, van Arkel RJ. Partial and Combined Partial Knee Arthroplasty: Greater Anterior-Posterior Stability Than Posterior Cruciate-Retaining Total Knee Arthroplasty. J Arthroplasty 2021; 36:3765-3772.e4. [PMID: 34330602 DOI: 10.1016/j.arth.2021.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/15/2021] [Accepted: 06/21/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Little is known regarding anterior-posterior stability after anterior cruciate ligament-preserving partial (PKA) and combined partial knee arthroplasty (CPKA) compared to standard posterior cruciate-retaining total knee arthroplasty (TKA). METHODS The anterior-posterior tibial translation of twenty-four cadaveric knees was measured, with optical tracking, while under 90N drawer with the knee flexed 0-90°. Knees were tested before and after PKA, CPKA (medial and lateral bicompartmental and bi-unicondylar), and then posterior cruciate-retaining TKA. The anterior-posterior tibial translations of the arthroplasty states, at each flexion angle, were compared to the native knee and each other with repeated measures analyses of variance and post-hoc t-tests. RESULTS Unicompartmental and bicompartmental arthroplasty states had similar laxities to the native knee and to each other, with ≤1-mm differences throughout the flexion range (P ≥ .199). Bi-unicondylar arthroplasty resulted in 6- to 8-mm increase of anterior tibial translation at high flexion angles compared to the native knee (P ≤ .023 at 80-90°). Meanwhile, TKA exhibited increased laxity across all flexion angles, with increased anterior tibial translation of up to 18 ± 6 mm (P < .001) and increased posterior translation of up to 4 ± 2 mm (P < .001). CONCLUSIONS In a cadaveric study, anterior-posterior tibial translation did not differ from native laxity after PKA and CPKA. Posterior cruciate ligament-preserving TKA demonstrated increased laxity, particularly in anterior tibial translation.
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Affiliation(s)
- Amy J Garner
- MSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, White City Campus, London, UK; Mechanical Engineering Department, Biomechanics Group, Imperial College London, London, UK; Royal College of Surgeons of England and Dunhill Medical Trust Clinical Research Fellowship, Royal College of Surgeons of England, London, UK; Health Education Kent, Surrey and Sussex, London, UK
| | - Oliver W Dandridge
- Mechanical Engineering Department, Biomechanics Group, Imperial College London, London, UK
| | - Andrew A Amis
- Mechanical Engineering Department, Biomechanics Group, Imperial College London, London, UK
| | - Justin P Cobb
- MSk Lab, Sir Michael Uren Biomedical Engineering Research Hub, Imperial College London, White City Campus, London, UK
| | - Richard J van Arkel
- Mechanical Engineering Department, Biomechanics Group, Imperial College London, London, UK
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Inui H, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Tanaka S. Preoperative and intraoperative factors contributing to patient satisfaction after bi-cruciate stabilized total knee arthroplasty. J Orthop Surg (Hong Kong) 2021; 29:23094990211034004. [PMID: 34423689 DOI: 10.1177/23094990211034004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND One of the causes of dissatisfaction following total knee arthroplasty (TKA) is abnormal knee kinematics. A newly designed bi-cruciate stabilized (BCS) TKA system has been developed to produce close-to-normal kinematics because of its anatomic tibiofemoral articular geometry and cam-post mechanism. Although BCS TKA is expected to improve patient satisfaction, no reports have described the appropriate technique or soft tissue handling required to achieve excellent satisfaction with BCS TKA. This study is to identify preoperative and intraoperative predictors of patient satisfaction after BCS TKA. METHODS Altogether, we studied 113 knees with primary varus knee osteoarthritis that underwent BCS TKA with a navigation system. Preoperative parameters including Knee Society Score and patient-reported scores [the Knee injury and Osteoarthritis Outcome Score (KOOS)] and intraoperative parameters including coronal, sagittal and axial alignment and joint laxity in each compartment that affected patient satisfaction was evaluated. Satisfaction score was evaluated with use of the 2011 Knee Society Scoring system. The multivariate regression analysis included age and preoperative and intraoperative parameters that correlated with satisfaction scores in the univariate analysis (P < 0.05). RESULTS The mean satisfaction score was 28.2 ± 6.1. Multivariate regression analysis showed that the predictors of patient satisfaction were a preoperative high KOOS score for activities of daily living (P < 0.001), male sex (P = 0.005), older age (P = 0.027), and minimal medial joint laxity during flexion (P = 0.031). CONCLUSION When performing BCS TKA, surgeons should pay attention to maintaining proper stability of the medial compartment, especially during flexion.
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Affiliation(s)
- Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, 13143The University of Tokyo, Tokyo, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, 13143The University of Tokyo, Tokyo, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, 13143The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, 13143The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, 13143The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, 13143The University of Tokyo, Tokyo, Japan
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Marino D, Zelinski Z, Mesko D, Cochran J. Catastrophic Failures of the Tibial Post in a Bicruciate Substituting Total Knee Prosthesis. Arthroplast Today 2021; 8:231-236. [PMID: 33937464 PMCID: PMC8079333 DOI: 10.1016/j.artd.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/26/2021] [Accepted: 03/07/2021] [Indexed: 01/01/2023] Open
Abstract
Failure of the tibial post in a bicruciate substituting total knee prosthesis is a rare but catastrophic complication. The authors report 2 cases of a fracture of the polyethylene tibial post with subsequent episodes of knee subluxation. Prompt recognition and early revision of these complications are associated with a favorable early outcome.
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Affiliation(s)
- Dominic Marino
- Corresponding author. 2727 South Pennsylvania Avenue, Lansing, MI 48910, USA. Tel.: +1 518 744 9800.
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Inui H, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Uehara K, Tanaka S. Influence of surgical factors on patient satisfaction after bi-cruciate stabilized total knee arthroplasty: retrospective examination using multiple regression analysis. BMC Musculoskelet Disord 2021; 22:215. [PMID: 33622292 PMCID: PMC7903778 DOI: 10.1186/s12891-021-04098-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 02/17/2021] [Indexed: 12/28/2022] Open
Abstract
Background One of the causes of dissatisfaction following total knee arthroplasty (TKA) is abnormal knee kinematics. A newly designed bi-cruciate stabilized (BCS) TKA system has been developed to produce close-to-normal kinematics because of its anatomic tibiofemoral articular geometry and cam-post mechanism. Although BCS TKA is expected to improve patient satisfaction, no reports have described the appropriate technique or soft tissue handling required to achieve excellent satisfaction with BCS TKA. This study is to identify intraoperative surgical predictors of patient satisfaction after BCS TKA. Methods We studied 104 knees with primary varus knee osteoarthritis that underwent BCS TKA with a navigation system retrospectively. Surgical parameters including coronal, sagittal and axial alignment and joint laxity in each compartment that affected patient satisfaction was evaluated. Satisfaction score was evaluated with use of the 2011 Knee Society Scoring system. The multivariate regression analysis included age, gender, body mass index and intraoperative parameters that correlated with satisfaction scores in the univariate analysis (P < 0.05). The current study focused on the patient satisfaction score at 1 year postoperatively and didn’t evaluate the long term clinical results nor survivorship. Results The postoperative satisfaction score was 28.6 ± 8.1. Multivariate analysis showed that medial joint laxity at 30° flexion (P = 0.003), tibial excessive external rotation alignment (P = 0,009) and tibial varus alignment (P = 0.029) were predictors of poor satisfaction score. Conclusions When performing BCS TKA, surgeons should pay attention to maintaining proper stability of the medial compartment at mid flexion range and should avoid tibial varus and excessive external rotational alignment.
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Affiliation(s)
- Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan
| | - Kosuke Uehara
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113-0033, Tokyo, Japan
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10
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Inui H, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Takagi K, Kage T, Tanaka S. Comparison of intraoperative kinematics and their influence on the clinical outcomes between posterior stabilized total knee arthroplasty and bi-cruciate stabilized total knee arthroplasty. Knee 2020; 27:1263-1270. [PMID: 32711890 DOI: 10.1016/j.knee.2020.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/16/2020] [Accepted: 06/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Of all the intraoperative kinematic parameters recorded using navigation systems, femorotibial rotational alignment is reportedly associated with the clinical outcomes of cruciate retaining and posterior stabilized (PS) total knee arthroplasty (TKA). However, to our knowledge, there are no reports on the relationship of newly designed bi-cruciate stabilized (BCS) TKA and intraoperative rotational kinematics. We aimed to clarify and compare the relationships between the intraoperative kinematics and clinical outcomes of BCS TKA and PS TKA. METHODS We compared the intraoperative rotational kinematics and clinical outcomes at two years postoperatively of 56 BCS TKA patients and 55 PS TKA patients. Further, we evaluated the relationship between the femorotibial rotational kinematics and clinical outcomes. RESULTS The maximum flexion angle and the pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS) in BCS TKA were significantly better than those in PS TKA. The intraoperative kinematic data of BCS TKA showed "screw-home" movement, while that of PS TKA did not show this movement. The rotational angular differences between at maximum flexion angle and at 60° flexion of BCS TKA showed positive correlations with the improvement of KOOS pain, symptom, activity of daily living and sports subscales. The rotational angular differences between at maximum flexion angle and at 30° flexion in PS TKA showed positive correlations with the maximum flexion angle. CONCLUSION Intraoperative femorotibial rotational kinematics and its influence on the clinical outcomes were different between BCS and PS TKA. BCS TKA showed more normal-like kinematics and better clinical results than PS TKA.
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Affiliation(s)
- Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Kentarou Takagi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
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11
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Kwon YM, Arauz P, Peng Y, Klemt C. In vivo kinematics of deep lunges and sit-to-stand activities in patients with bicruciate-retaining total knee arthroplasty. Bone Joint J 2020; 102-B:59-65. [PMID: 32475273 DOI: 10.1302/0301-620x.102b6.bjj-2019-1552.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS The removal of the cruciate ligaments in total knee arthroplasty (TKA) has been suggested as a potential contributing factor to patient dissatisfaction, due to alteration of the in vivo biomechanics of the knee. Bicruciate retaining (BCR) TKA allows the preservation of the cruciate ligaments, thus offering the potential to reproduce healthy kinematics. The aim of this study was to compare in vivo kinematics between the operated and contralateral knee in patients who have undergone TKA with a contemporary BCR design. METHODS A total of 29 patients who underwent unilateral BCR TKA were evaluated during single-leg deep lunges and sit-to-stand tests using a validated computer tomography and fluoroscopic imaging system. In vivo six-degrees of freedom (6DOF) kinematics were compared between the BCR TKA and the contralateral knee. RESULTS During single-leg deep lunge, BCR TKAs showed significantly less mean posterior femoral translation (13 mm; standard deviation (SD) 4) during terminal flexion, compared with the contralateral knee (16.6 mm, SD 3.7; p = 0.001). Similarly, BCR TKAs showed significantly less mean femoral rollback (11.6 mm (SD 4.5) vs 14.4 mm (SD 4.6); p < 0.043) during sit-to-stand. BCR TKAs showed significantly reduced internal rotation during many parts of the strenuous flexion activities particularly during high-flexion lunge (4° (SD 5.6°) vs 6.5° (SD 6.1°); p = 0.051) and during sit-to-stand (4.5° (SD 6°) vs 6.9° (SD 6.3°); p = 0.048). CONCLUSION The contemporary design of BCR TKA showed asymmetrical flexion-extension and internal-external rotation, suggesting that the kinematics are not entirely reproduced during strenuous activities. Future studies are required to establish the importance of patient factors, component orientation and design, in optimizing kinematics in patients who undergo BCR TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):59-65.
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Affiliation(s)
- Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Arauz
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yun Peng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Klemt
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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12
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Symmetrical cruciate-retaining versus medial pivot prostheses: The effect of intercondylar sagittal conformity on knee kinematics and contact mechanics. Comput Biol Med 2019; 108:101-110. [DOI: 10.1016/j.compbiomed.2019.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 01/28/2023]
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13
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Iriuchishima T, Ryu K. Bicruciate Substituting Total Knee Arthroplasty Improves Stair Climbing Ability When Compared with Cruciate-Retain or Posterior Stabilizing Total Knee Arthroplasty. Indian J Orthop 2019; 53:641-645. [PMID: 31488934 PMCID: PMC6699219 DOI: 10.4103/ortho.ijortho_392_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to compare stair climbing and descent ability following bicruciate substituting (BCS), cruciate retaining (CR), and posterior stabilizing (PS) total knee arthroplasties (TKAs). MATERIALS AND METHODS Sixty-three participants undergoing BCS-TKA (journey II: Smith and Nephew), 47 participants undergoing CR-TKA (FINE: Teijin Nakashima Medical), and 38 participants undergoing PS-TKA (FNK: Teijin Nakashima Medical) were included in this study. Before and 12 months after surgery, a questionnaire was administered to assess daily stair climbing and descent ability. In the questionnaire, stair climbing and descent ability were classified as (1) stair climbing and descent one step at a time, (2) stair climbing and descent two steps at a time, and (3) unable to climb or descend stairs. The necessity of a handrail was also evaluated and classified as: (1) necessary, (2) unnecessary, and (3) unable to climb or descend stairs with handrail. Statistical analysis (χ 2-test) was performed to compare these data between the types of TKA. RESULTS Preoperatively, no significant differences in stair climbing and descent ability or between handrail classifications were observed between the three different TKA groups. Postoperatively, the percentage of patients able to climb stairs one step at a time was significantly higher in BCS-TKA group (89%), when compared with CR (72%) or PS (58%) TKA groups. No significant differences in stair descent ability or among the handrail necessity classifications were observed between the types of TKA. CONCLUSION BCS-TKA resulted in significantly better stair climbing ability when compared with CR or PS-TKA. This may indicate that the design of BCS-TKA better reproduces native anterior cruciate ligament and posterior cruciate ligament function and improves knee stability during stair climbing activity.
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Affiliation(s)
- Takanori Iriuchishima
- Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan,Address for correspondence: Dr. Takanori Iriuchishima, Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, 198-2, Minakami, Gunma 378-1311, Japan. E-mail:
| | - Keinosuke Ryu
- Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
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14
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Inui H, Taketomi S, Yamagami R, Kawaguchi K, Nakazato K, Tanaka S. The relationship between anteroposterior stability and medial-lateral stability of the bi-cruciate stabilized total knee arthroplasty. Knee 2018; 25:1247-1253. [PMID: 30414789 DOI: 10.1016/j.knee.2018.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/09/2018] [Accepted: 08/01/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Acquisition of appropriate anteroposterior (AP) stability depends on the prosthetic design and intraoperative soft tissue handling. A bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) has a two cam-post mechanism, which substitutes for the anterior cruciate ligament and posterior cruciate ligament (PCL). Therefore, appropriate AP stability is expected. Because the PCL is sacrificed during BCS TKA, medial stability and lateral stability are thought to be important factors to determine AP stability. However, no previous study has reported AP stability after BCS TKA and the relationship between AP and medial-lateral stability. METHODS AP stability was measured using a navigation system intraoperatively and the KT 2000 device postoperatively. Intraoperative joint laxity of the medial and lateral compartments was evaluated separately using a compartment-specific ligament tensioner. The relationship between AP stability and medial-lateral laxity was assessed. RESULTS Intraoperative AP translation at 30° and 90° knee flexion angles was 7.7 ± 3.1 mm and 5.9 ± 2.0 mm, respectively. Postoperative AP translation at 30° was 5.9 ± 1.7 mm. AP translation correlated positively with medial joint laxity at 30° (R = 0.29) and 90° (R = 0.40). The intraoperative and postoperative AP translations at 30° flexion had a positive relationship (R = 0.61). CONCLUSION AP stability of the BCS TKA had a positive relationship with intraoperative medial stability. Therefore, surgical soft tissue handling focusing on medial stability is also appropriate for AP stability of BCS TKA. Additionally, intraoperative AP translation turned out to be a predictive indicator for postoperative knee AP stability at 30° flexion.
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Affiliation(s)
- Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiu Nakazato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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15
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Tsai TY, Liow MHL, Peng Y, Arauz P, Li G, Kwon YM. In-vivo elongation of anterior and posterior cruciate ligament in bi-cruciate retaining total knee arthroplasty. J Orthop Res 2018; 36:3239-3246. [PMID: 30175858 DOI: 10.1002/jor.24132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/27/2018] [Indexed: 02/04/2023]
Abstract
Anterior and posterior cruciate ligament (ACL and PCL) sacrifice in contemporary total knee arthroplasty (TKA) has been considered a potential factor leading to abnormal knee kinematics. Bi-cruciate retaining (BCR) TKA design allows retention of both ACL and PCL. However, there is a limited data on the ACL/PCL in-vivo elongation characteristics of BCR TKA. The study aimed to evaluate and compare the in-vivo elongation patterns of ACL/PCL between BCR TKA and contralateral non-implanted knee and to explore potential factors leading to the changed elongation patterns between limbs. ACL/PCL elongations of both knees during sit-to-stand were measured in 29 unilateral BCR TKA patients using a validated dual fluoroscopic tracking technique. Joint gap changes of the BCR TKA knees relative to the contralateral knee were quantified. BCR TKA and the contralateral non-implanted knee exhibited similar ACL elongation at extension and clinical anterior knee laxity. However, BCR TKA showed significantly greater PCL elongation during flexion than the non-implanted knee. Variation of changed elongation was observed for both ACL and PCL, suggesting a heterogeneous restoration of normal ACL/PCL functions. A significant correlation was found between extension joint gap change and the change of ACL elongation, highlighting the importance of precise joint line restoration and soft tissue balancing during BCR TKA surgery. Our findings suggest that BCR TKA did not fully restore "near-normal" cruciate ligament elongation patterns and anteroposterior stability. Considerable heterogeneity remains in the retained ligament elongation patterns and warrants further investigations of multifactorial factors to optimize ACL/PCL functions in BCR TKA. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3239-3246, 2018.
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Affiliation(s)
- Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Ming H L Liow
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Yun Peng
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Paul Arauz
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Guoan Li
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
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16
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Evangelista PJ, Laster SK, Lenz NM, Sheth NP, Schwarzkopf R. A Computer Model of Mid-Flexion Instability in a Balanced Total Knee Arthroplasty. J Arthroplasty 2018; 33:S265-S269. [PMID: 29567003 DOI: 10.1016/j.arth.2018.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/23/2018] [Accepted: 02/05/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Some patients have mid-flexion instability despite stability at 0° and 90° of flexion. This study aims to determine the effects of total knee arthroplasty (TKA) stability while changing femur implant size and position. METHODS A computational analysis was performed simulating knee flexion of posterior stabilized (PS) and cruciate retaining (CR) TKA designs. Deviations from the ideal TKA implant position were simulated by adjusting tibiofemoral proximal-distal position and femur anterior-posterior position as well as implant size. Forces in ligaments connecting the femur and tibia were collected. Total tibiofemoral ligament load for mid-knee flexion of 15°-75° was analyzed vs proximal-distal implant position, implant size, implant design, and knee flexion for PS and CR knees. Posterior cruciate ligament load was also analyzed for CR knees. RESULTS Total tibiofemoral ligament load was significantly reduced by a more proximal tibiofemoral and anterior femur position (P < .001). Implant size did not have a significant effect on tibiofemoral ligament load (P > .1). Implant design and knee flexion significantly influenced total tibiofemoral ligament load (P < .001), but the interactions with implant proximal-distal position were not significant (P > .2), indicating that implant proximal-distal position had a similar effect across the 15°-75° knee flexion range for both studied PS and CR implant designs. CONCLUSION PS and CR TKA can be well-balanced at 0° and 90° knee flexion and have instability in mid-flexion. Elevating the joint line and shifting the femur anteriorly can cause the knee to be too loose in mid-flexion.
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Affiliation(s)
- Perry J Evangelista
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Scott K Laster
- Orthopaedic Product Development, Smith and Nephew, Memphis, TN
| | - Nathan M Lenz
- Orthopaedic Product Development, Smith and Nephew, Memphis, TN
| | - Neil P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
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Stokes MD, Greene BC, Pietrykowski LW, Gambon TM, Bales CE, DesJardins JD. The use of synthetic ligaments in the design of an enhanced stability total knee joint replacement. Proc Inst Mech Eng H 2018; 232:282-288. [PMID: 29350088 DOI: 10.1177/0954411917751002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current total knee replacement designs work to address clinically desired knee stability and range of motion through a balance of retained anatomy and added implant geometry. However, simplified implant geometries such as bearing surfaces, posts, and cams are often used to replace complex ligamentous constraints that are sacrificed during most total knee replacement procedures. This article evaluates a novel total knee replacement design that incorporates synthetic ligaments to enhance the stability of the total knee replacement system. It was hypothesized that by incorporating artificial cruciate ligaments into a total knee replacement design at specific locations and lengths, the stability of the total knee replacement could be significantly altered while maintaining active ranges of motion. The ligament attachment mechanisms used in the design were evaluated using a tensile test, and determined to have a safety factor of three with respect to expected ligamentous loading in vivo. Following initial computational modeling of possible ligament orientations, a physical prototype was constructed to verify the function of the design by performing anterior/posterior drawer tests under physiologic load. Synthetic ligament configurations were found to increase total knee replacement stability up to 94% compared to the no-ligament case, while maintaining total knee replacement flexion range of motion between 0° and 120°, indicating that a total knee replacement that incorporates synthetic ligaments with calibrated location and lengths should be able to significantly enhance and control the kinematic performance of a total knee replacement system.
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Affiliation(s)
- Michael D Stokes
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Brendan C Greene
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | | | - Taylor M Gambon
- Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - Caroline E Bales
- Department of Bioengineering, Clemson University, Clemson, SC, USA
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18
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Marra MA, Strzelczak M, Heesterbeek PJC, van de Groes SAW, Janssen D, Koopman BFJM, Verdonschot N, Wymenga AB. Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:3377-3385. [PMID: 29560510 PMCID: PMC6208942 DOI: 10.1007/s00167-018-4900-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 03/16/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE When downsizing the femoral component to prevent mediolateral overhang, notching of the anterior femoral cortex may occur, which could be solved by flexing the femoral component. In this study, we investigated the effect of flexion of the femoral component on patellar tendon moment arm, patellofemoral forces and kinematics in posterior-referencing CR-TKA. Our hypothesis was that flexion of the femoral component increases the patellar tendon moment arm, reduces the patellofemoral forces and provides stable kinematics. METHODS A validated musculoskeletal model of CR-TKA was used. The flexion of the femoral component was increased in four steps (0°, 3°, 6°, 9°) using posterior referencing, and different alignments were analysed in combination with three implant sizes (3, 4, 5). A chair-rising trial was analysed using the model, while simultaneously estimating quadriceps muscle force, patellofemoral contact force, tibiofemoral and patellofemoral kinematics. RESULTS Compared to the reference case (size 4 and 0° flexion), for every 3° of increase in flexion of the femoral component the patellar tendon moment arm increased by 1% at knee extension. The peak quadriceps muscle force and patellofemoral contact force decreased by 2%, the patella shifted 0.8 mm more anteriorly and the remaining kinematics remained stable, with knee flexion. With the smaller size, the patellar tendon moment arm decreased by 6%, the quadriceps muscle force and patellofemoral contact force increased by 8 and 12%, and the patellar shifted 5 mm more posteriorly. Opposite trends were found with the bigger size. CONCLUSION Flexing the femoral component with posterior referencing reduced the patellofemoral contact forces during a simulated chair-rising trial with a patient-specific musculoskeletal model of CR-TKA. There seems to be little risk when flexing and downsizing the femoral component, compared to when using a bigger size and neutral alignment. These findings provide relevant information to surgeons who wish to prevent anterior notching when downsizing the femoral component.
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Affiliation(s)
- Marco A. Marra
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Marta Strzelczak
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | | | | | - Dennis Janssen
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Bart F. J. M. Koopman
- Department of Biomechanical Engineering, University of Twente, Postbus 217, 7500 AE Enschede, The Netherlands
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Postbus 9101, 6500 HB Nijmegen, The Netherlands ,Department of Biomechanical Engineering, University of Twente, Postbus 217, 7500 AE Enschede, The Netherlands
| | - Ate B. Wymenga
- Sint Maartenskliniek Orthopaedics, Postbus 9011, 6500 GM Nijmegen, The Netherlands
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Seito N, Onodera T, Kasahara Y, Kondo E, Iwasaki N, Majima T. Preoperative knee deformity and kinematics impact postoperative knee kinematics in total knee arthroplasty. Knee 2017; 24:1462-1468. [PMID: 28970121 DOI: 10.1016/j.knee.2017.08.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 07/09/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the relationship between the preoperative knee deformity/kinematic pattern and the postoperative knee kinematic pattern in posterior cruciate ligament substituting (PS)-total knee arthroplasty (TKA). METHODS This study involved 39 patients with medial osteoarthritis who underwent a primary PS-TKA using a computed-tomography-based navigation system. All the operations were performed by a single surgeon using a subvastus approach, modified gap technique and the same PS type of prosthesis (Genesis II™ total knee system, Smith & Nephew, Memphis, TN, USA). Knee deformity, kinematic pattern after capsule incision (preoperative knee kinematics), and kinematic pattern after implantation (postoperative knee kinematics) in PS-TKA were measured. Kinematic patterns were divided into two groups: a medial pivot group and a non-medial pivot group. RESULTS Preoperative varus knee deformity was significantly larger in the non-medial pivot group than in the medial pivot group (femorotibial angle: 184.7±6.4° vs. 180.8±3.9°, P<0.05). In addition, preoperative knee kinematics were conserved postoperatively, at a rate of 82% (P<0.01). CONCLUSIONS The severity of varus knee deformity and the preoperative knee kinematic pattern might have affected the postoperative knee kinematics in PS-TKA. This must be confirmed with a randomized controlled trial on a large population study. LEVEL OF EVIDENCE case control study, Level III.
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Affiliation(s)
- Naoki Seito
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Tomohiro Onodera
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Yasuhiko Kasahara
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Eiji Kondo
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan
| | - Tokifumi Majima
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan; Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5, Senndagi, Bunkyo-ku, Tokyo 113-8603, Japan.
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20
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Watanabe M, Kuriyama S, Nakamura S, Tanaka Y, Nishitani K, Furu M, Ito H, Matsuda S. Varus femoral and tibial coronal alignments result in different kinematics and kinetics after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:3459-3466. [PMID: 28484791 DOI: 10.1007/s00167-017-4570-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/03/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Abnormal knee motion under various conditions has been described after total knee arthroplasty (TKA). However, differences in kinematics and kinetics of knees with varus femoral versus varus tibial alignment have not been evaluated. It was hypothesized that varus femoral and tibial alignments have the same impact on knee motion. METHODS A musculoskeletal computer simulation was used. Femoral and tibial alignment in the coronal plane was each varied from neutral to 5° of varus in 1° increments. Lift-off, defined as an intercomponent distance of >2 mm, and tibiofemoral contact forces were evaluated during gait up to 60° of knee flexion. Knee kinematics and contact stresses were also examined during squat, with up to 130° of knee flexion. RESULTS During gait, lift-off occurred readily with more than 3° of varus tibial alignment and slight lateral joint laxity. In contrast, lift-off did not occur with varus femoral or tibial alignment of up to 5° during squat. Peak medial contact forces with varus femoral alignment were approximately twice those observed with varus tibial alignment. The lowest points of the femoral condyles moved internally with varus femoral alignment, contrary to the kinematics with neutral or varus tibial alignment. On the other hand, there was femoral medial sliding and edge loading against the tibia in mid-flexion with varus tibial alignment. CONCLUSION Varus femoral alignment affects the non-physiological rotational movement of the tibiofemoral joint, whereas varus tibial alignment causes medial-lateral instability during mid-flexion. Varus femoral and tibial alignments might lead to post-TKA discomfort and unreliability.
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Affiliation(s)
- Mutsumi Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshihisa Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Moritoshi Furu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Peersman G, Slane J, Dirckx M, Vandevyver A, Dworschak P, Heyse TJ, Scheys L. The influence of polyethylene bearing thickness on the tibiofemoral kinematics of a bicruciate retaining total knee arthroplasty. Knee 2017; 24:751-760. [PMID: 28433348 DOI: 10.1016/j.knee.2017.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/11/2017] [Accepted: 03/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The recently reintroduced bicruciate retaining Total Knee Arthroplasty (BCR TKA) is an effort to reproduce kinematics closer to the native knee. However, there is no data on appropriate balancing with this implant. Balancing is crucial and challenging as medial and lateral polyethylene (PE) inlays are modular, which allows for placement of different thicknesses in the medial and lateral compartments. This study aimed at providing a detailed kinematic view on balancing BCR TKA. METHODS Seven fresh frozen cadaver legs were mounted in a kinematic rig that applied squatting under application of physiologic quadriceps and hamstring forces. Additionally, specimen laxity was assessed using Lachman tests and varus/valgus stress tests. Following testing on the native knee, a BCR TKA was implanted in each specimen and all trials were repeated. Using one millimeter increments, five inlay thicknesses were tested to simulate optimal balancing, symmetric under-, and overstuffing, valgus constellation, and varus constellation. RESULTS Overall, knee kinematics following BCR TKA seem to be very close to the native knee. The changes as introduced to tibiofemoral kinematics through over- or understuffing the polyethylene inserts are affecting the system only to a minor degree and generally lack statistical significance. Reproduction of the tibial varus via PE-Inlays did not lead to kinematics much closer to the native knee. CONCLUSIONS The changes introduced to tibiofemoral kinematics by removal of the conforming meniscus and cartilage and replacement with a flat PE insert and femoral component are of more impact than different inlay sizes and their combinations for a BCR TKA.
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Affiliation(s)
- Geert Peersman
- ZNA Stuivenberg, Antwerp, Belgium; Institute for Orthopaedic Research and Training, KU Leuven/UZ Leuven, Campus Pellenberg, Leuven, Belgium.
| | - Josh Slane
- Institute for Orthopaedic Research and Training, KU Leuven/UZ Leuven, Campus Pellenberg, Leuven, Belgium
| | | | | | - Philipp Dworschak
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Germany
| | - Thomas J Heyse
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Germany
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training, KU Leuven/UZ Leuven, Campus Pellenberg, Leuven, Belgium
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Manning WA, Ghosh K, Blain A, Longstaff L, Deehan DJ. Tibiofemoral forces for the native and post-arthroplasty knee: relationship to maximal laxity through a functional arc of motion. Knee Surg Sports Traumatol Arthrosc 2017; 25:1669-1677. [PMID: 27034084 DOI: 10.1007/s00167-016-4093-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Accurate soft tissue balance must be achieved to improve functional outcome after total knee arthroplasty (TKA). Sensor-integrated tibial trials have been introduced that allow real-time measurement of tibiofemoral kinematics during TKA. This study examined the interplay between tibiofemoral force and laxity, under defined intraoperative conditions, so as to quantify the kinematic behaviour of the CR femoral single-radius knee. METHODS TKA was undertaken in eight loaded cadaveric specimens. Computer navigation in combination with sensor data defined laxity and tibiofemoral contact force, respectively, during manual laxity testing. Fixed-effect linear modelling allowed quantification of the effect for flexion angle, direction of movement and TKA implantation upon the knee. RESULTS An inverse relationship between laxity and contact force was demonstrated. With flexion, laxity increased as contact force decreased under manual stress. Change in laxity was significant beyond 30° for coronal plane laxity and beyond 60° for rotatory laxity (p < 0.01). Rotational stress in mid-flexion demonstrated the greatest mismatch in inter-compartmental forces. Contact point position over the tibial sensor demonstrated paradoxical roll-forward with knee flexion. CONCLUSION Traditional balancing techniques may not reliably equate to uniform laxity or contact forces across the tibiofemoral joint through a range of flexion and argue for the role of per-operative sensor use to aid final balancing of the knee.
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Heyse TJ, Slane J, Peersman G, Dirckx M, van de Vyver A, Dworschak P, Fuchs-Winkelmann S, Scheys L. Kinematics of a bicruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:1784-1791. [PMID: 28078394 DOI: 10.1007/s00167-016-4414-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/13/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE The recently reintroduced bicruciate-retaining Total Knee Arthroplasty (BCR TKA) is an interesting approach in the quest for close replication of knee joint biomechanics and kinematics closer to the native knee. Therefore, this study aimed at providing a detailed biomechanical view on the functional resemblance of BCR TKA to the native knee joint. METHODS Seven fresh-frozen full leg cadaver specimens (76 ± 10 year) were mounted in a 6 degrees-of-freedom kinematic rig that applied a dynamic squatting motion knee flexion. Two motion patterns were performed pre- and post-implantation of a fixed bearing BCR TKA: passive flexion-extension and squatting while an infrared camera system tracked the location of reflective markers attached to the tibia and femur. Additionally, specimen laxity was assessed using Lachman tests and varus/valgus stress tests in triplicate. RESULTS Overall, differences in tibiofemoral kinematics between native knee and BCR TKA were small. Some minor differences appeared under the load of a squat: less internal tibial rotation and some minor paradoxical anterior translation of the medial femoral condyle during mid-flexion. BCR TKA may slightly elevate the joint line. Knee laxity as measured by the Lachman and varus/valgus tests was not significantly influenced by BCR TKA implantation. CONCLUSION As both cruciate ligaments are preserved with BCR TKA the unloaded knee closely resembles native knee kinematics including preserving the rollback mechanism. The loss of the conforming anatomy of menisci and tibial cartilage and replacement via a relatively flat polyethylene inlay may account for the loss of tibial internal rotation and the slight paradoxical AP motion of the medial femoral condyle with BCR TKA. This phenomenon reproduces findings made earlier with fixed bearing unicondylar knee arthroplasty.
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Affiliation(s)
- Thomas J Heyse
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Joshua Slane
- Department of Orthopaedics, Katholieke Universiteit Leuven, Campus Pellenberg, Louvain, Belgium
| | | | | | | | - Philipp Dworschak
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Susanne Fuchs-Winkelmann
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Lennart Scheys
- Department of Orthopaedics, Katholieke Universiteit Leuven, Campus Pellenberg, Louvain, Belgium
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Hommel H, Wilke K. Good Early Results Obtained with a Guided-Motion Implant for Total Knee Arthroplasty: A Consecutive Case Series. Open Orthop J 2017; 11:51-56. [PMID: 28400873 PMCID: PMC5366378 DOI: 10.2174/1874325001711010051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Previous studies have shown a high incidence of complications with a bi-cruciate stabilized (BCS) guided-motion total knee arthroplasty (TKA) design, which led to recent modifications of the design by the manufacturer. Objective: The current study was undertaken to assess whether the use of this TKA system with an extension-first surgical technique is associated with a similar rate of short-term adverse outcome as reported in literature. Material and Methods: This retrospective study enrolled 257 consecutive patients (257 knees) undergoing TKA for osteoarthritis of the knee, with the first 153 receiving cemented Journey BCS I implants and the remaining 104 receiving cemented Journey BCS II implants when these became available. Results: Mean follow-up time for the cohort was 24.5 ± 7.8 months (range, 12 - 36 months). There were no cases of stiffness. Incidence of iliotibial friction syndrome was considered low: three (2.0%) knees in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). Five (2.5%) knees presented with mild instability in midflexion, three (2.0%) in the BCS I group and two (1.9%) in the BCS II group (p = 0.676). One patient with a BCS I implant required reoperation for aseptic loosening 23 months postoperatively. At one-year follow-up, there were no clinically relevant differences in any of the clinical outcomes. Conclusion: When used in combination with an extension-first surgical technique, good early functional results with an acceptable rate of complications were obtained with both the original and the updated Journey BCS knee implant.
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Affiliation(s)
- Hagen Hommel
- Krankenhaus Märkisch Oderland GmbH BT Wriezen, Klinik für Orthopädie, Sportmedizin und Rehabilitation, Wriezen, Germany
| | - Kai Wilke
- Krankenhaus Märkisch Oderland GmbH BT Wriezen, Klinik für Orthopädie, Sportmedizin und Rehabilitation, Wriezen, Germany
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25
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No condylar lift-off occurs because of excessive lateral soft tissue laxity in neutrally aligned total knee arthroplasty: a computer simulation study. Knee Surg Sports Traumatol Arthrosc 2016; 24:2517-24. [PMID: 26142165 DOI: 10.1007/s00167-015-3687-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Condylar lift-off can induce excessive polyethylene wear after total knee arthroplasty (TKA). A computer simulation was used to evaluate the influence of femoral varus alignment and lateral collateral ligament (LCL) laxity on lift-off after single-design TKA. It was hypothesised that proper ligament balancing and coronal alignment would prevent lift-off. METHODS The computer model in this study is a dynamic musculoskeletal program that simulates gait up to 60° of knee flexion. The lift-off phenomenon was defined as positive with an intercomponent distance of >2 mm. In neutrally aligned components in the coronal plane, the femoral and tibial components were set perpendicular to the femoral and tibial mechanical axis, respectively. The femoral coronal alignment was changed from neutral to 5° varus in 1° increments. Simultaneously, the LCL length was elongated from 0 to 5 mm in 1-mm increments to provide a model of pathological slack. RESULTS Within 2° of femoral varus alignment, lift-off did not occur even if the LCL was elongated by up to 5 mm. However, lift-off occurred easily in the stance phase in femoral varus alignments of >3° with slight LCL slack. The contact forces of the tibiofemoral joint were influenced more by femoral varus alignment than by LCL laxity. CONCLUSIONS Aiming for neutral alignment in severely varus knees makes it difficult to achieve appropriate ligament balance. Our study suggests that no lift-off occurs with excessive LCL laxity alone in a neutrally aligned TKA and therefore that varus alignment should be avoided to decrease lift-off after TKA. LEVEL OF EVIDENCE Case series, Level IV.
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Lin KJ, Wei HW, Huang CH, Liu YL, Chen WC, McClean CJ, Cheng CK. Change in collateral ligament length and tibiofemoral movement following joint line variation in TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24:2498-505. [PMID: 25354558 DOI: 10.1007/s00167-014-3400-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/21/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The primary intent of total knee arthroplasty is the restoration of normal knee kinematics, with ligamentous constraint being a key influential factor. Displacement of the joint line may lead to alterations in ligament attachment sites relative to knee flexion axis and variance of ligamentous constraints on tibiofemoral movement. This study aimed to investigate collaterals strains and tibiofemoral kinematics with different joint line levels. METHODS A previously validated knee model was employed to analyse the change in length of the collateral ligaments and tibiofemoral motion during knee flexion. The models shifted the joint line by 3 and 5 mm both proximally and distally from the anatomical level. The data were captured from full extension to flexion 135°. RESULTS The elevated joint line revealed a relative increase in distance between ligament attachments for both collateral ligaments in comparison with the anatomical model. Also, tibiofemoral movement decreased with an elevation in the joint line. Conversely, lowering the joint line led to a significant decrease in distance between ligament attachments, but greater tibiofemoral motion. CONCLUSION Elevation of the joint line would strengthen the capacity of collateral ligaments for knee motion constraint, whereas a distally shifted joint line might have the advantage of improving tibiofemoral movement by slackening the collaterals. It implies that surgeons can appropriately change the joint line position in accordance with patient's requirement or collateral tensions. A lowered joint line level may improve knee kinematics, whereas joint line elevation could be useful to maintain knee stability. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Kun-Jhih Lin
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Chungli City, Taiwan
| | - Hung-Wen Wei
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Chungli City, Taiwan
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Chang-Hung Huang
- Biomechanics Research Laboratory, Department of Biomedical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
| | | | - Wen-Chuan Chen
- Orthopaedic Device Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Colin Joseph McClean
- Orthopaedic Biomechanics Laboratory, Institute of Biomedical Engineering, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Shih-Pai, Taipei, 11221, Taiwan
| | - Cheng-Kung Cheng
- Orthopaedic Biomechanics Laboratory, Institute of Biomedical Engineering, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Shih-Pai, Taipei, 11221, Taiwan.
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27
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Steinbrück A, Schröder C, Woiczinski M, Fottner A, Pinskerova V, Müller PE, Jansson V. Femorotibial kinematics and load patterns after total knee arthroplasty: An in vitro comparison of posterior-stabilized versus medial-stabilized design. Clin Biomech (Bristol, Avon) 2016; 33:42-48. [PMID: 26945720 DOI: 10.1016/j.clinbiomech.2016.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/02/2015] [Accepted: 02/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femorotibial kinematics and contact patterns vary greatly with different total knee arthroplasty (TKA) designs. Therefore, guided motion knee systems were developed to restore natural knee kinematics and make them more predictable. The medial stabilized TKA design is supposed to replicate physiological kinematics more than the posterior-stabilized TKA system. We conducted this study to compare a newly developed medial stabilized design with a conventional posterior-stabilized design in terms of femorotibial kinematics and contact patterns in vitro. METHODS Twelve fresh-frozen knee specimens were tested in a weight-bearing knee rig after implantation of a posterior stabilized and medial-stabilized total knee arthroplasty under a loaded squat from 20° to 120° of flexion. Femorotibial joint contact pressures in the medial and lateral compartments were measured by pressure sensitive films and knee kinematics were recorded by an ultrasonic 3-dimensional motion analysis system. FINDINGS The medial stabilized design showed a reduction of medial femorotibial translation compared to posterior-stabilized design (mean 3.5mm compared to 15.7 mm, P<0.01). In the lateral compartment, both designs showed a posterior translation of the femur with flexion, but less in the medial stabilized design (mean 14.7 mm compared to 19.0mm, P<0.01). In the medial femorotibial compartment of medial stabilized design, we observed an enlarged contact area and lower peak pressure, in contrast in the lateral compartment there was a reduced contact area and an increased peak pressure. INTERPRETATION While posterior-stabilized design enforces a medio-lateral posterior translation, the medial stabilized arthroplasty system enables a combination of a lateral translation with a medial pivot, which restores the physiological knee kinematics better.
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Affiliation(s)
- Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany.
| | - Christian Schröder
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany
| | - Matthias Woiczinski
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany
| | - Andreas Fottner
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany
| | - Vera Pinskerova
- 1st Orthopaedic Clinic, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Peter E Müller
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany
| | - Volkmar Jansson
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr, 15, 81377 Munich, Germany
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Hosseini A, Qi W, Tsai TY, Liu Y, Rubash H, Li G. In vivo length change patterns of the medial and lateral collateral ligaments along the flexion path of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23:3055-61. [PMID: 25239504 PMCID: PMC4368498 DOI: 10.1007/s00167-014-3306-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 09/03/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The knowledge of the function of the collateral ligaments-i.e., superficial medial collateral ligament (sMCL), deep medial collateral ligament (dMCL) and lateral collateral ligament (LCL)-in the entire range of knee flexion is important for soft tissue balance during total knee arthroplasty (TKA). The objective of this study was to investigate the length changes of different portions (anterior, middle and posterior) of the sMCL, dMCL and LCL during in vivo weightbearing flexion from full extension to maximal knee flexion. METHODS Using a dual fluoroscopic imaging system, eight healthy knees were imaged while performing a lunge from full extension to maximal flexion. The length changes of each portion of the collateral ligaments were measured along the flexion path of the knee. RESULTS All anterior portions of the collateral ligaments were shown to have increasing length with flexion except that of the sMCL, which showed a reduction in length at high flexion. The middle portions showed minimal change in lengths except that of the sMCL, which showed a consistent reduction in length with flexion. All posterior portions showed reduction in lengths with flexion. CONCLUSIONS These data indicated that every portion of the ligaments may play important roles in knee stability at different knee flexion range. The soft tissue releasing during TKA may need to consider the function of the ligament portions along the entire flexion path including maximum flexion. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ali Hosseini
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA
| | - Wei Qi
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA
- Department of Orthopaedic Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Tsung-Yuan Tsai
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA
| | - Yujie Liu
- Department of Orthopaedic Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Harry Rubash
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA, 02114, USA.
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29
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Femoral and tibial insert downsizing increases the laxity envelope in TKA. Knee Surg Sports Traumatol Arthrosc 2014; 22:3003-11. [PMID: 25274088 PMCID: PMC4237933 DOI: 10.1007/s00167-014-3339-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/17/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE This study examines the effect of component downsizing in a modern total knee arthroplasty (TKA) system on the laxity envelope of the knee throughout flexion. METHODS A robotic testing system was utilized to measure laxity envelopes in the implanted knee by in the anterior-posterior (AP), medial-lateral (ML), internal-external (IE) and varus-valgus (VV) directions. Five fresh-frozen cadavers were tested with a modern cruciate retaining TKA implantation, a 1-mm thinner polyethylene insert and a femoral component 2 mm smaller in the AP dimension. RESULTS The downsized tibial insert was more lax throughout the flexion arc with up to 2.0 mm more laxity in the AP direction at full extension, a 43.8% increase over the original implantation. A thinner insert consistently increased laxity throughout the arc of flexion in all degrees of freedom. Downsizing the femoral component resulted in 8.5 mm increase in AP laxity at 90°, a 73.9% increase. In mid-flexion, downsizing the femur produced similar laxity values to the downsized insert in AP, ML, IE and VV directions. CONCLUSION Downsizing the TKA components had significant effects on laxity throughout flexion. Downsizing a femoral component 2 mm had an equivalent increase in laxity in mid-flexion as downsizing the tibial insert 1 mm. This study quantifies the importance of choosing the appropriate implant component size, having the appropriate size available and the effect of downsizing. The laxity of the implanted knee contributes to how the implant feels to the patient and ultimately the patient's satisfaction with their new knee.
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