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Yu W, Zou D, Tan J, Zheng N, Ma X, Cheng R, Chen Y, Tsai TY. Medial-pivot total knee arthroplasty enhances tibiofemoral axial rotation stability in weight-bearing mid-range flexion compared to posterior-stabilised system. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38713882 DOI: 10.1002/ksa.12200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE Total knee arthroplasty (TKA) stands as a primary intervention for severe knee ailments, yet concerns remain regarding postoperative patient satisfaction and flexion instability. This study aims to evaluate the in-vivo kinematics of medial-pivot (MP) and posterior-stabilised (PS) designs during step-up activity, in comparison to the kinematics of the nonoperated contralateral knee. METHODS Sixteen patients with PS-TKA and 14 with MP-TKA were retrospectively examined. Clinical outcomes were assessed using patient-completed questionnaires. Motion during step-up was captured using a dual fluoroscopic system. Statistical analysis was applied to evaluate the in-vivo tibiofemoral six-degree-of-freedom kinematics and articular contact positions between the two groups. RESULTS Despite being older, patients in the MP group reported higher postoperative subjective scores for weight-bearing functional activities. The axial rotation centres of MP-TKA located on the medial tibial plateau exhibited less variance compared to PS-TKA and contralateral knees. Compared to the contralateral knee (contralateral to medial-pivot [C-MP] or contralateral to posterior-stabilised [C-PS]), the MP group exhibited limited range of motion in terms of anteroposterior translation (MP: 3.6 ± 1.3 mm vs. C-MP: 7.4 ± 2.5 mm, p < 0.01) and axial rotation (MP: 6.6 ± 1.9° vs. C-MP: 10.3 ± 4.9°, p = 0.02), as well as in the PS group for anteroposterior translation (PS: 3.9 ± 1.7 mm vs. C-PS: 7.2 ± 3.7 mm, p < 0.01). CONCLUSION The MP group with better postoperative ratings demonstrated a more stable MP axial rotation pattern during step-up activity compared to the PS group, underscoring the pivotal role of prosthetic design in optimising postoperative rehabilitation and functional recovery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Wanxin Yu
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tan
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Ma
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunsu Chen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Research and Development Division, TAOiMAGE Medical Technologies Corporation, Shanghai, China
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Zheng Z, Liu Y, Zhang A, Chen H, Wan Q, Zhong L, Wang X, Han Q, Wang J. Medial-lateral translational malalignment of the prosthesis on tibial stress distribution in total knee arthroplasty: A finite element analysis. Front Bioeng Biotechnol 2023; 11:1119204. [PMID: 36937745 PMCID: PMC10017773 DOI: 10.3389/fbioe.2023.1119204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Background: Poor prosthesis alignment during total knee arthroplasty could cause problems such as polyethylene spacer wear, leading to surgical failure and revision surgery. The problems caused by the malalignment of the tibial plateau prosthesis in the medial and lateral planes are unclear. We aimed to investigate the stress distribution and micromotion of the tibia when the tibial plateau prosthesis is translated 1 and 2 mm medially and laterally, respectively, using finite element analysis (FEA). Method: A non-homogeneous tibia model was created and load conditions when standing on two legs were applied using FEA to simulate the misaligned prosthesis. The stresses, stress distribution, and micromotion of the proximal tibia were analyzed in five positions of the tibial plateau prosthesis: Lateral-2 mm; Lateral-1 mm; Medium; Medial-2 mm; Medial-1 mm. Result: The maximum stress in the five groups with different misalignments of the platform was 47.29 MPa (Lateral-2 mm). The maximum micromotion among the five groups in different positions was 7.215 μm (Lateral-2 mm). Conclusion: When placing the tibial plateau prosthesis during total knee arthroplasty, an error of 2 mm or less is acceptable as long as it does not overhang.
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Affiliation(s)
| | | | | | | | | | | | | | - Qing Han
- *Correspondence: Qing Han, ; Jincheng Wang,
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Nedopil AJ, Zamora T, Delman C, Howell SM, Hull ML. Which Asymmetric Tibial Component Is Optimally Designed for Calipered Kinematically Aligned Total Knee Arthroplasty? J Knee Surg 2022; 35:1610-1618. [PMID: 33932950 DOI: 10.1055/s-0041-1728815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Calipered kinematically aligned (KA) total knee arthroplasty (TKA) restores the patient's prearthritic joint lines and sets internal-external rotation of the tibial component parallel to the flexion-extension (FE) plane, which is not a mechanical alignment (MA) target. Two asymmetric tibial components designed for MA set the tibial component to either a femoral component (FC) target or a tibial tubercle (TT) target. The study determined the optimal asymmetric tibial component to use with KA as the one with smaller IE deviation from the MA target, greater coverage of tibial resection, and lower incidence of cortical overhang. The study included 40 patients treated with bilateral calipered KA TKA with different asymmetric tibial components in opposite knees. A best-fit of a kinematic tibial template to the tibial resection set the template's slot parallel to the knee's FE plane. Each asymmetric tibial component's anterior-posterior (AP) axis was set parallel to the slot. Computer tomography analysis determined the IE deviation (-internal/+ external) of each tibial component from its MA target, tibial resection coverage by the baseplate and insert, and incidence of cortical overhang. The patient-reported Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) determined outcomes. The mean IE deviation from the MA target was 2 degrees external for the FC-target asymmetric tibial component and -8 degrees internal for the TT-target asymmetric tibial component (p < 0.001). Tibial resection coverage by the baseplate (insert) was 88% (84%) for the FC target and 84% (79%) for the TT target (p < 0.001 for baseplate and insert). The FC target insert covered 3 mm more of the posterolateral resection (p < 0.001). Posteromedial coverage was comparable. The incidence of cortical overhang was 2.5% for each baseplate. There was no difference in FJS and OKS. When performing calipered KA, the more optimal design was the asymmetric tibial component with the FC target because of the smaller deviation from its MA target and the greater coverage of the tibial resection by the baseplate and insert.
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Affiliation(s)
- Alexander J Nedopil
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
| | - Tomas Zamora
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Connor Delman
- Department of Orthopaedics, University of California, Davis, Davis, California
| | - Stephen M Howell
- Biomedical Engineering Graduate Group, University of California, Davis, Davis, California
| | - Maury L Hull
- Department of Mechanical Engineering, University of California, Davis, Davis, California
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Nedopil AJ, Zamora T, Shelton T, Howell SM, Hull M. A Best-Fit of an Anatomic Tibial Baseplate Closely Parallels the Flexion-Extension Plane and Covers a High Percentage of the Proximal Tibia. J Knee Surg 2021; 34:1486-1494. [PMID: 32403149 DOI: 10.1055/s-0040-1710367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There are no reports of in vivo internal-external (I-E) rotational alignment and coverage of the proximal tibia after performing a best-fit method of an anatomically designed and asymmetrically shaped tibial baseplate during calipered kinematically aligned (KA) total knee arthroplasty (TKA). We hypothesized that a best-fit plane sets the anterior-posterior (A-P) axis of the anatomic baseplate closely parallel to the flexion-extension (F-E) plane of the knee and covers a high percentage of the proximal tibia. A total of 145 consecutive primary TKAs were prospectively collected. The calipered KA method and verification checks set the positions and orientations of the components without ligament release in all knees without restrictions on the preoperative deformities. A best-fit method selected one of six trials of anatomic baseplates that maximized coverage and set I-E rotation parallel to and within the cortical edge of the proximal tibia. The angle between the transverse axes of the components (i.e., the deviation of the A-P axis of the anatomic baseplate from the F-E plane of the native knee) and the cross-sectional area (CSA) of the proximal tibia were measured on postoperative computerized tomographic scans. The mean deviation of the anatomic baseplate from the F-E plane was 2-degree external ± 5 degrees. The mean coverage of the proximal tibia was 87 ± 6% (CSA of baseplate from the manufacturer/CSA of proximal tibia × 100). The anatomic baseplate and best-fit method adequately set I-E rotation of the baseplate closely parallel to the F-E plane of the knee and cover a high percentage of the proximal tibia.
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Affiliation(s)
- Alexander J Nedopil
- Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - Tomas Zamora
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile Facultad de Medicina, Santiago, Chile
| | - Trevor Shelton
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, California
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California
| | - Maury Hull
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, California.,Department of Mechanical Engineering, University of California, Davis, California.,Department of Biomedical Engineering, University of California, Davis, California
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The original Akagi line is the most reliable: a systematic review of landmarks for rotational alignment of the tibial component in TKA. Knee Surg Sports Traumatol Arthrosc 2019; 27:1018-1027. [PMID: 30203197 DOI: 10.1007/s00167-018-5131-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE There is no present consensus on the most reliable anatomical landmarks or axes for tibial rotational alignment in total knee arthroplasty (TKA). The goal was therefore to review the literature and compare accuracy and repeatability of different axes for tibial baseplate rotation in TKA. METHODS Medline and Embase were searched for articles that reported accuracy in terms of error or discrepancy from the trans-epicondylar axes (TEA), and/or repeatability in terms of intraclass correlation coefficient, of one or more axes used for tibial baseplate rotation in TKA. Twenty-one articles met criteria, and their data were extracted and tabulated. RESULTS The selected articles evaluated 15 different axes, 13 for reliability, 12 for repeatability. The lowest errors or discrepancies from the projected TEA were reported for the original 'Akagi line' (posterior cruciate ligament posteriorly to medial border of tibial tuberosity), its variant using the sulcus of the tibial spines as anterior landmark, as well as the anterior tibial border and the curve-on-curve technique. The best inter-observer repeatabilities were reported for 'Akagi line' variants that use the geometric centre of the tibial plateau posteriorly and the medial border of the tibial tuberosity, or the medial sixth of the patellar tendon anteriorly. Considering accuracy and repeatability simultaneously, only two axes were found to satisfy both criteria consistently: the original 'Akagi line' and the anterior tibial border. CONCLUSIONS Because of the small number of studies found, the collected evidence remains insufficient to recommend reference axes for intra-operative rotational alignment of the tibial baseplate in TKA. A combination of two or more anatomical landmarks or projected axes could be used to ensure adequate tibial baseplate rotation, while considering individual patient morphology and implant design to optimize knee kinematics and prevent prosthetic overhang. LEVEL OF EVIDENCE Level IV, systematic review of level III and IV studies.
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Sojka JH, Everhart JS, Kirven JC, Beal MD, Flanigan DC. Variation in tibial tuberosity lateralization and distance from the tibiofemoral joint line: An anatomic study. Knee 2018; 25:367-373. [PMID: 29681529 DOI: 10.1016/j.knee.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 02/27/2018] [Accepted: 03/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND To describe variation in tibial tuberosity position in a normal adult population and inter-rater reliability of measurements of tibial tuberosity position. METHODS Surface models of 161 proximal tibia specimens (83 female, 78 male; 80 black, 81 white; age 28.7years, SD 7.5) were created with a three-dimensional laser scanner. Percent lateralization, tuberosity-eminence angle, and distance from joint surface were measured for each specimen. Variation in tuberosity position by sex, race, age, height, and BMI was calculated. Multivariate regression was used to assess for demographic factors independently associated with tuberosity positioning. RESULTS Mean percent lateralization was 57.9% (SD 2.4, range 52.4-64.9%). Tuberosity-eminence angle mean was 11.03° (SD 2.8, range 0-18.7°). Percent lateralization and tuberosity-eminence angle were not influenced by sex, race, age, height or, BMI (p>0.05). Mean tuberosity distance from joint surface was 29.2mm (SD 3.5, range 16.6-38.6mm) and larger in males than females (30.7mm (SD 2.9), 27.6mm (SD 3.3); p<0.001). Tuberosity distance from joint surface increased 0.18mm on average per 1.0cm increase in height (p<0.001). Inter-rater reliability was high for distance from joint surface (Cronbach alpha=0.99) and percent lateralization. CONCLUSIONS Tibial tuberosity percent lateralization falls in a narrow range for individuals, whereas tuberosity-eminence angle and distance from joint line are more variable. Inter-rater reliability is high for percent lateralization and distance for the joint surface. Distance of tibial tuberosity from joint surface is associated with sex and height.
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Affiliation(s)
- John H Sojka
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - Joshua S Everhart
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - James C Kirven
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States
| | - Matthew D Beal
- Department of Orthopaedics, Northwestern University Feinberg College of Medicine, United States
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, United States.
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Ishii Y, Noguchi H, Sato J, Ishii H, Todoroki K, Toyabe SI. Tibial component coverage and rotational alignment accuracy after mobile-bearing total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1143-1149. [PMID: 29428984 DOI: 10.1007/s00590-018-2155-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 02/06/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tibial component coverage (TCC) and tibial rotational angle (TRA) have been studied simultaneously in simulations, but not in clinical studies after total knee arthroplasty (TKA). The purposes of this study were (1) to evaluate TCC and rotational setting postoperatively in mobile-bearing TKA patients and (2) to compare the results with previously published simulation data. METHODS We prospectively examined 100 patients who underwent primary TKA using the LCS® Total Knee System (LCS) posterior cruciate ligament-substituting prosthesis. Clinical outcomes, TCC (coverage area of the tibial component over the tibia), and TRA (relative to the femoral transepicondylar axis (TEA)) were assessed. Quantitative three-dimensional computed tomography was used to assess TCC and TRA. All values are expressed as median (25th percentile, 75th percentile) using minus (-) for internal and plus (+) for external rotation. RESULTS Hospital for Special Surgery scores improved from 46 (36, 50) preoperatively to 92 (90, 92) postoperatively. TRA showed a median divergence of - 2.0° (- 4.75°, + 2.74°). All knees were located within 10° of the TEA (range - 10.0° to + 9.7°). The median TCC of the knees was 82.7% (80.6, 84.7%), and there were no knees that hung over the tibial component in any direction. CONCLUSIONS The LCS prosthesis had good clinical outcomes, comparable TCC, and improved TRA as compared to previous reports, as all knees were located within 10° of the TEA. Simultaneous optimization of both TCC and TRA may contribute to the excellent long-term outcomes that have been observed with this system. LEVEL OF EVIDENCE Level II, Prognostic study.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
| | - Hideo Noguchi
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hana Ishii
- Kouseiren Takaoka Hospital, 5-10 Eirakutyo Takaoka, Toyama, 933-8555, Japan
| | - Koji Todoroki
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Shin-Ichi Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan
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Murakami K, Hamai S, Okazaki K, Ikebe S, Nakahara H, Higaki H, Shimoto T, Mizu-Uchi H, Kuwashima U, Iwamoto Y. Kinematic analysis of stair climbing in rotating platform cruciate-retaining and posterior-stabilized mobile-bearing total knee arthroplasties. Arch Orthop Trauma Surg 2017; 137:701-711. [PMID: 28289890 DOI: 10.1007/s00402-017-2662-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The aim of our study was to compare and contrast the effects of two types of mobile-bearing total knee arthroplasties (TKA), namely, the cruciate-retaining (CR) and posterior-stabilized (PS) TKAs, on clinical outcomes and in vivo kinematics during stair climbing. MATERIALS AND METHODS The Press-Fit Condylar Sigma rotating platform was used for both CR and PS TKAs. Patient-reported outcomes were assessed using the 2011 Knee Society Score. Quadriceps muscle strength was evaluated by isokinetic dynamometry. In vivo kinematics were evaluated using periodic sagittal plane radiographic images obtained during stair climbing to quantify anteroposterior (AP) tibiofemoral translation, implant flexion and axial rotation angles using image-matching techniques. Outcomes were evaluated in 20 TKAs, which had been undergone with clinical success, including ten knees with CR types and ten knees with PS types. RESULTS There were no significant differences between the CR and PS TKA groups (p > 0.05) in isometric extensor torque (1.0 ± 0.2 and 1.1 ± 0.6 N m/kg, respectively) or patient-reported score for stair climbing function (4.0 ± 0.5 and 3.8 ± 0.9, respectively). Both types of TKAs showed stable AP translation in the mid range of knee flexion and paradoxical translation in the low range of flexion, with limited rotation, during stair climbing. There were no significant differences between the CR and PS TKA groups (P > 0.05) in anterior translation from 80° to 40° of knee flexion (4.2 ± 1.2 and 3.5 ± 1.6 mm, respectively), posterior translation from 40° to 10° of knee flexion (2.3 ± 1.9 and 2.0 ± 1.5 mm, respectively), and total external rotation (2.8° ± 4.9° and 0.5° ± 5.0°, respectively). CONCLUSIONS Both CR and PS types of rotating platform mobile-bearing TKAs provided reproducible knee joint kinematics during stair climbing and equivalent clinical outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Koji Murakami
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Katai Orthopaedic Hospital, 132-1 Okuma Kasuya-machi, Kasuya-gun, Fukuoka, 811-2302, Japan
| | - Satoru Ikebe
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Hiroyuki Nakahara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Takeshi Shimoto
- Department of Information and Systems Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka, 811-0295, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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