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Jeong HW, Yoo HJ, Park SY, Lee YS. Clinical Relevance of Posterior Osteophyte Formation in Ultra-congruent Total Knee Arthroplasty: Midterm Radiographic Rollback and Impingement Analysis. Clin Orthop Surg 2024; 16:413-421. [PMID: 38827750 PMCID: PMC11130627 DOI: 10.4055/cios23061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/27/2023] [Accepted: 05/27/2023] [Indexed: 06/04/2024] Open
Abstract
Background Posterior femoral condylar osteophytes were frequently observed in patients with the ultra-congruent (UC) deep-dish design prosthesis. Therefore, the purpose of the present study was to verify the clinical relevance of osteophyte formation in the UC design. Methods From March 2014 to February 2018, a comparative study was conducted on 96 knees using the UC design. They were divided into 2 groups (group 1: osteophyte +, group 2: osteophyte -). Intraoperative findings, indirect femoral rollback assessment using 30° flexion and active full flexion lateral radiographs, serial change of the osteophyte, and outcomes were compared. Results The mean follow-up period was 49.35 ± 3.47 months in group 1 and 47.52 ± 3.37 months in group 2. Posterior component coverage was significantly different between the groups: group 1 exhibited more underhang and group 2 exhibited more overhang (p = 0.022). On the indirect assessment of the femoral rollback, there was a statistically significant difference in deep flexion and change in distance (p < 0.001 and p < 0.001, respectively). There was no statistical difference between the 2 groups in the American Knee Society knee and function score, and group 2 showed significant improvement in pain compared to group 1 in Western Ontario and McMaster University Arthritis Index pain score (p = 0.029). Conclusions Posterior condylar osteophyte formation was related to posterior impingement. It was more frequently observed in the underhang of the femoral component and insufficient femoral rollback. In addition, it changed with time and caused negative effects, including a gradual decrease in flexion and more pain.
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Affiliation(s)
- Ho Won Jeong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Jin Yoo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Seong Yun Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yong Seuk Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Yoo HJ, Kim YB, Jeong HW, Park SB, Nam HS, Lee YS. Clinical relevance of roll-back replacement of ultra congruent total knee arthroplasty: comparison of mid-term outcomes with posterior stabilizing design. Arch Orthop Trauma Surg 2023; 143:6805-6813. [PMID: 37488457 DOI: 10.1007/s00402-023-04918-7] [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: 08/31/2022] [Accepted: 05/21/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The outcomes of total knee arthroplasty (TKA) remain controversial, and we do not know which factors are important for successful outcomes. This study aimed to compare the mid-term outcomes of different conceptual designs by evaluating the radiological and clinical outcomes. MATERIALS AND METHODS A total of 478 total knee arthroplasties (TKAs) were enrolled and allocated into groups I [posterior stabilizing (PS) with anterior referencing (AR)], II [PS with posterior referencing (PR), and III [ultra-congruent (UC) TKA)]. Preoperative findings, last follow-up clinical outcomes, and final follow-up radiological and indirect assessments of the femoral rollback were compared between the groups. RESULTS The mean follow-up period was 72.6 ± 12.9 months. The tourniquet was used samely applied to every group. Flexion contracture was significantly larger in group III than in groups I and II (3.3 ± 2.7, p < 0.001), and further flexion was significantly smaller in group III (130.0° ± 2.7°, p < 0.001). Among the radiological parameters, posterior osteophyte formation was the most common in group III (67.8%). The rollback distance was significantly smaller in group III than in groups I and II (p < 0.001). The active deep flexion angle was affected by the posterior condylar offset (PCO) ratio, and the contact point changed the distance (p < 0.05). CONCLUSION PS TKAs showed better ROMs than UC TKAs; however, no differences were noted in the clinical outcome scales. The flexion angle was affected by the PCOR and rollback at both PS and UC TKAs. However, rollback negatively affected the flexion angle during UC TKAs. An inappropriate femoral rollback was identified, and femoral osteophyte formation was determined to be the most prominent in UC TKAs. Level of evidence Level III comparative study.
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Affiliation(s)
- Hyun Jin Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Yong Beom Kim
- Department of Orthopaedic Surgery, Soonchunyang University Hospital, Seoul, Korea
| | - Ho Won Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Sung Bae Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Hee Seung Nam
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
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Medial Pivot Versus Posterior-Stabilized Prosthesis Design in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. Indian J Orthop 2022; 56:1506-1524. [PMID: 36052392 PMCID: PMC9385931 DOI: 10.1007/s43465-022-00678-5] [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: 08/11/2021] [Accepted: 05/30/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Studies of clinical outcomes that compare the Medial Pivot design (MP) with the Posterior-Stabilized design (PS) were controversial. The meta-analysis was performed to summarize existing evidence, aiming to determine whether MP was superior to PS prosthesis. METHODS Search strategies followed the recommendations of the Cochrane collaboration. Electronic searches such as PubMed, Embase, Web of Science, and Cochrane were systematically searched for publications concerning medical pivot and posterior stabilized prosthesis from the inception date to April 2021. Authors also manually checked and retrieved a reference list of included publications for potential studies, which the electronic searches had not found. Two investigators independently searched, screened, and reviewed the full text of the article. Disagreements generated throughout the process were resolved by consensus, and if divergences remain, they were arbitrated by a third author. Subsequently, patients were divided into the MP and PS groups. RESULTS This study included 18 articles, comprising a total of 2614 patients with a similar baseline. The results showed the PS group had a higher risk of the patellar clunk or crepitus. However, the theoretical advantages of MP prosthesis could not translate to the difference in knee function, clinical complications, revision rate and satisfaction. Similarly, the shape and mechanism of prostheses could not affect the implant position and postoperative alignment. CONCLUSIONS The MP prosthesis can reduce the patellar clunk or crepitus rate. However, choices between the MP and PS prosthesis would not affect knee function, clinical complications, revision rate, patient satisfaction, implant position, and postoperative alignment.
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Koh YG, Lee JA, Lee HY, Suh DS, Park JH, Kang KT. Finite element analysis of femoral component sagittal alignment in mobile-bearing total knee arthroplasty. Biomed Mater Eng 2022; 33:195-207. [DOI: 10.3233/bme-211280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Recently, there has been an increasing interest in mobile-bearing total knee arthroplasty (TKA). However, changes in biomechanics for femoral component alignment in mobile-bearing TKA have not been explored in depth. OBJECTIVE: This study aims to evaluate the biomechanical effect of sagittal alignment of the femoral component in mobile-bearing TKA. METHODS: We developed femoral sagittal alignment models with −3°, 0°, 3°, 5°, and 7° flexion. We also examine the kinematics of the tibiofemoral (TF) joint, contact point on the TF joint, contact stress on the patellofemoral (PF) joint, collateral ligament force, and quadriceps force using a validated computational model under a deep-knee-bend condition. RESULTS: Posterior kinematics of the TF joint increases as the femoral component flexes. The contact stress on the PF joint, collateral ligament force, and the quadriceps force decreases as the femoral component flexes. CONCLUSIONS: Our results show that a slight, approximately 0°∼3°, flexion of the implantation could be an effective substitute technique. However, excessive flexion should be avoided because of the potential loosening of the TF joint.
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Affiliation(s)
| | - Jin-Ah Lee
- , Yonsei University, , Republic of Korea
| | | | | | - Joon-Hee Park
- , , Hallym University College of Medicine, , Republic of Korea
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Takemura S, Ikawa T, Ohyama Y, Kim M, Takaoka K, Minoda Y, Kadoya Y. The posterior tibial slope does not influence the flexion angle in posterior-stabilized mobile-bearing total knee arthroplasty. ARTHROPLASTY 2021; 3:28. [PMID: 35236482 PMCID: PMC8796609 DOI: 10.1186/s42836-021-00085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
Background It remains uncertain whether an increase in the tibial slope leads to better flexion in posterior-stabilized (PS) total knee prostheses. Purpose To compare the intra-operative flexion angle between standard and an additional 10° posterior slope inserts. Patients and methods Between December 2014 and February 2015, 22 patients (25 knees) who underwent PS mobile-bearing primary total knee arthroplasty (TKA) were included. Flexion angles were measured using either standard or specially-made inserts. Differences in flexion angles between the two situations were analyzed to determine the relationship between changes in flexion angle and pre-operative flexion angle or body mass index (BMI), and between intra- and post-operative flexion angle. Results The difference between the average flexion angle of standard inserts and specially-made inserts was not statistically significant. Although the correlations between changes in flexion angle due to insert difference and flexion angle, pre-operative flexion angle or BMI were not significant, there was a positive correlation between intra-operative and post-operative flexion at 2 years. Conclusion The results showed an additional posterior tibial slope by 10° did not affect the intra-operative flexion angle. Surgeons performing PS mobile-bearing TKA do not need to excessively slope the tibial bone cutting to improve the post-operative flexion angle. Level of evidence I, Experimental study. Supplementary Information The online version contains supplementary material available at 10.1186/s42836-021-00085-5.
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Affiliation(s)
- Susumu Takemura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Tessyu Ikawa
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital Osaka, 2-10-39, Shibata, Kita-ku, Osaka, 530-0012, Japan
| | - Yohei Ohyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Mitsunari Kim
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
| | - Kunio Takaoka
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshinori Kadoya
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
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Hadizadeh H, Hadizadeh H, Ganjiani M, Karimpour M, Hosseinpour A. Investigation of the effect of the angle between femoral and prosthesis mechanical axes on bone remodeling of femur in total knee arthroplasty. Proc Inst Mech Eng H 2021; 235:976-984. [PMID: 33985375 DOI: 10.1177/09544119211016128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The bone remodeling is the process in which the bone adapts its structure to the variation of environmental loads. The joint might be broken or damaged as a result of aging or an accident. To remedy this situation, Total Knee Arthroplasty (TKA) and prosthesis implantation is recommended. The main goal of this research is to investigate the effects of femur implanting angle on the bone remodeling process after TKA in the Coronal, Sagittal and horizontal planes over seven years. First, the 3D CAD model from CT images is created then the bone behavior is simulated using a model with a USDFLD subroutine. The results show that as the implant rotates in one direction, the stress and density distribution increases in the same direction whereas the load and consequently the bone density decrease substantially in the opposite direction. Consequently, the bone density might even decrease 77 and 31 percent in the coronal and sagittal plane respectively, so in the total knee arthroplasty, the mechanical axes of prosthesis and femur should be parallel. The active bone which occurs as a result of mechanical axes of prosthesis and femur parallelism and consequently uniform load distribution, can protect the implant from prosthesis loosening and fracture.
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Affiliation(s)
- Hasan Hadizadeh
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Hossein Hadizadeh
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Mehdi Ganjiani
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Morad Karimpour
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Abolfazl Hosseinpour
- Department of Mechanical Engineering, University of North Carolina, Charlotte, NC, USA
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Koh YG, Lee JA, Lee HY, Suh DS, Kim HJ, Kang KT. Effect of sagittal femoral component alignment on biomechanics after mobile-bearing total knee arthroplasty. J Orthop Surg Res 2019; 14:400. [PMID: 31779650 PMCID: PMC6883526 DOI: 10.1186/s13018-019-1458-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/05/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Recently, there has been increasing interest in mobile-bearing total knee arthroplasty (TKA). However, changes in biomechanics with respect to femoral component alignment in mobile-bearing TKA have not been explored in depth. This study aims to evaluate the biomechanical effect of sagittal alignment of the femoral component in mobile-bearing TKA. METHODS We developed femoral sagittal alignment models with - 3°, 0°, 3°, 5°, and 7°. We also examined the kinematics of the tibiofemoral (TF) joint, contact point on the TF joint, contact stress on the patellofemoral (PF) joint, collateral ligament force, and quadriceps force using a validated computational model under a deep-knee-bend condition. RESULTS Posterior kinematics of the TF joint increased as the femoral component flexed. In addition, contact stress on the PF joint, collateral ligament force, and quadriceps force decreased as the femoral component flexed. The results of this study can assist surgeons in assessing risk factors associated with femoral component sagittal alignment for mobile-bearing TKA. CONCLUSIONS Our results showed that slight flexion implantation may be an effective alternative technique because of its advantageous biomechanical effect. However, excessive flexion should be avoided because of potential loosening of the TF joint.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Dong-Suk Suh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, 1239 Yangjae-dearo, Songpa-gu, Seoul, 05541, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Kang KT, Koh YG, Park KM, Lee JS, Kwon SK. Biomechanical analysis of a changed posterior condylar offset under deep knee bend loading in cruciate-retaining total knee arthroplasty. Biomed Mater Eng 2019; 30:157-169. [PMID: 30741664 DOI: 10.3233/bme-191041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The conservation of the joint anatomy is an important factor in total knee arthroplasty (TKA). The restoration of the femoral posterior condylar offset (PCO) has been well known to influence the clinical outcome after TKA. OBJECTIVE The purpose of this study was to determine the mechanism of PCO in finite element models with conservation of subject anatomy and different PCO of ±1, ±2, ±3 mm in posterior direction using posterior cruciate ligament-retaining TKA. METHODS Using a computational simulation, we investigated the influence of the changes in PCO on the contact stress in the polyethylene (PE) insert and patellar button, on the forces on the collateral and posterior cruciate ligament, and on the quadriceps muscle and patellar tendon forces. The computational simulation loading condition was deep knee bend. RESULTS The contact stresses on the PE insert increased, whereas those on the patellar button decreased as posterior condylar offset translated to the posterior direction. The forces exerted on the posterior cruciate ligament and collateral ligaments increased as PCO translated to the posterior direction. The translation of PCO in the anterior direction, in an equivalent flexion angle, required a greater quadriceps muscle force. CONCLUSIONS Translations of the PCO in the posterior and anterior directions resulted in negative effects in the PE insert and ligament, and the quadriceps muscle force, respectively. Our findings suggest that orthopaedic surgeons should be careful with regard to the intraoperative conservation of PCO, because an excessive change in PCO may lead to quadriceps weakness and an increase in posterior cruciate ligament tension.
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Affiliation(s)
- Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Kyoung-Mi Park
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Jun-Sang Lee
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Sae Kwang Kwon
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, Seoul, Republic of Korea
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Effects of posterior condylar offset and posterior tibial slope on mobile-bearing total knee arthroplasty using computational simulation. Knee 2018; 25:903-914. [PMID: 29980426 DOI: 10.1016/j.knee.2018.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 05/10/2018] [Accepted: 06/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postoperative changes of the femoral posterior condylar offset (PCO) and posterior tibial slope (PTS) affect the biomechanics of the knee joint after fixed-bearing total knee arthroplasty (TKA). However, the biomechanics of mobile-bearing is not well known. Therefore, the aim of this study was to investigate whether alterations to the PCO and PTS affect the biomechanics for mobile-bearing TKA. METHODS We used a computational model for a knee joint that was validated using in vivo experiment data to evaluate the effects of the PCO and PTS on the tibiofemoral (TF) joint kinematics, patellofemoral (PF) contact stress, collateral ligament force and quadriceps force, for mobile-bearing TKA. The computational model was developed using ±1-, ±2- and ±3-mm PCO models in the posterior direction and -3°, 0°, +3°, and +6° PTS models based on each of the PCO models. RESULTS The maximum PF contact stress, collateral ligament force and quadriceps force decreased as the PTS increased. In addition, the maximum PF contact stress and quadriceps force decreased, and the collateral ligament force increased as PCO translated in the posterior direction. This trend is consistent with that observed in any PCO and PTS. CONCLUSIONS Our findings show the various effects of postoperative alterations in the PCO and PTS on the biomechanical results of mobile-bearing TKA. Based on the computational simulation, we suggest that orthopaedic surgeons intraoperatively conserve the patient's own anatomical PCO and PTS in mobile-bearing TKA.
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Haruta Y, Kawahara S, Tsuchimochi K, Hamasaki A, Hara T. Deviation of femoral intramedullary alignment rod influences coronal and sagittal alignment during total knee arthroplasty. Knee 2018; 25:644-649. [PMID: 29778655 DOI: 10.1016/j.knee.2018.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/18/2018] [Accepted: 04/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND An intramedullary (IM) rod is used to resect the distal femur vertically to the femoral mechanical axis in the coronal plane in many cases of total knee arthroplasties (TKA). The valgus angle between the mechanical axis and the anatomical axis of the distal femur is estimated preoperatively. It is known the deviation of the IM rod in the femoral canal could influence the femoral component alignment. However, there is no published data regarding how many degrees of deviation to make with the IM rod. The purpose of this study is to measure each deviation of the IM rod using three-dimensional (3D) computer simulations. METHODS Preoperative CT scans on 30 knees undergoing TKA were studied. The line connecting central points at 10 and 20 cm proximal from the intercondylar notch was defined as the anatomical axis and the point at which the anatomical axis intersects the surface of the distal femur was considered as the entry point of the IM rod. The medio-lateral (ML) and antero-posterior (AP) deviations between the anatomical axis and the IM rod were measured. RESULTS The ML and AP deviations were 0.8 and 1.1° on average. The IM rod was deviated medio-laterally more than 1.0° in three knees (10%). CONCLUSION Surgeons should note the ML difference of the resection thickness of the distal femur for coronal alignment. If the ML difference varies greatly from the preoperative planning, they need to adjust at most 1.0° of valgus angle to achieve the appropriate coronal alignment. Level of evidence III, Therapeutic.
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Affiliation(s)
- Yohei Haruta
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-city, Fukuoka 820-8505, Japan
| | - Shinya Kawahara
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-city, Fukuoka 820-8505, Japan.
| | - Kanenobu Tsuchimochi
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-city, Fukuoka 820-8505, Japan
| | - Akihiko Hamasaki
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-city, Fukuoka 820-8505, Japan
| | - Toshihiko Hara
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, 3-83 Yoshio-machi, Iizuka-city, Fukuoka 820-8505, Japan
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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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Coles LG, Gheduzzi S, Miles AW. In vitro method for assessing the biomechanics of the patellofemoral joint following total knee arthroplasty. Proc Inst Mech Eng H 2014; 228:1217-26. [DOI: 10.1177/0954411914560835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The patellofemoral joint is a common site of pain and failure following total knee arthroplasty. A contributory factor may be adverse patellofemoral biomechanics. Cadaveric investigations are commonly used to assess the biomechanics of the joint, but are associated with high inter-specimen variability and often cannot be carried out at physiological levels of loading. This study aimed to evaluate the suitability of a novel knee simulator for investigating patellofemoral joint biomechanics. This simulator specifically facilitated the extended assessment of patellofemoral joint biomechanics under physiological levels of loading. The simulator allowed the knee to move in 6 degrees of freedom under quadriceps actuation and included a simulation of the action of the hamstrings. Prostheses were implanted on synthetic bones and key soft tissues were modelled with a synthetic analogue. In order to evaluate the physiological relevance and repeatability of the simulator, measurements were made of the quadriceps force and the force, contact area and pressure within the patellofemoral joint using load cells, pressure-sensitive film, and a flexible pressure sensor. The results were in agreement with those previously reported in the literature, confirming that the simulator is able to provide a realistic physiological loading situation. Under physiological loading, average standard deviations of force and area measurements were substantially lower and comparable to those reported in previous cadaveric studies, respectively. The simulator replicates the physiological environment and has been demonstrated to allow the initial investigation of factors affecting patellofemoral biomechanics following total knee arthroplasty.
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Affiliation(s)
- LG Coles
- Centre for Orthopaedic Biomechanics, Mechanical Engineering Department, University of Bath, Bath, UK
| | - S Gheduzzi
- Centre for Orthopaedic Biomechanics, Mechanical Engineering Department, University of Bath, Bath, UK
| | - AW Miles
- Centre for Orthopaedic Biomechanics, Mechanical Engineering Department, University of Bath, Bath, UK
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Femoral and tibial insert downsizing increases the laxity envelope in TKA. Knee Surg Sports Traumatol Arthrosc 2014; 22:3003-11. [PMID: 25274088 PMCID: PMC4237933 DOI: 10.1007/s00167-014-3339-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/17/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE This study examines the effect of component downsizing in a modern total knee arthroplasty (TKA) system on the laxity envelope of the knee throughout flexion. METHODS A robotic testing system was utilized to measure laxity envelopes in the implanted knee by in the anterior-posterior (AP), medial-lateral (ML), internal-external (IE) and varus-valgus (VV) directions. Five fresh-frozen cadavers were tested with a modern cruciate retaining TKA implantation, a 1-mm thinner polyethylene insert and a femoral component 2 mm smaller in the AP dimension. RESULTS The downsized tibial insert was more lax throughout the flexion arc with up to 2.0 mm more laxity in the AP direction at full extension, a 43.8% increase over the original implantation. A thinner insert consistently increased laxity throughout the arc of flexion in all degrees of freedom. Downsizing the femoral component resulted in 8.5 mm increase in AP laxity at 90°, a 73.9% increase. In mid-flexion, downsizing the femur produced similar laxity values to the downsized insert in AP, ML, IE and VV directions. CONCLUSION Downsizing the TKA components had significant effects on laxity throughout flexion. Downsizing a femoral component 2 mm had an equivalent increase in laxity in mid-flexion as downsizing the tibial insert 1 mm. This study quantifies the importance of choosing the appropriate implant component size, having the appropriate size available and the effect of downsizing. The laxity of the implanted knee contributes to how the implant feels to the patient and ultimately the patient's satisfaction with their new knee.
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Walker PS, Meere PA, Bell CP. Effects of surgical variables in balancing of total knee replacements using an instrumented tibial trial. Knee 2014; 21:156-61. [PMID: 24103411 DOI: 10.1016/j.knee.2013.09.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/27/2013] [Accepted: 09/11/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND In total knee surgery, typically the bone cuts are made first to produce the correct overall alignment. This is followed by balancing, often using spacer blocks to obtain equal parallel gaps in flexion and extension. Recently an electronically instrumented tibial trial has been introduced, which measures lateral and medial contact forces. The goal of our study was to determine the effect of different surgical variables; changing component sizes, modifying bone cuts, or ligament releases; on the contact forces, as a method to achieve balancing. METHODS A special rig was designed to fit on a standard operating table, on which tests on 10 lower extremity specimens were carried out. After making bone cuts for a posterior cruciate retaining knee using a navigation system, tibial thickness was determined in extension using the Sag Test. Different Surgical Variables were then implemented, and the changes in the condylar forces were determined throughout flexion using the Heel Push Test. RESULTS condylar forces were found to consist of gravity forces due to the weight of the leg plus forces due to pretension in the collateral ligaments. The pretension force averaged 145 N but there was considerable variation because of ligament stiffness properties. Balancing from an imbalanced state could be achieved with adjustments within only 2° or 2 mm. CONCLUSION The instrumented tibial trial provided force information which indicated which surgical correction options to carry out to achieve balancing. From an initial unbalanced state, relatively small changes could produce balancing, indicating the sensitivity of the procedure. CLINICAL RELEVANCE Non-clinical. This study will assist in the balancing of the knee at total knee replacement surgery.
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Affiliation(s)
- Peter S Walker
- Department of Orthopaedic Surgery, New York University, Hospital for Joint Diseases, United States.
| | - Patrick A Meere
- Department of Orthopaedic Surgery, New York University, Hospital for Joint Diseases, United States
| | - Christopher P Bell
- Department of Orthopaedic Surgery, New York University, Hospital for Joint Diseases, United States
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Singh G, Tan JH, Sng BY, Awiszus F, Lohmann CH, Nathan SS. Restoring the anatomical tibial slope and limb axis may maximise post-operative flexion in posterior-stabilised total knee replacements. Bone Joint J 2013; 95-B:1354-8. [PMID: 24078531 DOI: 10.1302/0301-620x.95b10.31477] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The optimal management of the tibial slope in achieving a high flexion angle in posterior-stabilised (PS) total knee replacement (TKR) is not well understood, and most studies evaluating the posterior tibial slope have been conducted on cruciate-retaining TKRs. We analysed pre- and post-operative tibial slope differences, pre- and post-operative coronal knee alignment and post-operative maximum flexion angle in 167 patients undergoing 209 TKRs. The mean pre-operative posterior tibial slope was 8.6° (1.3° to 17°) and post-operatively it was 8.0° (0.1° to 16.7°). Multiple linear regression analysis showed that the absolute difference between pre- and post-operative tibial slope (p < 0.001), post-operative coronal alignment (p = 0.02) and pre-operative range of movement (p < 0.001) predicted post-operative flexion. The variance of change in tibial slope became larger as the post-operative maximum flexion angle decreased. The odds ratio of having a post-operative flexion angle < 100° was 17.6 if the slope change was > 2°. Our data suggest that recreation of the anatomical tibial slope appears to improve maximum flexion after posterior-stabilised TKR, provided coronal alignment has been restored.
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Affiliation(s)
- G Singh
- National University Health System, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, 1E Kent Ridge Road, 119228, Singapore
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The effect of posterior tibial slope on knee flexion in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21:2696-703. [PMID: 22660964 DOI: 10.1007/s00167-012-2058-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 05/11/2012] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate and quantify the effect of the tibial slope on the postoperative maximal knee flexion and stability in the posterior-stabilized total knee arthroplasty (TKA). METHODS Fifty-six patients (65 knees) who had undergone TKA with the posterior-stabilized prostheses were divided into the following 3 groups according to the measured tibial slopes: Group 1: ≤4°, Group 2: 4°-7° and Group 3: >7°. The preoperative range of the motion, the change in the posterior condylar offset, the elevation of the joint line, the postoperative tibiofemoral angle and the preoperative and postoperative Hospital for Special Surgery (HSS) scores were recorded. The tibial anteroposterior translation was measured using the Kneelax 3 Arthrometer at both the 30° and the 90° flexion angles. RESULTS The mean values of the postoperative maximal knee flexion were 101° (SD 5), 106° (SD 5) and 113° (SD 9) in Groups 1, 2 and 3, respectively. A significant difference was found in the postoperative maximal flexion between the 3 groups (P < 0.001). However, no significant differences were found between the 3 groups in the postoperative HSS scores, the changes in the posterior condylar offset, the elevation of the joint line or the tibial anteroposterior translation at either the 30° or the 90° flexion angles. A 1° increase in the tibial slope resulted in a 1.8° flexion increment (r = 1.8, R (2) = 0.463, P < 0.001). CONCLUSION An increase in the posterior tibial slope can significantly increase the postoperative maximal knee flexion. The tibial slope with an appropriate flexion and extension gap balance during the operation does not affect the joint stability.
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Abstract
PURPOSE There has been much emphasis on the importance of cam impingement, which is a cause of pain and knee hyperflexion restriction in unicompartmental knee arthroplasty (UKA). This study aimed to correlate cam impingement in the posterior femoral condyle with an α-angle showing the severity of the impingement. METHODS The study groups consisted of 87 knees of 74 patients operated on with phase 3 medial Oxford UKA. Postoperatively, Group A (68 knees, 78.2 %) had no remnant of cam lesion; Group B (19 knees, 21.8 %) had cam lesion remnants. In Group C (18 knees, 20.7 %), which is a subgroup of Group A, cam lesions seen preoperatively were cleaned and not seen postoperatively. RESULTS The mean increase in active flexion was 20.4° (± 7.3°) in Group A, 9.7° (± 6.1°) in Group B and 20.8° (± 7.3°) in Group C. The difference between Group A and Group B and between Group B and Group C was statistically significant (p < 0.001, p < 0.001). The mean decrease of α-angle was 11.2° (± 4.1°) in Group B, and 31.1° (± 3.4°) in Group C. The difference was statistically significant (p < 0.001). Mean Oxford Knee Scores were 24 preoperatively, 41 postoperatively in Group A; 22 preoperatively, 38 postoperatively in Group B; and 24 preoperatively, 40 postoperatively in Group C. The differences were not significant. CONCLUSIONS Posterior condylar cam lesion is an impingement which limits hyperflexion and may be an early clinical finding prior to bearing dislocation and wear. The α-angle is a marker showing the severity of this cam lesion. This problem can be overcome using intraoperative fluoroscan views during cam excison and replacing the femoral component in 105° knee flexion.
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Effect of total knee arthroplasty implant position on flexion angle before implant-bone impingement. J Arthroplasty 2011; 26:721-7. [PMID: 20870382 DOI: 10.1016/j.arth.2010.08.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 08/01/2010] [Indexed: 02/01/2023] Open
Abstract
We generated patient-specific computer models of total knee arthroplasty from 10 patients to compute maximum flexion angle before implant-bone impingement. Motion was simulated for 5 different femoral implant positions and 11 different tibial insert positions at 4 different tibial posterior slopes. In the neutral position, the mean maximum flexion angle was 136.3°. The range because of anatomical variation among patients was 13.0°. A combination of 2-mm posterior translation of the femoral component with a 10-mm anterior translation of the insert and a 7° posterior slope increased flexion by a mean of 14° relative to the neutral position. The rate of change in flexion angle was 0.4°/mm to 1.5°/mm with respect to implant position and 1.5°/mm increase in the posterior condylar offset.
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Effect of posterior design changes on postoperative flexion angle in cruciate retaining mobile-bearing total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2010; 35:689-95. [PMID: 20532884 DOI: 10.1007/s00264-010-1060-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022]
Abstract
The Dual Bearing Knee (DBK) prosthesis is a new concept which has a mobile-bearing insert. In May 2001, the posterior femoral condyle design of the DBK was changed to become smaller and there was a posterior shift in the base of the insert dish (Hi-Flex). Between 1998 and 2004, 371 DBKs (112 Hi-Flex and 220 Standard) were performed by one surgical team. There was a significant difference in postoperative flexion angle between the Hi-Flex and Standard DBKs (117.0° and 111.3°; p = 0.001). The delta flexion angle in the Hi-Flex (-2.4°) was significantly increased compared with that in the Standard DBK (-9.6°) (p = 0.001). In the Hi-Flex DBK, the postoperative flexion angle (5.7°) and the delta flexion angle (7.2°) were significantly larger than for the Standard DBK (p < 0.001). These results suggest that the flexion is greater for a design with smaller posterior condyle prosthesis and with a posterior shift in the base of the insert dish in CR mobile-bearing TKA.
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Walker PS, Yildirim G, Arno S, Heller Y. Future directions in knee replacement. Proc Inst Mech Eng H 2010; 224:393-414. [PMID: 20408486 DOI: 10.1243/09544119jeim655] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The use of artificial joints for the treatment of osteoarthritis is expected to expand considerably over the next decade. While newer technologies can offer yet further improvements in total knee systems, implementation will be strongly affected by the need to satisfy apparently competing requirements. Patients expect quicker rehabilitation, improved performance, and lifelong durability; on the other hand, economic constraints require a reduction in cost for each procedure, as well as early intervention and preventative measures, while there is increased pressure from health care systems to use evidence-based medicine as the standard of choice for implants and techniques. The success of a knee replacement depends on the design itself, the surgical technique, the rehabilitation, and, not least, the patient. The major goal of the implant design can be redefined as a restoration of normal knee mechanics, whether by maximum preservation of tissues, or by guiding surfaces that replace their function. Surgical technique needs to be less invasive but achieve optimal patient-specific alignment and soft tissue balancing. Rehabilitation procedures must achieve the expectations of realistic patients. Testing and evaluation methods need to be upgraded for enhanced predictability. This paper discusses current trends and future possibilities to address this expansive scope of design criteria.
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Affiliation(s)
- P S Walker
- Laboratory for Minimally-Invasive Surgery, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY 10010, USA.
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Mikashima Y, Tomatsu T, Horikoshi M, Nakatani T, Saito S, Momohara S, Banks SA. In vivo deep-flexion kinematics in patients with posterior-cruciate retaining and anterior-cruciate substituting total knee arthroplasty. Clin Biomech (Bristol, Avon) 2010; 25:83-7. [PMID: 19853334 DOI: 10.1016/j.clinbiomech.2009.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 09/22/2009] [Accepted: 09/23/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Posterior-cruciate ligament retaining total knee arthroplasty designs have long been used with excellent clinical success, but often have shown kinematics and flexion performance that are significantly different from the natural knee. The purpose of this study was to compare deep-flexion knee kinematics in patients with two types of posterior-cruciate ligament retaining total knee arthroplasty. METHODS One group received a traditional curved symmetric articular configuration, and one group received a design incorporating a lateral compartment which constrains the lateral condyle to the antero-posterior center of the tibial plateau in extension, but allows translation in flexion--roughly approximating the role of the anterior cruciate ligament. In vivo kinematics were analyzed using three-dimensional model registration and plain radiographs of kneeling and squatting activities in 20 knees in 18 patients. FINDINGS Knees with the anterior cruciate ligament substituting design exhibited greater flexion, femoral antero-posterior translation and tibial internal rotation. INTERPRETATION Geometric features intended to improve knee flexion, including greater antero-posterior stability, a more posterior tibial sulcus, and reshaped femoral condyles, do provide measurable and significant differences in deep-flexion knee kinematics.
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Affiliation(s)
- Y Mikashima
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
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Yildirim G, Walker PS, Boyer J. Total knees designed for normal kinematics evaluated in an up-and-down crouching machine. J Orthop Res 2009; 27:1022-7. [PMID: 19148937 DOI: 10.1002/jor.20839] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We constructed a crouching machine to study the motion of the knee joint, in which a motor was used to wind the quadriceps tendon so as to move the knee from high flexion to extension and back into flexion, while springs simulated hamstrings forces. Seven human cadaveric knees were tested intact and then after anterior cruciate ligament (ACL) resection. Motions of the femur, tibia, and patella were recorded by an optical tracking system. We then inserted plastic models representing commonly used total condylar and posterior stabilized knee replacement designs. Femoral motion was described by successive positions of the transverse axis of the femur projected onto the tibial surface. In the knee replacements, motions were similar to that of an ACL-deficient knee. We then tested two new designs with features intended to prevent anterior paradoxical sliding and to promote a medial pivot motion with femoral rollback primarily on the lateral side. The motion path more closely followed that of the normal intact knee. We concluded that motion guiding features in a total knee replacement could reproduce a normal neutral path that might result in functional improvements for the patient.
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Affiliation(s)
- Gokce Yildirim
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, c/o Veterans Administration Medical Center, 423 East 23rd Street, Annex Building #2, Room 206A, New York, New York 10010, USA
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Mizu-uchi H, Matsuda S, Miura H, Okazaki K, Akasaki Y, Iwamoto Y. The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system. ACTA ACUST UNITED AC 2008; 90:1025-31. [PMID: 18669957 DOI: 10.1302/0301-620x.90b8.20265] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We compared the alignment of 39 total knee replacements implanted using the conventional alignment guide system with 37 implanted using a CT-based navigation system, performed by a single surgeon. The knees were evaluated using full-length weight-bearing anteroposterior radiographs, lateral radiographs and CT scans. The mean hip-knee-ankle angle, coronal femoral component angle and coronal tibial component angle were 181.8 degrees (174.2 degrees to 188.3 degrees), 88.5 degrees (84.0 degrees to 91.8 degrees) and 89.7 degrees (86.3 degrees to 95.1 degrees), respectively for the conventional group and 180.8 degrees (178.2 degrees to 185.1 degrees), 89.3 degrees (85.8 degrees to 92.0 degrees) and 89.9 degrees (88.0 degrees to 93.0 degrees), respectively for the navigated group. The mean sagittal femoral component angle was 85.5 degrees (80.6 degrees to 92.8 degrees) for the conventional group and 89.6 degrees (85.5 degrees to 94.0 degrees) for the navigated group. The mean rotational femoral and tibial component angles were -0.7 degrees (-8.8 degrees to 9.8 degrees) and -3.3 degrees (-16.8 degrees to 5.8 degrees) for the conventional group and -0.6 degrees (-3.5 degrees to 3.0 degrees) and 0.3 degrees (-5.3 degrees to 7.7 degrees) for the navigated group. The ideal angles of all alignments in the navigated group were obtained at significantly higher rates than in the conventional group. Our results demonstrated significant improvements in component positioning with a CT-based navigation system, especially with respect to rotational alignment.
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Affiliation(s)
- H Mizu-uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
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