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Dobrich J, Bauer S, Elicegui S, LaCour M, Ries M. Effect of Posterior Tibial Slope on Knee Kinematics After Bicruciate-Retaining Total Knee Arthroplasty. Arthroplast Today 2024; 27:101417. [PMID: 38882467 PMCID: PMC11180305 DOI: 10.1016/j.artd.2024.101417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/25/2024] [Accepted: 04/28/2024] [Indexed: 06/18/2024] Open
Abstract
Background Following total knee arthroplasty (TKA), normal knee kinematics are rarely replicated. Retention of both cruciate ligaments (bicruciate retaining TKA) has helped this. Postoperative posterior tibial slope (PPTS) may further affect ligament tension and kinematics. The objective of this study is to determine how changes between the preoperative posterior tibial slope (PTS) and PPTS affect knee kinematics. Methods Twenty bicruciate retaining TKAs were performed using standard instrumentation. Fluoroscopic kinematic data were obtained during gait and a single knee bend. Differences (Δ) between radiographic measurements of preoperative and PPTS were correlated with in-vivo knee kinematics. Patients were separated into 2 groups based on their Δ values. Group I consisted of Δ values less than 0.7, indicating either a similar PPTS compared to preoperative PTS or a slightly flatter PPTS. Group II consisted of Δ values above 0.7, indicating a steepened PPTS. Results Preoperative PTS values ranged from -0.5° to 11.2°, with an average of 5.0° ± 3.4°. PPTS values ranged from 3.0° to 12.1°, with an average of 7.1° ± 3.1°. Weight-bearing range of motion (WBROM) measured from 94° to 139°, and femorotibial axial rotation ranged from -2.9° to 17.3°. A t-test revealed average values for WBROM in Group IT (Δ < 0.7) to be significantly greater than those for Group IIT (Δ > 0.7) (P = .01). Conclusions These findings indicate that either a PPTS approximating the preoperative PTS or a slightly flattened PPTS in comparison (Δ < 0.7) is associated with WBROM greater than 130°. Values for axial rotation and anterior sliding were not significantly associated with changes to the PTS.
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Li G, Zhou C, Li S, Yu J, Foster T, Bedair H. Tibiofemoral articulation and axial tibial rotation of the knee after a cruciate retaining total knee arthroplasty. Knee Surg Relat Res 2024; 36:20. [PMID: 38790070 PMCID: PMC11127289 DOI: 10.1186/s43019-024-00224-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE Numerous research has reported that total knee arthroplasty (TKA) cannot reproduce axial tibial rotations of normal knees. The objective of this study was to measure the tibiofemoral articular contact motions and axial tibial rotations of TKA knees to investigate the mechanism causing the knee kinematics change of after TKAs. METHODS Eleven patients with unilateral cruciate retaining (CR) TKA were tested for measurements of knee motion during a weight-bearing flexion from 0° to 105° using an imaging technique. The tibiofemoral contact kinematics were determined using the contact points on medial and lateral surfaces of the tibia and femoral condyles. Axial tibial rotations were calculated using the differences between the medial and lateral articulation distances on the femoral condyles and tibial surfaces at each flexion interval of 15°. RESULTS On femoral condyles, articular contact distances are consistently longer on the medial than on the lateral sides (p < 0.05) up to 60° of flexion, corresponding to internal tibial rotations (e.g., 1.3° ± 1.0° at 15-30° interval). On tibial surfaces, the articular contact point on the medial side moved more posteriorly than on the lateral side at low flexion angles, corresponding to external tibial rotations (e.g., -1.4° ± 1.8° at 15-30° interval); and more anteriorly than on the lateral sides at mid-range flexion, corresponding to internal tibial rotations (e.g., 0.8° ± 1.7° at 45-60° interval). At higher flexion, articular motions on both femoral condyles and tibial surfaces caused minimal changes in tibial rotations. CONCLUSIONS These results indicate that the axial tibial rotations of these TKA knees were mainly attributed to asymmetric articulations on the medial and lateral femoral condyles and tibial surfaces. The data can help understand the mechanisms causing axial tibial rotations of TKA knees and help improve implant designs for restoration of normal knee kinematics.
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Affiliation(s)
- Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, 159 Wells Avenue, Newton, MA, 02459, USA.
| | - Chaochao Zhou
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, 159 Wells Avenue, Newton, MA, 02459, USA
| | - Sophia Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, 159 Wells Avenue, Newton, MA, 02459, USA
| | - Jia Yu
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, 159 Wells Avenue, Newton, MA, 02459, USA
| | - Timothy Foster
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, 159 Wells Avenue, Newton, MA, 02459, USA
| | - Hany Bedair
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Massachusetts General Brigham, 159 Wells Avenue, Newton, MA, 02459, USA
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
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Indelli PF, Giuntoli M, Zepeda K, Ghirardelli S, Valtanen RS, Iannotti F. Native knee kinematics is not reproduced after sensor guided cruciates substituting total knee arthroplasty. J Exp Orthop 2023; 10:17. [PMID: 36786878 PMCID: PMC9929011 DOI: 10.1186/s40634-023-00567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE Gait analysis was used to evaluate knee kinematics in patients who underwent successful primary total knee arthroplasty (TKA) using two modern bi-cruciate substituting designs. The knee joint was balanced intraoperatively using real-time sensor technology, developed to provide dynamic feedback regarding stability and tibiofemoral load. The authors hypothesized that major differences exist in gait parameters between healthy controls and post-TKA patients. METHODS Ten patients who underwent successful TKA using bi-cruciate substituting designs were evaluated at a minimum of 9 months postoperatively using three-dimensional knee kinematic analysis; a multi-camera optoelectronic system and a force platform were used. Sensor-extracted kinematic data included knee flexion angle at heel-strike (KFH), peak midstance knee flexion angle (MSKFA), maximum and minimum knee adduction angle (KAA) and knee rotational angle at heel-strike. Multiple gait analysis data from the study group were compared to a group of ten healthy controls who were matched by age, sex and BMI. Clinical outcome in the TKA group was also measured using the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS Clinically, at final follow-up, a statistically significant difference in pain, general symptoms, and activities of daily living was seen between the groups. From a gait analysis standpoint, TKA patients had significantly less rotation at heel strike (p = 0.04), lower late stance peak extension moments (p = 0.02), and less Knee Adduction Angle excursion during swing phase (p = 0.04) compared to the control group. No statistically significant difference was observed for knee flexion angle at heel strike, knee adduction moment, or peak knee flexion moment between the groups. CONCLUSIONS Modern bi-cruciate substituting TKA designs failed to reproduce normal knee kinematics. The lack of full knee extension during the stance phase, absence of the "screw-home mechanism" typical of an ACL functioning knee, and the reduced fluctuation in knee adduction angle during the swing phase still represent major proprioceptive and muscular recruitment differences between normal and replaced knees.
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Affiliation(s)
- Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, USA. .,Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway, Redwood City, CA, 94063, USA.
| | - Michele Giuntoli
- grid.5395.a0000 0004 1757 3729Department of Orthopaedic and Trauma Surgery, University of Pisa, Pisa, Italy
| | - Karlos Zepeda
- grid.430773.40000 0000 8530 6973Touro College of Osteopathic Medicine, New York, USA
| | | | - Rosa Susanna Valtanen
- grid.168010.e0000000419368956Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford and the Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, USA
| | - Ferdinando Iannotti
- Department of Orthopaedic and Trauma Surgery, San Paolo Hospital, Civitavecchia, Italy
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Early outcomes of a novel bicruciate-retaining knee system: a 2-year minimum retrospective cohort study. Arch Orthop Trauma Surg 2023; 143:503-509. [PMID: 35041078 DOI: 10.1007/s00402-022-04351-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bicruciate retaining (BCR) total knee arthroplasty (TKA) was designed to simulate natural knee kinematics and improve proprioception by retaining both the ACL and PCL. While the prospect of the design appears favorable to patients, previous designs have demonstrated modest survivorship rates compared to traditional designs. This study aims to report the early functional outcomes and implant survivorship of a novel BCR design. MATERIALS AND METHODS A multi-center, retrospective study was conducted identifying BCR TKA patients from 2016 to 2017. Patient demographics, quality outcomes, and post-operative complications were collected. A Kaplan-Meier analysis was used to evaluate revision-free survival. RESULTS One-hundred thirty-three patients with a mean follow-up time of 2.35 ± 0.25 years (range: 2.00-2.87 years) were identified. Patients receiving BCR TKA were, on average, 61.46 ± 9.27 years-old, obese (BMI = 31.80 ± 6.01 kg/m2), predominantly white (71.4%), and female (69.9%). The device was most often implanted using standard instruments (85.7%) compared to computer-assisted navigation (13.5%). Average length-of-stay was 1.77 ± 0.97 days. Six patients had a reoperation; three (2.5%) full revisions occurred for: infection (n = 1), arthrofibrosis (n = 1), and ACL rupture (n = 1); one (0.8%) tibial revision occurred for: arthrofibrosis; two (1.5%) liner exchanges occurred for: infection (n = 1) and arthrofibrosis (n = 1). Kaplan-Meier survivorship analysis of cumulative failure at 2-year showed a survival rate of 96.2% (95% confidence interval, 91.2-98.4%) for all-cause reoperation, 97.3% (91.6-99.1%) for aseptic revision, and 100% for mechanical failure. CONCLUSION Survivorship was 96.2% for all-cause reoperation, 97.3% for aseptic revision, and 100% for mechanical implant failure at 2-years. This novel BCR TKA demonstrated no implant-related complications and excellent survivorship outcomes over 2 years with comparable revision rates to those previously reported in the literature.
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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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