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Hanada M, Hotta K, Matsuyama Y. Impact of implant positions in total knee arthroplasty on the postoperative knee kinematics of tibial rotation. J Orthop 2024; 58:24-28. [PMID: 39045510 PMCID: PMC11262114 DOI: 10.1016/j.jor.2024.06.025] [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: 06/10/2024] [Accepted: 06/20/2024] [Indexed: 07/25/2024] Open
Abstract
Introduction In total knee arthroplasty (TKA), the implant positions and knee kinematics, as well as the manifestation of medial pivot motion, play pivotal roles in determining postoperative clinical outcomes. The purpose of the current study was to analyze the correlation between knee kinematics, which was measured during TKA and implant positions derived using computed tomography (CT) examination after TKA. Methods This study comprised 64 patients (76 knees) who underwent primary TKA between 2015 and 2022. A navigation system was used in TKA procedures, and intraoperative knee kinematics were automatically calculated with it. Utilizing three-dimensional evaluation software, positioning of implants was quantified with CT images taken pre- and post-operatively. Multiple regression analyses were employed to explore the impact of femoral component position (FP) and tibial component position (TP) on knee kinematics, focusing on the extent of tibial rotational motion (TRM) during passive knee motion. Results FP affected TRM between knee extension and 90° flexion (p = 0.003, 95 % confidence interval [CI]: 0.315-1.384) and between knee extension and full flexion (p = 0.0002, 95 % CI: 0.654-1.844) after TKA. FP in internal rotation positively affected internal TRM after TKA. TP was not associated with TRM. Conclusions Findings of the current study suggest that FP in internal rotation positively impacts knee kinematics after TKA.
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Affiliation(s)
- Mitsuru Hanada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Kensuke Hotta
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan
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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; 32:2075-2086. [PMID: 38713882 DOI: 10.1002/ksa.12200] [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: 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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Wood DS, Jensen K, Crane A, Lee H, Dennis H, Gladwell J, Shurtz A, Fullwood DT, Seeley MK, Mitchell UH, Christensen WF, Bowden AE. Accurate Prediction of Knee Angles during Open-Chain Rehabilitation Exercises Using a Wearable Array of Nanocomposite Stretch Sensors. SENSORS 2022; 22:s22072499. [PMID: 35408112 PMCID: PMC9003122 DOI: 10.3390/s22072499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 01/14/2023]
Abstract
In this work, a knee sleeve is presented for application in physical therapy applications relating to knee rehabilitation. The device is instrumented with sixteen piezoresistive sensors to measure knee angles during exercise, and can support at-home rehabilitation methods. The development of the device is presented. Testing was performed on eighteen subjects, and knee angles were predicted using a machine learning regressor. Subject-specific and device-specific models are analyzed and presented. Subject-specific models average root mean square errors of 7.6 and 1.8 degrees for flexion/extension and internal/external rotation, respectively. Device-specific models average root mean square errors of 12.6 and 3.5 degrees for flexion/extension and internal/external rotation, respectively. The device presented in this work proved to be a repeatable, reusable, low-cost device that can adequately model the knee's flexion/extension and internal/external rotation angles for rehabilitation purposes.
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Affiliation(s)
- David S. Wood
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; (D.S.W.); (K.J.); (A.C.); (D.T.F.)
| | - Kurt Jensen
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; (D.S.W.); (K.J.); (A.C.); (D.T.F.)
| | - Allison Crane
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; (D.S.W.); (K.J.); (A.C.); (D.T.F.)
| | - Hyunwook Lee
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA; (H.L.); (H.D.); (M.K.S.); (U.H.M.)
| | - Hayden Dennis
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA; (H.L.); (H.D.); (M.K.S.); (U.H.M.)
| | - Joshua Gladwell
- Department of Statistics, Brigham Young University, Provo, UT 84602, USA; (J.G.); (A.S.); (W.F.C.)
| | - Anne Shurtz
- Department of Statistics, Brigham Young University, Provo, UT 84602, USA; (J.G.); (A.S.); (W.F.C.)
| | - David T. Fullwood
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; (D.S.W.); (K.J.); (A.C.); (D.T.F.)
| | - Matthew K. Seeley
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA; (H.L.); (H.D.); (M.K.S.); (U.H.M.)
| | - Ulrike H. Mitchell
- Department of Exercise Science, Brigham Young University, Provo, UT 84602, USA; (H.L.); (H.D.); (M.K.S.); (U.H.M.)
| | - William F. Christensen
- Department of Statistics, Brigham Young University, Provo, UT 84602, USA; (J.G.); (A.S.); (W.F.C.)
| | - Anton E. Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602, USA; (D.S.W.); (K.J.); (A.C.); (D.T.F.)
- Correspondence:
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Smith LA, LaCour MT, Dennis DA, Komistek RD. Anatomic vs Dome Patella: Is There a Difference Between Fixed- vs Mobile-Bearing Posterior-Stabilized Total Knee Arthroplasties? J Arthroplasty 2021; 36:3773-3780. [PMID: 34362598 DOI: 10.1016/j.arth.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It has been hypothesized that the patella, working in conjunction with both medial and lateral femoral condyles, can influence kinematic parameters such as posterior femoral rollback and axial rotation. The objective of this study is to determine the in vivo kinematics of subjects implanted with a fixed-bearing (FB) or mobile-bearing (MB) posterior-stabilized (PS) total knee arthroplasty (TKA), with a specific focus on evaluating the impact that Anatomic and Medialized Dome patellar components have on tibiofemoral kinematic patterns. METHODS Tibiofemoral kinematics were assessed for 40 subjects; 20 with an anatomic patella and 20 with a dome patella. Within these groups, 10 subjects received an FB PS TKA and 10 subjects received an MB PS TKA. All subjects were analyzed using fluoroscopy while performing a deep knee bend activity. Kinematics were collected during specific intervals to determine similarities and differences in regard to patella and bearing type. RESULTS The greatest variation in kinematics was detected between the 2 Anatomic patellar groups. Specifically, the MB-Anatomic subjects experienced greater translation of the lateral condyle, the highest magnitude of axial rotation, and the highest range of motion compared to the FB-Anatomic subjects. Subjects with a Dome Patella displayed much variability among the average kinematics, with all parameters between FB and MB cohorts being similar. CONCLUSION The findings in this study suggest that subjects with an Anatomic patellar component could have more normal kinematic patterns with an MB PS TKA as opposed to an FB PS TKA, while subjects with a Dome patella could achieve similar kinematics regardless of TKA type.
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Affiliation(s)
- Lauren A Smith
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, TN
| | - Michael T LaCour
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, TN
| | | | - Richard D Komistek
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, TN
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5
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Mirulla AI, Bragonzoni L, Zaffagnini S, Ingrassia T, Zinno R, Innocenti B. Assessment of paradoxical anterior translation in a CR total knee prosthesis coupling dynamic RSA and FE techniques. J Exp Orthop 2021; 8:50. [PMID: 34245384 PMCID: PMC8272767 DOI: 10.1186/s40634-021-00361-y] [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: 04/20/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose The study aims were to assess the kinematic data, Internal-External (IE) rotation, and Antero-Posterior (AP) translation of the contact points between the femoral condyles and polyethylene insert and to develop a combined dynamic RSA-FE (Radiostereometric – Finite Element) model that gives results congruent with the literature. Methods A cohort of 15 patients who underwent cemented cruciate-retaining highly congruent mobile-bearing total knee arthroplasty were analyzed during a sit-to-stand motor task. The kinematical data from Dynamic RSA were used as input for a patient-specific FE model to calculate condylar contact points between the femoral component and polyethylene insert. Results The femoral component showed an overall range about 4 mm of AP translation during the whole motor task, and the majority of the movement was after 40° of flexion. Concerning the IE rotation, the femoral component started from an externally rotate position (− 6.7 ± 10°) at 80° of flexion and performed an internal rotation during the entire motor task. The overall range of the IE rotation was 8.2°. Conclusions During the sit to stand, a slight anterior translation from 40° to 0° of flexion of the femoral component with respect to polyethylene insert, which could represent a paradoxical anterior translation. Despite a paradoxical anterior femoral translation was detected, the implants were found to be stable. Dynamic RSA and FE combined technique could provide information about prosthetic component’s stress and strain distribution and the influence of the different designs during the movement.
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Affiliation(s)
- Agostino Igor Mirulla
- Department of Engineering, University of Palermo, Palermo, Italy.,Department of Biomedical and Neuromotor Sciencies, Università di Bologna, Bologna, BO, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Rimini, Italy
| | - Stefano Zaffagnini
- Department of Biomedical and Neuromotor Sciencies, Università di Bologna, Bologna, BO, Italy.,2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Raffaele Zinno
- Department for Life Quality Studies, University of Bologna, Rimini, Italy.
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), Université Libre de Bruxelles, Bruxelles, Belgium
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6
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Khasian M, Meccia BA, LaCour MT, Komistek RD. Effects of the Medial Plateau Bearing Insert Conformity on Mid-Flexion Paradoxical Motion in a Posterior-Stabilized Total Knee Arthroplasty Design. J Arthroplasty 2021; 36:2386-2392. [PMID: 33602585 DOI: 10.1016/j.arth.2021.01.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/08/2021] [Accepted: 01/24/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND One of the most common kinematic abnormalities reported for posterior-stabilized (PS) total knee arthroplasty (TKA) design is paradoxical anterior sliding during early and mid-flexion. PS TKAs have been designed such that the cam-post mechanism does not engage until later in flexion, making these implants vulnerable to anterior sliding during early and mid-flexion. The objective of this study is to investigate the biomechanical effect of increasing bearing conformity on a PS TKA. METHODS Using a validated computational model of the knee joint, the sagittal conformity of the medial plateau of a PS TKA design was altered. Three scenarios were created and evaluated for mechanics: (1) baseline conformity, (2) increased conformity, and (3) decreased conformity. RESULTS From full extension to approximately 70° of knee flexion, the medial condyle demonstrated minimal anterior sliding for the increased medial conformity design but revealed anterior sliding of 2 and 4 mm for the baseline and decreased conformity designs, respectively. After cam-post engagement, the medial condyle consistently rolled back for all 3 designs. The lateral condyle experienced consistent rollback throughout the entire flexion range for all 3 designs. However, femorotibial contact force was higher for the increased conformity design, peaking at 3.13 times body weight (×BW) compared to 3.0 × BW contact force for other 2 designs. CONCLUSION Increasing medial conformity of the bearing insert appears to reduce mid-flexion sliding for PS TKA designs, although this comes at the expense of increased femorotibial forces. This could be due to kinematic conflicts that may be introduced with highly constraining designs.
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Affiliation(s)
- Milad Khasian
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN
| | - Bradley A Meccia
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN
| | - Michael T LaCour
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN
| | - Richard D Komistek
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN
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7
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Khasian M, Meccia BA, LaCour MT, Komistek RD. Effects of Posterior Tibial Slope on a Posterior Cruciate Retaining Total Knee Arthroplasty Kinematics and Kinetics. J Arthroplasty 2021; 36:2379-2385. [PMID: 33376035 DOI: 10.1016/j.arth.2020.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/01/2020] [Accepted: 12/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It has been hypothesized that increasing posterior tibial slope can influence condylar rollback and play a role in increasing knee flexion. However, the effects of tibial slope on knee kinematics are not well studied. The objective of this study is to assess the effects of tibial slope on femorotibial kinematics and kinetics for a posterior cruciate retaining total knee arthroplasty design. METHODS A validated forward solution model of the knee was implemented to predict the femorotibial biomechanics of a posterior cruciate retaining total knee arthroplasty with varied posterior slopes of 0°-8° at 2° intervals. All analyses were conducted on a weight-bearing deep knee bend activity. RESULTS Increasing the tibial slope shifted the femoral component posteriorly at full extension but decreased the overall femoral rollback throughout flexion. With no tibial slope, the lateral condyle contacted the polyethylene 6 mm posterior of the midline, but as the slope increased to 8°, the femur shifted an extra 5 mm, to 11 mm posterior of the tibial midline. Similar shifts were observed for the medial condyle, ranging from 7 mm posterior to 13 mm posterior, respectively. Increasing posterior slope decreased the posterior cruciate ligament tension and femorotibial contact force. CONCLUSION The results of this study revealed that, although increasing the tibial slope shifted the femur posteriorly at full extension and maximum flexion, it reduced the amount of femoral rollback. Despite the lack of rollback, a more posterior location of condyles suggests lower chances of bearing impingement of the posterior femur and may explain why increasing slope may lead to higher knee flexion.
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Affiliation(s)
- Milad Khasian
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
| | - Bradley A Meccia
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
| | - Michael T LaCour
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
| | - Richard D Komistek
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
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Lynch JT, Perriman DM, Scarvell JM, Pickering MR, Galvin CR, Neeman T, Smith PN. The influence of total knee arthroplasty design on kneeling kinematics: a prospective randomized clinical trial. Bone Joint J 2021; 103-B:105-112. [PMID: 33380183 DOI: 10.1302/0301-620x.103b1.bjj-2020-0958.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Modern total knee arthroplasty (TKA) prostheses are designed to restore near normal kinematics including high flexion. Kneeling is a high flexion, kinematically demanding activity after TKA. The debate about design choice has not yet been informed by six-degrees-of-freedom in vivo kinematics. This prospective randomized clinical trial compared kneeling kinematics in three TKA designs. METHODS In total, 68 patients were randomized to either a posterior stabilized (PS-FB), cruciate-retaining (CR-FB), or rotating platform (CR-RP) design. Of these patients, 64 completed a minimum one year follow-up. Patients completed full-flexion kneeling while being imaged using single-plane fluoroscopy. Kinematics were calculated by registering the 3D implant models onto 2D-dynamic fluoroscopic images and exported for analysis. RESULTS CR-FB designs had significantly lower maximal flexion (mean 116° (SD 2.1°)) compared to CR-RP (123° (SD 1.6°)) and PS-FB (125° (SD 2.1°)). The PS-FB design displayed a more posteriorly positioned femur throughout flexion. Furthermore, the CR-RP femur was more externally rotated throughout kneeling. Finally, individual patient kinematics showed high degrees of variability within all designs. CONCLUSION The increased maximal flexion found in the PS-FB and CR-RP designs were likely achieved in different ways. The PS-FB design uses a cam-post to hold the femur more posteriorly preventing posterior impingement. The external rotation within the CR-RP design was surprising and hasn't previously been reported. It is likely due to the polyethylene bearing being decoupled from flexion. The findings of this study provide insights into the function of different knee arthroplasty designs in the context during deep kneeling and provide clinicians with a more kinematically informed choice for implant selection and may allow improved management of patients' functional expectations. Cite this article: Bone Joint J 2021;103-B(1):105-112.
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Affiliation(s)
- Joseph T Lynch
- Trauma and Orthopaedic Research Unit, Medical School, Australian National University, Canberra, Australia
| | - Diana M Perriman
- Trauma and Orthopaedic Research Unit, Medical School, Australian National University, Canberra, Australia
| | | | - Mark R Pickering
- School of Engineering and Information Technology, University of New South Wales, Canberra, Australia.,Australian Defence Force Academy, Canberra, Australia
| | - Catherine R Galvin
- College of Engineering and Computer Science, Australian National University, Canberra, Australia
| | - Teresa Neeman
- Biological Data Science Institute, Australian National University, Canberra, Australia
| | - Paul N Smith
- Trauma and Orthopaedic Research Unit, Medical School, Australian National University, Canberra, Australia
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Association of knee flexion angle after posterior-stabilized total knee arthroplasty with postoperative tibial external position relative to the femur and the extent of tibial internal rotation from knee extension to flexion. Knee 2020; 27:1467-1475. [PMID: 33010763 DOI: 10.1016/j.knee.2020.07.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 06/08/2020] [Accepted: 07/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study evaluated the relationship between preoperative and postoperative knee kinematics, moreover, investigated tibial rotational position and the extent of tibial internal rotation from knee extension to flexion as factors to obtain significant knee flexion after total knee arthroplasty (TKA). METHODS Fifty-four patients (60 knees total; 15 males, 16 knees; 39 females, 44 knees) who underwent posterior-stabilized TKA using a navigation system were included. Intraoperative knee kinematics involving tibial rotational position relative to the femur and the extent of tibial internal rotation were examined at two time points: 1) after landmarks registration (pre-TKA) and 2) after skin closure (post-TKA). The relationship between the knee flexion angle at one year postoperatively and intraoperative tibial rotational position, or the extent of tibial rotation among several knee flexion angles calculated with a navigation system were investigated. RESULTS The postoperative knee flexion angle was positively associated with the preoperative flexion angle and intraoperative knee kinematics at post-TKA involving tibial external position relative to the femur at knee extension and the extent of tibial internal rotation from extension to 90° of flexion or to maximum flexion. There was a positive relationship between the extent of tibial internal rotation at pre-TKA and that at post-TKA. CONCLUSIONS The intraoperative kinematics of the extent of tibial internal rotation at post-TKA was influenced by that at pre-TKA. The greater external position of the tibia relative to the femur at knee extension and the greater extent of tibial internal rotation at post-TKA might lead to good knee flexion angle.
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10
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Khasian M, LaCour MT, Coomer SC, Bolognesi MP, Komistek RD. In Vivo Knee Kinematics for a Cruciate Sacrificing Total Knee Arthroplasty Having Both a Symmetrical Femoral and Tibial Component. J Arthroplasty 2020; 35:1712-1719. [PMID: 32111514 DOI: 10.1016/j.arth.2020.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Early total knee arthroplasty (TKA) designs were symmetrical, but lead to complications due to over-constraint leading to loosening and poor flexion. Next-generation TKAs have been designed to include asymmetry, pertaining to the trochlear groove, femoral condylar shapes, and/or the tibial component. More recently, an advanced posterior cruciate sacrificing (PCS) TKA was designed to include both a symmetrical femoral component with a patented V-shaped trochlear groove and a symmetrical tibial component with an ultracongruent insert, in an attempt to reduce inventory costs. Because previous PCS TKA designs produced variable results, the objective of this study is to determine and evaluate the in vivo kinematics for subjects implanted with this symmetrical TKA. METHODS Twenty-one subjects, implanted with symmetrical PCS fixed-bearing TKA, were asked to perform a weight-bearing deep knee bend (DKB) while under fluoroscopic surveillance. A 3-dimensional to 2-dimensional registration technique was used to determine each subject's anteroposterior translation of lateral and medial femoral condyles as well as tibiofemoral axial rotation and their weight-bearing knee flexion. RESULTS During the DKB, the average active maximum weight-bearing flexion was 111.7° ± 13.3°. On average, from full extension to maximum knee flexion, subjects experienced -2.5 ± 2.0 mm of posterior femoral rollback of the lateral condyle and 2.5 ± 2.2 mm of medial condyle motion in the anterior direction. This medial condyle motion was consistent for the majority of the subjects, with the lateral condyle exhibiting rollback from 0° to 60° of flexion and then experienced an average anterior motion of 0.3 mm from 60° to 90° of knee flexion. On average, the subjects in this study experienced 6.6°± 3.3° of axial rotation, with most of the rotation occurring in early flexion, averaging 4.9°. CONCLUSION Although subjects in this study were implanted with a symmetrical PCS TKA, they did experience femoral rollback of the lateral condyle and a normal-like pattern of axial rotation, although less in magnitude than the normal knee. The normal axial rotation pattern occurred because the lateral condyle rolled in the posterior direction, while the medial condyle moved in the anterior direction. Interestingly, the magnitude of posterior femoral rollback and axial rotation for subjects in this study was similar in magnitude reported in previous studies pertaining to asymmetrical TKA designs. It is proposed that more patients be analyzed having this TKA implanted by other surgeons.
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Affiliation(s)
- Milad Khasian
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Michael T LaCour
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Seth C Coomer
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | | | - Richard D Komistek
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
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Cardinale U, Bragonzoni L, Bontempi M, Alesi D, Roberti di Sarsina T, Lo Presti M, Zaffagnini S, Marcheggiani Muccioli GM, Iacono F. Knee kinematics after cruciate retaining highly congruent mobile bearing total knee arthroplasty: An in vivo dynamic RSA study. Knee 2020; 27:341-347. [PMID: 31874820 DOI: 10.1016/j.knee.2019.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 10/23/2019] [Accepted: 11/05/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE This work presents a kinematic evaluation of a cruciate retaining highly congruent mobile bearing total knee arthroplasty design using dynamic Roentgen sterephotogrammetric analysis. The aim was to understand the effect of this implant design on the kinematics of prosthetic knees during dynamic activities. METHODS A cohort of 15 patients was evaluated at nine month follow-up after surgery. The mean age was 74.8 (range 66-85) years. The kinematics was evaluated using the Grood and Suntay decomposition and the Low-Point (LP) methods. RESULTS ?tlsb=-0.15pt?>From sitting to standing up position, the femoral component internally rotated (from -11.3 ± 0.2° to -7.0 ± 0.2°). Varus-valgus rotations were very close to 0° during the whole motor task. LP of medial condyle moved from an anterior position of 12.0 ± 0.2 mm to a posterior position of -12.4 ± 0.2 mm; LP of the lateral condyle moved from an anterior position of 8.1 ± 0.2 mm to a posterior position of -12.4 ± 0.2 mm, showing a bi-condylar rollback where both condyles moved parallel backward. Moreover, the femoral component showed anterior translation with respect to the tibia from 80° to 20° (from -4.9 ± 0.2 mm to 3.3 ± 0.2 mm), then a posterior translation from 20° to full extension was identified (from 3.3 ± 0.2 mm to 0.5 ± 0.2 mm). CONCLUSIONS Paradoxical anterior femoral translation and absence of medial-pivoting motion were recorded, highlighting the role of the symmetric deep dishes insert as main driver of the kinematic of this TKA design.
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Affiliation(s)
| | | | | | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic - IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Mirco Lo Presti
- II Orthopaedic and Traumatologic Clinic - IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic - IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy.
| | | | - Francesco Iacono
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, Rozzano, Milan 20089, Italy; Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Milan 20089, Italy
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Are TKA Kinematics During Closed Kinetic Chain Exercises Associated with Patient-reported Outcomes? A Preliminary Analysis. Clin Orthop Relat Res 2020; 478:255-263. [PMID: 31634171 PMCID: PMC7438127 DOI: 10.1097/corr.0000000000000991] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Kinematic patterns after TKA can vary considerably from those of the native knee. It is unknown, however, if there is a relationship between a given kinematic pattern and patient satisfaction after TKA. QUESTIONS/PURPOSES Is there an association between kinematic patterns as measured by AP translation during open kinetic chain flexion-extension and closed kinetic chain exercises (rising from a chair and squatting) and a custom aggregate of patient-reported outcome measures (PROMs) that targeted symptoms, pain, activities of daily living (ADL), sports, quality of life (QOL), and patient satisfaction after TKA? METHODS Thirty patients who underwent TKA between 2014 and 2016 were tested at a minimum follow-up of 6 months. As three different implants were used, per implant the first 10 patients who presented themselves at the follow-up consultations and were able to bend the knee at least 90°, were recruited. Tibiofemoral kinematics during an open kinetic chain flexion-extension and closed kinetic chain exercises-rising from a chair and squatting-were analyzed using fluoroscopy. A two-step cluster analysis was performed, resulting in two clusters of patients who answered the Knee Injury and Osteoarthritis Outcome Score and the satisfaction subscore of the Knee Society Score questionnaires. Cluster 1 (CL1) consisted of patients with better (good-to-excellent) patient-reported outcome measures scores (high-PROMs cluster); Cluster 2 (CL2) consisted of patients with poorer scores (low-PROMs cluster). Tibiofemoral kinematics were compared between patients in these clusters by performing a Mann-Whitney U test with Bonferroni correction. RESULTS Concerning open kinetic chain flexion-extension, there was no difference in kinematic patterns between the patients in the high-PROMs cluster and those in the low-PROMs cluster, with the numbers available. However, during the closed-chain kinetic exercises, medially, initial anterior translation (femur relative to tibia) was found in patients in Cluster 1 during early flexion, but in those in Cluster 2, translation was steeper and ran more anteriorly (CL1 -1.5 ± 7.3%; CL2 -8.5 ± 4.4%); mean difference 7.0% [95% CI 0.1 to 13.8]; p = 0.046). In midflexion, the femur did not translate anterior nor posterior in relation to the tibia, resulting in a stable medial compartment in Cluster 1, whereas Cluster 2 had already started translating posteriorly (CL1 -0.7 ± 3.5%; CL2 3.4 ± 3.6%; mean difference -4.1% [95% CI -7.0 to -1.2]; p = 0.008). There was no difference, with the numbers available, between the two clusters with respect to posterior translation in deep flexion. Laterally, there was small initial anterior translation in early flexion, followed by posterior translation in midflexion that continued in deep flexion. Patients in Cluster 1 demonstrated more pronounced posterior translation in deep flexion laterally than patients in Cluster 2 did (CL1 8.3 ± 5.2%; CL2 3.5 ± 4.5%); mean difference 4.9% [95% CI 0.6 to 9.1]; p = 0.026). CONCLUSIONS This study of total knee kinematics suggests that during closed kinetic chain movements, patients with poor PROM scores after TKA experience more anterior translation on the medial side followed by a medial mid-flexion instability and less posterior translation on the lateral side in deep flexion than patients with good PROM scores. The relationship of kinematic variations with patient-reported outcomes including satisfaction must be further elaborated and translated into TKA design and position. Reproduction of optimal kinematic patterns during TKA could be instrumental in improving patient satisfaction after total knee replacement. Future expansion of the study group is needed to confirm these findings.Level of Evidence Level II, therapeutic study.
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Angerame MR, Holst DC, Jennings JM, Komistek RD, Dennis DA. Total Knee Arthroplasty Kinematics. J Arthroplasty 2019; 34:2502-2510. [PMID: 31229370 DOI: 10.1016/j.arth.2019.05.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023] Open
Abstract
Knee kinematics is an analysis of motion pattern that is utilized to assess a comparative, biomechanical performance of healthy nonimplanted knees, injured nonimplanted knees, and various prosthetic knee designs. Unfortunately, a consensus between implanted knee kinematics and outcomes has not been reached. One might hypothesize that the kinematic variances between the nonimplanted and implanted knee might play a role in patient dissatisfaction following TKA. There is a wide range of TKA designs available today. With such variety, it is important for surgeons and engineers to understand the various geometries and kinematic profiles of available prostheses. The purpose of this review is to provide readers with the pertinent information related to TKA kinematics.
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Affiliation(s)
| | - David C Holst
- Department of Orthopedic Surgery, Duke University, Raleigh, NC
| | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Denver, Denver, CO
| | - Richard D Komistek
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Denver, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN; Department of Orthopaedics, University of Colorado Health School of Medicine, Aurora, CO
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14
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Nicolet-Petersen SJ, Howell SM, Hull M. Force and Contact Location Measurement Errors of the VERASENSE. J Biomech Eng 2018; 140:2686527. [PMID: 30029259 DOI: 10.1115/1.4040601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 02/28/2024]
Abstract
BACKGROUND The OrthoSensor VERASENSE knee system is a commercially available instrumented tibial insert that provides real-time intraoperative measurements of tibial contact force and contact location to guide surgeons toward improving outcomes in total knee arthroplasty (TKA). However, the device has been used contrary to the manufacturer's recommendations in several studies and lacks published accuracy data. Therefore, the primary objectives of this study were to evaluate the device's error in tibial contact force when used according to and contrary to the manufacturer's recommendations, and also to evaluate the device's error in anterior-posterior (A-P) and medial-lateral (M-L) contact locations. METHODS The error in tibial contact force in single compartment distributed loading was evaluated by applying known forces in ranges within and exceeding that recommended by the manufacturer, with rezeroing as recommended by the manufacturer, and without rezeroing. The error in tibial contact location in single compartment concentrated loading was evaluated by applying known forces at known locations on the articular surface. RESULTS Exceeding the maximum allowable load and not rezeroing did not adversely affect the bias (i.e. average error) (p > 0.05). The maximum absolute bias without rezeroing was 2.9 lbf. Rezeroing more than doubled the bias. The maximum root mean squared error in tibial contact location was 1.5 mm in the A-P direction. CONCLUSION The device measures tibial contact force with comparable error well above the maximum allowable load and without rezeroing, contrary to the manufacturer's instructions.
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Affiliation(s)
- Stephanie J Nicolet-Petersen
- Biomedical Engineering Graduate Group, University of California, Davis, 4635 2nd Ave (Building 97), Sacramento, CA 95817
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, 4635 2nd Ave (Building 97), Sacramento, CA 95817
| | - Maury Hull
- Department of Mechanical Engineering, Department of Biomedical Engineering, and Department of Orthopaedic Surgery, University of California, Davis, 4635 2nd Ave (Building 97), Sacramento, CA 95817
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Schiapparelli FF, Amsler F, Hirschmann MT. Medial parapatellar approach leads to internal rotation of tibial component in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1564-1570. [PMID: 28560546 DOI: 10.1007/s00167-017-4586-7] [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: 12/05/2016] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate if the type of approach [medial parapatellar approach (MPA) versus lateral parapatellar approach with tibial tubercle osteotomy (LPA)] influences rotation of femoral and/or tibial component and leg axis in total knee arthroplasty (TKA). It was the hypothesis that MPA leads to an internally rotated tibial TKA component. METHODS This study included 200 consecutive patients in whom TKA was performed using either a parapatellar medial (n = 162, MPA) or parapatellar lateral approach with tibial tubercle osteotomy (n = 38, LPA). All patients underwent clinical follow-up, standardized radiographs and computed radiography (CT). TKA components' position and the whole leg axis were assessed on 3D reconstructed CT scans (sagittal, coronal and rotational). Mean values of TKA component position and the whole leg alignment of both groups were compared using a t test. The tibial component was graded as internally rotated (<3° of external rotation (ER)), neutral rotation (equal or between 3° and 6° of ER) and externally rotated (>6° ER). The femoral component was graded as internally rotated [>3° of internal rotation (IR)], neutral rotation (equal or between -3° IR and 3° of ER) and externally rotated (>3° ER). RESULTS There was no significant difference in terms of whole leg axis after TKA between both groups (MPA: 0.2° valgus ± 3.4; LPA: 0.0° valgus ± 3.5). Means of tibial component rotation were 2.7° ER ± 6.1 (MPA) and 7.6° ER ± 5.4 (LPA). Patients of group LPA presented a significantly less internally rotated (LPA: 18.4%; MPA: 48.8%) and more externally rotated (LPA: 52.6%; MPA: 22.8%) tibial component (p < 0.001). No significant differences were seen for the femoral component position, tibial valgus/varus and tibial slope. CONCLUSION The type of approach (medial versus lateral) significantly influenced tibial TKA component rotation. It appears that a MPA tends to internally rotate the tibial TKA component and a LPA tends to externally rotate the tibial TKA. The anterior cortex should not be used as landmark for tibial TKA component placement when using the lateral approach with tibial tubercle osteotomy. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Filippo-Franco Schiapparelli
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland. .,University of Basel, Basel, Switzerland.
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16
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Roth JD, Howell SM, Hull ML. An Improved Tibial Force Sensor to Compute Contact Forces and Contact Locations In Vitro After Total Knee Arthroplasty. J Biomech Eng 2017; 139:2594422. [PMID: 27987299 DOI: 10.1115/1.4035471] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Indexed: 11/08/2022]
Abstract
Contact force imbalance and contact kinematics (i.e., motion of the contact location in each compartment during flexion) of the tibiofemoral joint are both important predictors of a patient's outcome following total knee arthroplasty (TKA). Previous tibial force sensors have limitations in that they either did not determine contact forces and contact locations independently in the medial and lateral compartments or only did so within restricted areas of the tibial insert, which prevented them from thoroughly evaluating contact force imbalance and contact kinematics in vitro. Accordingly, the primary objective of this study was to present the design and verification of an improved tibial force sensor which overcomes these limitations. The improved tibial force sensor consists of a modified tibial baseplate which houses independent medial and lateral arrays of three custom tension-compression transducers each. This sensor is interchangeable with a standard tibial component because it accommodates tibial articular surface inserts with a range of sizes and thicknesses. This sensor was verified by applying known loads at known locations over the entire surface of the tibial insert to determine the errors in the computed contact force and contact location in each compartment. The root-mean-square errors (RMSEs) in contact force are ≤ 6.1 N which is 1.4% of the 450 N full-scale output. The RMSEs in contact location are ≤ 1.6 mm. This improved tibial force sensor overcomes the limitations of the previous sensors and therefore should be useful for in vitro evaluation of new alignment goals, new surgical techniques, and new component designs in TKA.
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Affiliation(s)
- Joshua D Roth
- Biomedical Engineering Graduate Group, University of California, Davis, 4635 2nd Avenue (Building 97), Sacramento, CA 95817 e-mail:
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, 4635 2nd Avenue (Building 97), Sacramento, CA 95817 e-mail:
| | - Maury L Hull
- Department of Mechanical Engineering, Department of Biomedical Engineering, Department of Orthopaedic Surgery, University of California, Davis, 4635 2nd Avenue (Building 97), Sacramento, CA 95817 e-mail:
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17
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Ross DS, Howell SM, Hull ML. Errors in Calculating Anterior–Posterior Tibial Contact Locations in Total Knee Arthroplasty Using Three-Dimensional Model to Two-Dimensional Image Registration in Radiographs: An In Vitro Study of Two Methods. J Biomech Eng 2017; 139:2650611. [DOI: 10.1115/1.4037632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Indexed: 11/08/2022]
Abstract
Knowledge of anterior–posterior (A-P) tibial contact locations provides an objective assessment of the relative motion of the tibia on the femur following total knee arthroplasty (TKA), which can be used to compare the effects of different components, surgical techniques, and alignment goals on knee function in vivo. Both the lowest point method and the penetration method have been used to calculate A-P tibial contact locations using three-dimensional (3D) model to two-dimensional (2D) image registration. The primary objective of this study was to quantify errors in calculating the A-P tibial contact location using the lowest point and penetration methods because the errors in calculating the A-P tibial contact locations using these two methods are unknown. The A-P tibial contact locations were calculated with the two methods and simultaneously measured with a tibial force sensor in ten fresh-frozen cadaveric knee specimens with a TKA. Single-plane radiographs of the knee specimens were acquired at 0 deg, 30 deg, 60 deg, and 90 deg of flexion in neutrally, internally, and externally rotated orientations. While the radiographs were exposed, reference A-P tibial contact locations were simultaneously collected using the tibial force sensor to be compared to the calculated A-P tibial contact locations. The overall root-mean-squared-errors (RMSEs) in the A-P tibial contact location calculated with the lowest point method, the penetration method with penetration, and penetration method without penetration were 5.5 mm, 3.6 mm, and 8.9 mm, respectively. The overall RMSE was lowest for the penetration method with penetration, making it the superior method for calculating A-P tibial contact locations.
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Affiliation(s)
- Derrick S. Ross
- Biomedical Engineering Graduate Group, University of California, Davis, Davis, CA 95616
| | - Stephen M. Howell
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Maury L. Hull
- Department of Mechanical and Aerospace Engineering, University of California, Davis, Davis, CA 95616
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
- Department of Orthopaedic Surgery, University of California, Davis, 1 Shields Avenue, Davis, CA, 95616 e-mail:
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18
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Belvedere C, Leardini A, Catani F, Pianigiani S, Innocenti B. In vivo kinematics of knee replacement during daily living activities: Condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses. J Orthop Res 2017; 35:1396-1403. [PMID: 27572247 DOI: 10.1002/jor.23405] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/26/2016] [Indexed: 02/04/2023]
Abstract
In total knee replacement, the investigation on the exact contact patterns at the post-cam in implanted patients from real in vivo data during daily living activities is fundamental for validating implant design concepts and assessing relevant performances. This study is aimed at verifying the restoration of natural tibio-femoral condylar kinematics by investigating the post-cam engagement at different motor tasks. An innovative validated technique, combining three-dimensional fluoroscopic and finite element analyses, was applied to measure joint kinematics during daily living activities in 15 patients implanted with guided motion posterior-stabilized total knee replacement. Motion results showed physiological antero-posterior translations of the tibio-femoral condyles for every motor task. However, high variability was observed in the position of the calculated pivot point among different patients and different motor tasks, as well as in the range of post-cam engagement. Physiological tibio-femoral joint rotations and contacts at the condyles were found restored in the present knee replacement. Articular contact patterns experienced at the post-cam were found compatible with this original prosthesis design. The present study reports replaced knee kinematics also in terms of articular surface contacts, both at the condyles and, for the first time, at the post-cam. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1396-1403, 2017.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory and Functional-Clinical Evaluation of Prostheses, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Fabio Catani
- Department of Orthopaedics and Traumatology, Modena Policlinic, Modena, Italy
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Roth JD, Howell SM, Hull ML. Characterization and Correction of Errors in Computing Contact Location Between Curved Articular Surfaces: Application to Total Knee Arthroplasty. J Biomech Eng 2017; 139:2610239. [PMID: 28267191 DOI: 10.1115/1.4036147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Indexed: 11/08/2022]
Abstract
In total knee arthroplasty (TKA), one common metric used to evaluate innovations in component designs, methods of component alignment, and surgical techniques aimed at decreasing the high rate of patient-reported dissatisfaction is tibiofemoral contact kinematics. Tibiofemoral contact kinematics are determined based on the movement of the contact locations in the medial and lateral compartments of the tibia during knee flexion. A tibial force sensor is a useful instrument to determine the contact locations, because it can simultaneously determine contact forces and contact locations. Previous reports of tibial force sensors have neither characterized nor corrected errors in the computed contact location (i.e., center of pressure) between the femoral and tibial components in TKA that, based on a static analysis, are caused by the curved articular surface of the tibial component. The objectives were to experimentally characterize these errors and to develop and validate an error correction algorithm. The errors were characterized by calculating the difference between the errors in the computed contact locations when forces were applied normal to the tibial articular surface and those when forces were applied normal to the tibial baseplate. The algorithm generated error correction functions to minimize these errors and was validated by determining how much the error correction functions reduced the errors in the computed contact location caused by the curved articular surface. The curved articular surface primarily caused bias (i.e., average or systematic error) which ranged from 1.0 to 2.7 mm in regions of high curvature. The error correction functions reduced the bias in these regions to negligible levels ranging from 0.0 to 0.6 mm (p < 0.001). Bias in the computed contact locations caused by the curved articular surface of the tibial component as small as 1 mm needs to be accounted for, because it might inflate the computed internal-external rotation and anterior-posterior translation of femur on the tibia leading to false identifications of clinically undesirable contact kinematics (e.g., internal rotation and anterior translation during flexion). Our novel error correction algorithm is an effective method to account for this bias to more accurately compute contact kinematics.
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Affiliation(s)
- Joshua D Roth
- Biomedical Engineering Graduate Group, UC Davis, 4635 2nd Avenue (Building 97), Sacramento, CA 95817 e-mail:
| | - Stephen M Howell
- Department of Biomedical Engineering, UC Davis, 451 E. Health Sciences Drive, Davis, CA 95616 e-mail:
| | - Maury L Hull
- Department of Orthopaedic Surgery, UC Davis, 4635 2nd Avenue (Building 97), Sacramento, CA 95817;Department of Biomedical Engineering, UC Davis, 451 E. Health Sciences Drive, Davis, CA 95616;Department of Mechanical Engineering, UC Davis, One Shields Avenue, Davis, CA 95616 e-mail:
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20
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Wang JT, Zhang Y, Liu Q, He Q, Zhang DL, Zhang Y, Xiao JX, Mu X, Hu M. Effect of posterior condylar offset on clinical results after posterior-stabilized total knee arthroplasty. Chin J Traumatol 2017; 18:259-66. [PMID: 26777708 DOI: 10.1016/j.cjtee.2015.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To determine the effect of the posterior condylar offset (PCO) on clinical results after total knee arthroplasty (TKA) using a high-flex posterior-stabilized (PS) fixed-bearing prosthesis. METHODS We prospectively studied the clinical and radiographic materials of 89 consecutive female patients (89 knees), who had undergone primary TKAs for end-stage osteoarthritis. All operations were performed by a single senior surgeon or under his supervision using the same operative technique. Based on the corrected PCO change, we divided all cases into two groups: group A (corrected PCO change ≥0 mm, 58 knees) and group B (corrected PCO change<0 mm, 31 knees). One-year postoperatively, clinical and radiographic variables from the two groups were compared by independent t-test. The associations between the corrected PCO changes and the improvements of clinical variables in all patients were analyzed by Pearson linear correlation. RESULTS One-year postoperatively, the Knee Society Scores, the Western Ontario and McMaster Universities Osteoarthritis Index, non-weight-bearing active and passive range of knee flexion, flexion contracture, extensor lag, and their improvements had no statistical differences between the two groups (all p>0.05). The corrected PCO change was not significantly correlated with the improvement of any clinical variable (all p>0.05). Group A demonstrated greater flexion than group B during active weight bearing (p<0.05). CONCLUSIONS Restoration of PCO plays an important role in the optimization of active knee flexion during weight-bearing conditions after posterior-stabilized TKA, while it has no benefit to non-weight-bearing knee flexion or any other clinical result.
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Affiliation(s)
- Jian-Tao Wang
- Department of Orthopedics, Nankai University Tianjin Union Medical Center, Tianjin 300121, China
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Urish KL, Conditt M, Roche M, Rubash HE. Robotic Total Knee Arthroplasty: Surgical Assistant for a Customized Normal Kinematic Knee. Orthopedics 2016; 39:e822-7. [PMID: 27398788 DOI: 10.3928/01477447-20160623-13] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 11/11/2015] [Indexed: 02/03/2023]
Abstract
Although current total knee arthroplasty (TKA) is considered a highly successful surgical procedure, patients undergoing TKA can still experience substantial functional impairment and increased revision rates as compared with those undergoing total hip arthroplasty. Robotic-assisted surgery has been available clinically for almost 15 years and was developed, in part, to address these concerns. Robotic-assisted surgery aims to improve TKA by enhancing the surgeon's ability to optimize soft tissue balancing, reproduce alignment, and restore normal knee kinematics. Current systems include a robotic arm with a variety of different navigation systems with active, semi-active, or passive control. Semi-active systems have become the dominant strategy, providing a haptic window through which the surgeon consistently prepares a TKA based on preoperative planning. A review of previous designs and clinical studies demonstrates that these robotic systems decrease variability and increase precision, primarily with the mechanical axis and restoration of the joint line. Future design objectives include precise planning and consistent intraoperative execution. Preoperative planning, intraoperative sensors, augmenting surgical instrumentation, and biomimetic surfaces will be used to re-create the 4-bar linkage system in the knee. Implants will be placed so that the knee functions with a medial pivot, lateral rollback, screw home mechanism, and patellar femoral tracking. Soft tissue balancing will become more than equalizing the flexion and extension gaps and will match the kinematics to a normal knee. Together, coupled with advanced knee designs, they may be the key to a patient stating, "My knee feels like my natural knee." [Orthopedics. 2016; 39(5):e822-e827.].
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Sanford BA, Williams JL, Huffman KD, Zucker-Levin AR, Mihalko WM. Tibiofemoral Rotation During Sit-to-Stand Activity After TKA. Orthopedics 2016; 39:S41-4. [PMID: 27219726 DOI: 10.3928/01477447-20160509-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/23/2016] [Indexed: 02/03/2023]
Abstract
The objective of this study was to describe how tibiofemoral internal/external rotation varies in patients after total knee arthroplasty (TKA) when compared with control participants during a sit-to-stand (STS) maneuver. Motion analysis was used to measure internal/external knee rotation during STS in the control and TKA groups. Fourteen participants were included in the study. Six patients with 7 TKA knees (6 posterior stabilized and 1 cruciate-retaining TKA) were compared with 8 control participants with 8 knees from the current authors' laboratory database. Participants performed 3 STS maneuvers, and the average internal/external rotation of the femur with respect to the tibia was compared. All control participants and 2 TKA participants had internal rotation of the femur with respect to the tibia, whereas 4 TKA participants had external rotation, and 1 had no rotation during STS. Further investigation into the surgical and patient- and implant-related factors that affect this resulting reverse kinematic profile seems to be warranted. [Orthopedics. 2016; 39(3):S41-S44.].
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Mihalko WM, Lowell J, Higgs G, Kurtz S. Total Knee Post-Cam Design Variations and Their Effects on Kinematics and Wear Patterns. Orthopedics 2016; 39:S45-9. [PMID: 27219727 DOI: 10.3928/01477447-20160509-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/02/2016] [Indexed: 02/03/2023]
Abstract
Post-cam designs for posterior-stabilized total knee arthroplasy (TKA) implants have evolved over the last 2 decades. These designs have evolved from symmetric post and cam to asymmetric designs that include anterior post interactions to affect a kinematic change in full extension. All design changes have consequences on the resulting femorotibial contact kinematics and, depending on the amount of constraint built into the design, these changes may have significant consequences on the wear patterns on the tibial polyethylene insert. The current authors review the kinematic effects of symmetric and asymmetric cam designs and use a retrieval database of TKA implants obtained at the time of necropsy to show how different design variables may affect polyethylene wear patterns after 10 or more years of implantation or from modeled wear in simulators. More modern designs seem to have moved the post posteriorly and sloped the anterior aspect to avoid impingement of the anterior post in terminal flexion on the inferior aspect of the patella button. [Orthopedics. 2016; 39(3):S45-S49.].
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Maas A, Kim TK, Miehlke RK, Hagen T, Grupp TM. Differences in anatomy and kinematics in Asian and Caucasian TKA patients: influence on implant positioning and subsequent loading conditions in mobile bearing knees. BIOMED RESEARCH INTERNATIONAL 2014; 2014:612838. [PMID: 25538943 PMCID: PMC4258361 DOI: 10.1155/2014/612838] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 11/17/2022]
Abstract
The objective of our study was to determine the mechanical stress conditions under tibiofemoral loading with an overlay of knee kinematics in deep flexion on two different mobile bearing designs in comparison to in vivo failure modes. This study investigates the seldom but severe complication of fatigue failure of polyethylene components at mobile bearing total knee arthroplasty designs. Assuming a combination of a floor-based lifestyle and tibial malrotation as a possible reason for a higher failure rate in Asian countries we developed a simplified finite element model considering a tibiofemoral roll-back angle of 22° and the range of rotational motion of a clinically established floating platform design (e.motion FP) at a knee flexion angle of 120° in order to compare our results to failure modes found in retrieved implants. Compared to the failure mode observed in the clinical retrievals the locations of the occurring stress maxima as well as the tensile stress distribution show analogies. From our observations, we conclude that the newly introduced finite element model with an overlay of deep knee flexion (lateral roll-back) and considerable internally rotated tibia implant positioning is an appropriate analysis for knee design optimizations and a suitable method to predict clinical failure modes.
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Affiliation(s)
- Allan Maas
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany
| | - Tae Kyun Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam 463-707, Republic of Korea
| | - Rolf K. Miehlke
- Knee Division, The Rhine-Main Centre for Joint Diseases, Wilhelmstraße 30, 65183 Wiesbaden, Germany
- Knee Division, The Muensterland Centre for Joint Diseases, Buelt 13, 48143 Muenster, Germany
| | - Thomas Hagen
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany
| | - Thomas M. Grupp
- Aesculap AG Research & Development, Am Aesculap-Platz, 78532 Tuttlingen, Germany
- Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern, Marchioninistraße 15, 81377 Munich, Germany
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