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Hung KT, Hsu KY, Cheng CM, Chen YJ, Chiu CH, Chan YS, Chen ACY, Yang CP. Analysis of correlation between medial joint line change and lower limb coronal alignment after Oxford unicompartmental knee arthroplasty. Clinics (Sao Paulo) 2024; 79:100478. [PMID: 39226870 PMCID: PMC11419923 DOI: 10.1016/j.clinsp.2024.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/23/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Lower limb coronal alignment was thought to be a predictive factor for Unicompartmental Knee Arthroplasty (UKA) result. The tibial bony resection and implant position lead to joint line change postoperatively. Analysis was done to find out the correlation between these factors. METHODS From 2019 to 2021, 90 medial Oxford UKA were implanted by a single surgeon. Hip Knee Ankle Angle (HKAA), Lateral Distal Femoral Angle (LDFA), Medial Proximal Tibial Angle (MPTA), and intraoperative bony resection thickness were measured. The medial joint line change was calculated. The correlation between joint line change and alignment change was evaluated. RESULTS The mean tibial resection thickness was 4.3 mm. The mean tibial joint line was elevated by 2.3 mm, while the mean femoral joint line proximalized by 0.8 mm. HKAA changed from 8.4° varus preoperatively to 3.6° varus postoperatively. LDFA changed from 89.0° to 86.7°. MPTA changed from 85.6° to 86.6°. Preoperative HKAA showed a strong correlation with postoperative HKAA (p < 0.001), and preoperative MPTA showed a positive correlation with postoperative HKAA (p < 0.001). While preoperative LDFA had a negative correlation with postoperative HKAA (p < 0.001). The femoral joint line change and LDFA change had a significant correlation with HKAA change (p < 0.05). CONCLUSION The change of joint line had no correlation with postoperative HKAA in Oxford UKA. Preoperative HKAA strongly correlated with postoperative HKAA; while preoperative smaller LDFA and larger MPTA had a moderate correlation with postoperative HKAA. The femoral joint line change and LDFA change had a weak to moderate correlation with HKAA change.
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Affiliation(s)
- Kung-Tseng Hung
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Kuo-Yao Hsu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Chieh-Ming Cheng
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Yi-Jou Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Chih-Hao Chiu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Yi-Shen Chan
- Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC)
| | - Cheng Pang Yang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC); Bone and Joint Research Center, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan (ROC).
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Yang Y, Guo Y, Wang C, Zhang X, Zhang K, Ji B. Finite element analysis of sagittal angles of unicompartmental knee arthroplasty. Clin Biomech (Bristol, Avon) 2024; 114:106232. [PMID: 38547571 DOI: 10.1016/j.clinbiomech.2024.106232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/26/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Unicompartmental knee arthroplasty is an effective treatment for knee osteoarthritis, but it has the risk of failure, and the installation position of the prosthesis is one of the factors affecting the failure. There are few biomechanical studies on the installation angle of unicompartmental knee prosthesis. METHODS Constructed a finite element model of a normal human knee joint, and the validity of the model was verified by stress and front anterior methods. The mobile-bearing unicompartmental knee arthroplasty femoral prosthesis was placed at 3° intervals from 0° sagittal plane to 15° flexion, and - 2° and 17°were established, and observing the biomechanical changes of components. FINDINGS Maximum peak stresses occurred at a sagittal mounting angle of -2° for the insert and the contralateral meniscus, with the tibia showing a maximum at 17° sagittal and the tibial prosthesis stress maximum occurring at 6° sagittal. As the sagittal plane angle of the femoral prosthesis increases and the osteotomy distance extends posteriorly, more bone is amputated during the osteotomy. The ratio of the distance from the tip of the anterior intramedullary nail to the anterior end of the osteotomy to the total anteroposterior length of the sagittal osteotomy ranged from 43.2% to 44.6%. INTERPRETATION In this paper, the more appropriate sagittal mounting position for the femoral prosthesis is between 9 and 12°, based on the amount of osteotomy and the peak stress of each component in a standing position.
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Affiliation(s)
- Yuzhu Yang
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi, China
| | - Yuan Guo
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi, China.
| | - Changjiang Wang
- Department of Engineering and Design, University of Sussex, Sussex House, Brighton BN19RH, United Kingdom.
| | - Xushu Zhang
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, Shanxi, China
| | - Kai Zhang
- Shanxi Hua Jin Orthopaedic Hospital, Taiyuan 030400, Shanxi, China.
| | - Binping Ji
- Shanxi Hua Jin Orthopaedic Hospital, Taiyuan 030400, Shanxi, China
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Wang X, Liu H, Dong Z, Chen X, Xu C, Ji G, Kang H, Wang F. Contact area and pressure changes of patellofemoral joint during stair ascent and stair descent. BMC Musculoskelet Disord 2023; 24:767. [PMID: 37770867 PMCID: PMC10537124 DOI: 10.1186/s12891-023-06882-0] [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: 01/29/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE To investigate the differences of patellofemoral joint pressure and contact area between the process of stair ascent and stair descent. METHODS The finite element models of 9 volunteers without disorders of knee (9 males) to estimate patellar cartilage pressure during the stair ascent and the stair descent. Simulations took into account cartilage morphology from magnetic resonance imaging, joint posture from weight-bearing magnetic resonance imaging, and ligament model. The three-dimension models of the patella, femur and tibia were developed with the medical image processing software, Mimics 11.1. The ligament was established by truss element of the non-linear FE solver. The equivalent gravity direction (-z direction) load was applied to the whole end of femur (femoral head) according to the body weight of the volunteers, and the force of patella was observed. A paired-samples t-test or Wilcoxon rank sum test to make comparisons between stair ascent and stair descent. Statistical analyses were performed using SPSS 22.0 using a P value of 0.05 to indicate significance. RESULTS During the stair descent (knee flexion at 30°), the contact pressure of the patella was 2.59 ± 0.06Mpa. The contact pressure of femoral trochlea cartilage was 2.57 ± 0.06Mpa. During the stair ascent (knee flexion at 60°), the contact pressure with patellar cartilage was 2.82 ± 0.08Mpa. The contact pressure of the femoral trochlea cartilage was 3.03 ± 0.11Mpa. The contact area between patellar cartilage and femoral trochlea cartilage was 249.27 ± 1.35mm2 during the stair descent, which was less than 434.32 ± 1.70mm2 during the stair ascent. The area of high pressure was located in the lateral area of patella during stair descent and the area of high pressure was scattered during stair ascent. CONCLUSION There are small change in the cartilage contact pressure between stair ascent and stair descent, indicating that the joint adjusts the contact pressure by increasing the contact area.
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Affiliation(s)
- Xiaomeng Wang
- Foot and Ankle Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huixin Liu
- Ultrasound medicine department, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenyue Dong
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaobo Chen
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenyue Xu
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gang Ji
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huijun Kang
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fei Wang
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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Patellar height after unicompartmental knee arthroplasty: comparison between fixed and mobile bearing. Arch Orthop Trauma Surg 2022; 142:3449-3460. [PMID: 34669039 DOI: 10.1007/s00402-021-04183-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to determine the changes in patellar heights by comparing standardised pre- and post-operative radiographs in a consecutive series of patients undergoing unicompartmental knee arthroplasty (UKA) with two different approaches and implant designs [fixed bearing (FB) vs mobile bearing (MB)] and to correlate the patellar heights with clinical outcomes. METHODS One hundred and seventy-two UKA patients were prospectively enrolled in the study. 75 patients underwent a minimally invasive FB medial UKA (referred to hereinafter as the 'FB group'); 97 patients were treated with a minimally invasive MB medial UKA. The pre-operative and mid-term (1-year) post-operative patellar heights and clinical scores of these groups of patients were compared using the Insall-Salvati (IS) and Caton-Deschamps (CD) indices and the Oxford Knee Score (OKS). RESULTS No differences were found between the two groups either with regard to the pre-operative data (p > 0.05) or between pre- and post-operative radiographic scores at the time of each follow-up (p > 0.05). Both the groups reported a significant clinical improvement (p<0.05) as did all the sub-groups (p < 0.05). In the MB group, a higher CD index in females was found at the final follow-up stage (p = 0.043) and a higher pre-operative CD index was found in patients with BMI ≥ 28 (p = 0.040). A statistically negative correlation was found between the pre-operative OKS and pre-operative IS index (rho=- 0.165; p=0.031). CONCLUSIONS Both FB and MB arthroplastys with different surgical approaches did not change the patellar height regardless of the age, gender and BMI at short-medium-term follow-up. The post-operative patellar height seems not to be correlated with the clinical outcomes. A higher pre-operative IS index was correlated with knee pain and function. LEVEL OF EVIDENCE Level II-prospective comparative study. STUDY REGISTRATION Researchregistry6433- www.researchregistry.com .
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Ma P, Muheremu A, Zhang S, Zheng Q, Wang W, Jiang K. Biomechanical effects of fixed-bearing femoral prostheses with different coronal positions in medial unicompartmental knee arthroplasty. J Orthop Surg Res 2022; 17:150. [PMID: 35264185 PMCID: PMC8905781 DOI: 10.1186/s13018-022-03037-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background To study the biomechanical effects of femoral prostheses at different coronal positions using finite element analysis and provide a clinical reference for unicompartmental knee arthroplasty (UKA). Methods A normal knee joint model was established and verified, establishing 13 working conditions for the femoral prosthesis: the standard position, varus and valgus angles of 3°, 6° and 9° and medial and lateral translations of 1 mm, 3 mm and 5 mm. The stress changes at different positions were analysed, including the polyethylene (PE) insert upper surface, the surface of lateral compartment cartilage and the surface of cancellous bone under tibial prosthesis. Results The stresses on the PE insert upper surface and the cancellous bone surface increased with increasing femoral prosthesis valgus/varus, and the stress increased gradually during medial to lateral translation. The stress change is more significant during valgus and lateral translation. However, the stress on the cartilage surface decreases in the process of varus to valgus and medial translation to lateral translation. Conclusion The fixed-bearing femoral prosthesis of the medial UKA should avoid translation or varus/valgus tilt on the coronal plane as much as possible. The obvious misalignment of the femoral prosthesis will significantly affect the stress on the internal structure of the knee joint, especially the PE insert and cartilage surface. A femoral prosthesis coronal tilt of more than 6° may significantly increase the stress on the PE surface, and varus of more than 6° may significantly increase the stress on the cartilage surface. For the femoral prosthesis position at the distal end of the femoral condyle, it is recommended to be placed in the centre.
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Affiliation(s)
- Pengcheng Ma
- Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, 39 Wuxing Nan Rd, Tianshan District, Ürümqi, 830001, Xinjiang, People's Republic of China
| | - Aikeremujiang Muheremu
- Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Ürümqi, 830001, Xinjiang, People's Republic of China
| | - Siping Zhang
- Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, 39 Wuxing Nan Rd, Tianshan District, Ürümqi, 830001, Xinjiang, People's Republic of China
| | - Qian Zheng
- Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, 39 Wuxing Nan Rd, Tianshan District, Ürümqi, 830001, Xinjiang, People's Republic of China
| | - Wei Wang
- Urumqi DW Innovation InfoTech Co., Ltd., Ürümqi, 830001, Xinjiang, People's Republic of China
| | - Kan Jiang
- Department of Orthopedics, Sixth Affiliated Hospital of Xinjiang Medical University, 39 Wuxing Nan Rd, Tianshan District, Ürümqi, 830001, Xinjiang, People's Republic of China.
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The Effect on the Fracture Healing following Femoral Neck Shortening after Osteoporotic Femoral Neck Fracture Treated with Internal Fixation: Finite Element Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3490881. [PMID: 34395612 PMCID: PMC8360725 DOI: 10.1155/2021/3490881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Objective To evaluate the stress status of fracture site caused by femoral neck shortening and to analyze the stress of fracture site and the implants from the finite element point of view. Methods CT scan data of hip of a normal adult female were collected. Three-dimensional reconstruction MICs and related module function simulation was used to establish the postoperative shortening model of femoral neck fracture with Pauwels angle > 50°, which was treated with cannulated screws. The models were divided into four groups: normal femoral neck, shortening in 2.5 mm, shortening in 7.5 mm, and shortening in 12.5 mm. The finite element analysis software msc.nastran2012 was used, and the data of maximum stress and stress nephogram of fracture site and implants were carried out. Results From normal femoral neck to shortening in 12.5 mm of the femoral neck, the maximum tensile stress increased gradually in the fracture site above the cannulated screws while compressive stress decreased gradually in the fracture site below the cannulated screws, and the maximum stress of the cannulated screws increased gradually with obvious stress concentration at the screw holes in the fracture site, and the peak value of stress concentration was about 179 MPa. Conclusion The biomechanical environment of the fracture site changed by femoral neck shortening. With the increasing of femoral neck shortening, the stress of the fracture site and implants would be uneven; then, the stability of fracture site would become worse, and the possibility of implant sliding or even breakage would be increased.
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Xiong H, Zeng Y, Si H, Wu Y, Shen B. [Research progress on finite element analysis of unicompartmental knee arthroplasty in medial knee compartmental osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:781-785. [PMID: 34142508 DOI: 10.7507/1002-1892.202101028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To review the research progress on finite element analysis (FEA) of unicompartmental knee arthroplasty (UKA) in medial knee compartmental osteoarthritis. Methods The FEA research literature on the medial knee UKA at home and abroad was reviewed, and the progress on the aspects of the influences of the prosthesis arrangement and the postoperative joint line on the mechanical distribution of the knee joint, the improvement of the UKA prosthesis, and the related research of different types of prostheses were summarized. Results At present, scholars have conducted a large number of FEA studies on UKA in the medial knee compartmental osteoarthritis. The results of the study show that the recommended coronal alignment and the tibial slope angle of tibial component in medial fixed-bearing UKA are 0° and 5°-7°, respectively; and the coronal alignment and the tibial slope angle of tibial component in mobile-bearing UKA are 4° varus to 4° valgus and 5°-7°, respectively. The femoral component is arranged in the neutral position of the distal femur. The joint line is recommended to be the primary alignment. The anatomical UKA prosthesis can restore the biomechanical properties of the normal knee joint. Conclusion FEA research can clarify the best arrangement and joint line of the medial knee UKA prosthesis based on the mechanical distribution results, and guide the design of UKA prostheses that are more suitable for patients.
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Affiliation(s)
- Huazhang Xiong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.,No.1 Department of Orthopedics, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 564300, P.R.China
| | - Yi Zeng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Haibo Si
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yuangang Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Bin Shen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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KARIMI MOHAMMADTAGHI, HOSSEINI SAYEDIMAN, LARI YOUSEFBAZARGAN. DETERMINATION OF THE STRESS OF ANTERIOR CRUCIATE LIGAMENT IN VARIOUS DEGREES OF KNEE FLEXION, COMPARISON OF NORMAL AND RECONSTRUCTED LIGAMENT. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Knee joint stability is enhanced by ligamentus structures such as anterior cruciate (ACL), posterior cruciate (PCL), medial collateral (MCL) and lateral collateral ligaments (LCL). Rupture of ACL is the most common knee injuries, especially in sport related activities. The aim of this study is to evaluate the stress developed in knee joint structures in various degrees of knee flexion in ACL ruptured compared to normal condition. Method: CT scan images of knee joint were used to create 3d model of knee joint by use of Mimics software. Abaqus software was used to evaluate the stress developed in knee joint in normal and in ACL reconstructed conditions in various degrees of knee flexion. Results: The stress developed in ACL and other knee joint structures increased significantly by increase in knee joint flexion. The stress of knee joint structures (especially in ACL) in ACL reconstructed condition was more than that of normal condition. Conclusion: It is recommended to immobilize the knee joint in extension up to [Formula: see text] of knee flexion in those with ACL injuries. The stress of ACL increased due to an increase in tibia translation associated with knee flexion.
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Affiliation(s)
- MOHAMMAD TAGHI KARIMI
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - SAYED IMAN HOSSEINI
- Department of Mechanical and Aerospace, Engineering Shiraz University of Technology, Shiraz, Iran
| | - YOUSEF BAZARGAN LARI
- Department of Mechanical Engineering, Shiraz Branch, Islamic University, Shiraz, Iran
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Chui ECS, Lau LCM, Kwok CKB, Ng JP, Hung YW, Yung PSH, Fan JCH. Tibial cutting guide (resector) holding pins position and subsequent risks of periprosthetic fracture in unicompartmental knee arthroplasty: a finite element analysis study. J Orthop Surg Res 2021; 16:205. [PMID: 33752713 PMCID: PMC7983218 DOI: 10.1186/s13018-021-02308-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/17/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Periprosthetic fracture of the tibia after unicompartmental knee arthroplasty has been reported to be associated with excessive pin holes created for stabilization of the cutting guide. However, fractures have also been reported in cases using two pins as in the method suggested by the manufacturer. It is currently unclear whether variations in pinhole positions make a difference in proximal tibial fracture risk. METHODS Finite element models were constructed using Chinese female bone computed tomography images, with bone cuts made according to the surgical steps of implanting a fixed bearing unicompartmental arthroplasty. Four combinations of pinholes (pins placed more closely to the medial tibial cortex or centrally along the mechanical axis as allowed by the tibial cutting guide) created for tibial cutting guide placement were tested by finite element analyses. Testing loads were applied for simulating standing postures. The maximum von Mises stress on the tibial plateau was evaluated. RESULTS Pinhole placed close to the medial edge of the proximal tibial plateau is associated with the highest stress (27.67 Mpa) and is more likely to result in medial tibial fracture. On the contrary, pinhole placed along the central axis near the tibial tuberosity has the lowest stress (1.71 Mpa) and reflects lower risk of fracture. CONCLUSION The present study revealed that placing tibial cutting guide holding pins centrally would lower the risks of periprosthetic fracture of the medial tibial plateau by analyzing the associated stress in various pin hole positions using finite element analysis.
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Affiliation(s)
- Elvis Chun-sing Chui
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Shatin, Hong Kong SAR
| | - Lawrence Chun-man Lau
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Shatin, Hong Kong SAR
| | - Carson Ka-bon Kwok
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Taipo, Hong Kong
| | - Jonathan Patrick Ng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Shatin, Hong Kong SAR
| | - Yuk-wah Hung
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Taipo, Hong Kong
| | - Patrick Shu-hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Room 74029, 5/F, Lui Che Woo Clinical Science Building, Shatin, Hong Kong SAR
| | - Jason Chi-ho Fan
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Taipo, Hong Kong
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Lu F, Sun X, Wang W, Zhang Q, Guo W. Anthropometry of the medial femoral condyle in the Chinese population: the morphometric analysis to design unicomparmental knee component. BMC Musculoskelet Disord 2021; 22:95. [PMID: 33472632 PMCID: PMC7819177 DOI: 10.1186/s12891-021-03979-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to assess the radii of the distal and posterior articular surfaces of the medial femoral condyle in a Chinese population and provide detailed parameters of the knee joint for the future design of UKA components. METHODS This study included 500 consecutive Chinese patients who underwent knee MRI from Jan 2019 to Jan 2020. The two most appropriate circles were used to reveal the distal and posterior joint surfaces in the sagittal plane of the MRI images. The radius of the circle representing the distal articular surface in the sagittal plane was measured as R1, and the radius of the posterior articular surface was measured as R2. The distance between the centers of the two rotation circles was recorded as d. An independent t test was used to compare the differences between men and women. The Pearson correlation coefficient was calculated to analyze the correlation between R1 and R2. SPSS v19.0 software was used for statistical analysis. RESULTS The average values of R1, R2, R1/R2 and d were calculated. Scatter plots were constructed to show the trend of changes in the radius of the distal and posterior articular surfaces of the femoral condyle. R1, R2 and d differed significantly between men and women (p < 0.05). Correlation analysis showed that R1 was positively correlated with R2 (r = 0.61, p < 0.05). CONCLUSIONS The data of the radii of the distal and posterior articular surfaces of the medial femoral condyle were provided. In the UKA design, the relationships between the radii of the distal and posterior articular surfaces should be taken into account.
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Affiliation(s)
- Feifan Lu
- China- Japan Friendship School of Clinical Medicine, Peking University, 100029, Beijing, China
| | - Xiaowei Sun
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, 100029, Beijing, China
| | - Weiguo Wang
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical School, 100029, Beijing, China
| | - Qidong Zhang
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical School, 100029, Beijing, China.
| | - Wanshou Guo
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Peking Union Medical School, 100029, Beijing, China.
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Nishida R, Hiranaka T, Kamenaga T, Hida Y, Fujishiro T, Okamoto K, Kuroda R, Matsumoto T. Impact of joint line orientation on clinical outcomes in bilateral Oxford mobile-bearing unicompartmental knee arthroplasty. Knee 2021; 28:186-193. [PMID: 33387809 DOI: 10.1016/j.knee.2020.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/05/2020] [Accepted: 11/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Joint line orientation angle (JLOA) is the angle between the knee joint line and the floor. It has been reported to be related to postoperative outcome after TKA. Regarding unicompartmental knee arthroplasty (UKA), although it can be horizontal after UKA because it is a resurfacing surgery, there are few reports about the JLOA after UKA and its impact on clinical outcomes. PURPOSE The purpose of this study was to reveal the relationship between JLOA and clinical outcome after UKA. METHODS This study included 106 knees in 53 consecutive patients with osteoarthritis who underwent simultaneous bilateral mobile-bearing UKA. Their pre- and postoperative JLOAs were measured by full-leg-length standing coronal radiographs. We also evaluated the tibial component height (TCH) as the factor which we assumed could influence JLOA. We analyzed the patients' JLOAs, TCHs and clinical outcomes. RESULTS Pre- and postoperative JLOA were 0.4 ± 2.4° and 2.7 ± 2.6°, respectively. The JLOA significantly tilted medially (P < 0.0001). The JLOA significantly negatively correlated with the improvement of the clinical outcomes (Oxford Knee Score (OKS): r = 0.40, P < 0.0001, Knee Society Knee Score (KSKS): r = 0.25, P < 0.01, Knee Society Function Score (KSFS): r = 0.22, P = 0.02). The TCH showed a positive correlation with postoperative JLOA and with the postoperative JLOA change (r = 0.45, P < 0.001; r = 0.25, P < 0.01, respectively). CONCLUSION The JLOA significantly tilted medially after UKA. An excessive medial tilt of the JLOA was associated with poorer postoperative outcomes of UKA. It is therefore recommended to keep the JLOA horizontal and to avoid a lower tibial cut.
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Affiliation(s)
- Ryota Nishida
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Yuichi Hida
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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Lu F, Zhang Q, Liu P, Guo W. Anthropometry of the medial tibial plateau in the Chinese population: the morphometric analysis and adaptability with Oxford Phase III tibial components. Knee Surg Sports Traumatol Arthrosc 2020; 28:3048-3054. [PMID: 31701164 DOI: 10.1007/s00167-019-05777-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/28/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE The objective of this study was to measure resected surfaces of the medial tibial plateau and to provide accurate anatomical parameters for the Chinese population and improve the unicompartmental knee arthroplasty (UKA) component design in the future. METHODS This study measured different dimensions of the medial tibial plateau on MRIs of 1000 consecutive healthy Chinese people without knee deformity. The anteroposterior (AP) dimension and mediolateral dimensions at defined points (recorded as WA, WB, WC) of the medial tibial plateau were measured. The aspect ratio (WB/AP, recorded as AR) was also recorded. The measured results were grouped to compare with the dimensions of the Oxford Phase III tibial component. An independent t test was used to compare the differences between the males and females. RESULTS The Oxford Phase III tibial component showed mediolateral overhang or undersize for the whole range of measured anteroposterior dimensions of the resected medial tibial plateau. A total of 71.3% patients' resected surface did not match the Oxford Phase III tibial component well. The study also found a decrease in the aspect ratio (WB/AP) with an increase in the AP dimension in the medial tibial plateau. CONCLUSIONS There is a difference between the morphology of the Chinese knee joint and the configuration of the Oxford Phase III tibial components. The results of this study provided accurate anatomical parameters for Chinese and guidelines for designing UKA components suitable for the Chinese population. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- Feifan Lu
- China-Japan Friendship School of Clinical Medicine, Peking University, 100029, Beijing, China
| | - Qidong Zhang
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Pei Liu
- Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Wanshou Guo
- China-Japan Friendship School of Clinical Medicine, Peking University, 100029, Beijing, China. .,Department of Orthopedic Surgery, Beijing Key Lab Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, 100029, Beijing, China.
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Abstract
Supplemental Digital Content is available in the text Background: Previously, the authors modified the surgical technique to preserve tibial bone mass for Oxford unicompartmental knee arthroplasty (UKA). The purpose of this study was to determine the clinical outcomes and values of this modified technique. Methods: Clinical data of 34 consecutive patients who underwent the unilateral modified UKA technique (modified group, 34 knees) were retrospectively analyzed. To compare the outcome, a match-paired control group (conventional group, 34 knees) of an equal number of patients using the conventional technique system in the same period were selected and matched with respect to diagnosis, age, pre-operative range of motion (ROM), and radiological grade of knee arthrosis. Clinical outcomes including knee Hospital for Special Surgery (HSS) score, ROM, and complications were compared between the two groups. Post-operative radiographic assessments included hip-knee-ankle angle (HKA), joint line change, implant position, and alignment. Results: The mean follow-up time was 38.2 ± 6.3 months. There was no difference in baseline between the two groups. The amount of proximal tibial bone cut in the modified group was significantly less than that of the conventional group (4.7 ± 1.1 mm vs. 6.7 ± 1.3 mm, t = 6.45, P < 0.001). Joint line was elevated by 2.1 ± 1.0 mm in the modified group compared with –0.5 ± 1.7 mm in the conventional group (t = –7.46, P < 0.001). No significant differences were observed between the two groups after UKA with respect to HSS score, VAS score, ROM, and HKA. Additionally, the accuracy of the post-operative implant position and alignment was similar in both groups. As for implant size, the tibial implant size in the modified group was larger than that in the conventional group (χ2 = 4.95, P = 0.035). Conclusions: The modified technique for tibial bone sparing was comparable with the conventional technique in terms of clinical outcomes and radiographic assessments. It can preserve tibial bone mass and achieve a larger cement surface on the tibial side.
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Influence of Preservation of Normal Knee Contact Stress on Other Compartments with respect to the Tibial Insert Design for Unicompartmental Knee Arthroplasty. Appl Bionics Biomech 2019; 2019:9246379. [PMID: 31827605 PMCID: PMC6885156 DOI: 10.1155/2019/9246379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 08/02/2019] [Accepted: 10/11/2019] [Indexed: 12/05/2022] Open
Abstract
Recent advances in imaging technology and additive manufacturing have led to the introduction of customized unicompartmental knee arthroplasty (UKA) that can potentially improve functional performance due to customized geometries, including customized sagittal and coronal curvature and enhanced bone preservation. The purpose of this study involved evaluating the biomechanical effect of the tibial insert design on the customized medial UKA using computer simulations. We developed sagittal and coronal curvatures in a native knee mimetic femoral component design. We utilized three types of tibial insert design: flat, anatomy mimetic, and conforming design. We evaluated contact stress on the tibial insert and other compartments, including the lateral meniscus and articular cartilage, under gait and squat loading conditions. For the conforming UKA design, the tibial insert and lateral meniscus exhibited the lowest contact stress under stance phase gait cycle. However, for the conforming UKA design, the tibial insert and lateral meniscus exhibited the highest contact stress under swing phase gait cycle. For the flat UKA design, the articular cartilage exhibited the lowest contact stress under gait and squat loading conditions. The anatomy mimetic UKA design exhibited the most normal-like contact stress on the other compartments under gait and squat loading conditions. The results reveal the importance of conformity between the femoral component and the tibial insert in the customized UKA. Based on the results on the femoral component as well as the tibial insert in the customized UKA, the anatomy mimetic design preserves normal knee joint biomechanics and thus may prevent progressive osteoarthritis of the other knee compartments.
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