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Danaei B, McPhee J. Optimal Implant Positioning Following Total Knee Arthroplasty Using Predictive Dynamic Simulation. J Biomech Eng 2024; 146:111003. [PMID: 38959084 DOI: 10.1115/1.4065879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 07/01/2024] [Indexed: 07/05/2024]
Abstract
In this paper, a novel method is proposed for the determination of the optimal subject-specific placement of knee implants based on predictive dynamic simulations of human movement following total knee arthroplasty (TKA). Two knee implant models are introduced. The first model is a comprehensive 12-degree-of-freedom (DoF) representation that incorporates volumetric contact between femoral and tibial implants, as well as patellofemoral contact. The second model employs a single-degree-of-freedom equivalent kinematic (SEK) approach for the knee joint. A cosimulation framework is proposed to leverage both knee models in our simulations. The knee model is calibrated and validated using patient-specific data, including knee kinematics and ground reaction forces. Additionally, quantitative indices are introduced to evaluate the optimality of implant positioning based on three criteria: balancing medial and lateral load distributions, ligament balancing, and varus/valgus alignment. The knee implant placement is optimized by minimizing the deviation of the indices from their user-defined desired values during predicted sit-to-stand motion. The method presented in this paper has the potential to enhance the results of knee arthroplasty and serve as a valuable instrument for surgeons when planning and performing this procedure.
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Affiliation(s)
- Behzad Danaei
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - John McPhee
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Wood MJ, Al-Jabri T, Maniar AR, Stelzhammer T, Lanting B, Giannoudis PV. Periprosthetic tibial fracture as a complication of unicompartmental knee arthroplasty: Current insights. Injury 2024; 55:111654. [PMID: 38878385 DOI: 10.1016/j.injury.2024.111654] [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] [Indexed: 07/26/2024]
Abstract
Periprosthetic fracture following knee arthroplasty is a rare but devastating complication associated with significant morbidity. With unicompartmental knee arthroplasty being performed far less frequently than total knee arthroplasty, periprosthetic fracture following unicompartmental knee arthroplasty presents a particular challenge to orthopaedic surgeons, due to clinical unfamiliarity and sparsity of literature. An up-to-date review of the epidemiology, risk factors, and management strategies for PPF after UKA is presented.
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Affiliation(s)
- Matthew J Wood
- Joint Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, United Kingdom
| | - Talal Al-Jabri
- Trauma and Orthopaedic Surgery, Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, United Kingdom; Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada.
| | - Adit R Maniar
- Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Thomas Stelzhammer
- Trauma and Orthopaedics Department, Whittington Health NHS Trust, Magdala Avenue, London, N19 5NF, UK
| | - Brent Lanting
- Rorabeck Bourne Joint Replacement Institute, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic Surgery, School of Medicine, University of Leeds, Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
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Gaggiotti S, Foissey C, Pineda T, Batailler C, Gaggiotti G, Gaggiotti S, Servien E, Lustig S. Enhancing robotic precision in medial UKA: Image-based robot-assisted system had higher accuracy in implant positioning than imageless robot-assisted system across 292 knees. Knee Surg Sports Traumatol Arthrosc 2024; 32:2097-2106. [PMID: 38690988 DOI: 10.1002/ksa.12215] [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: 01/28/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The objective of this study was to compare the degree of accuracy in implant positioning and limb alignment offered by two robot-assisted (RA) systems: an image-based robot-assisted (IBRA) versus an imageless robot-assisted (ILRA) system for the treatment of medial knee osteoarthritis with unicompartmental knee arthroplasty (UKA). METHODS This retrospective radiographic study included medial UKAs performed between 2011 and 2023. Radiographic measurements taken preoperatively and at 1-year postoperative control visit focusing on hip-knee-ankle angle (HKA), posterior tibial slope (PTS), tibial component coronal alignment relative to Cartier's angle and restoration of proper joint line (JL) height were analyzed. Outliers for postoperative measurements were defined as follows: HKA <175° or >180°, PTS <2° or >8°, >3° or <-3° alterations in Cartier's angle and ±2 mm changes in the height of the joint line. RESULTS The final sample consisted of 292 medial UKAs: 95 (32.5%) with an IBRA system and 197 (67.5%) with an ILRA system. Implant positioning and limb alignment were more accurate in the group of patients treated with IBRA, HKA (77.9% vs. 67.5%, p = 0.07), PTS (93.7% vs. 82.7%, p = 0.01), restoration of tibial varus relative to Cartier's angle (87.4% vs. 65%, p < 0.001) and restoration of JL height (81.1% vs. 69.5%, p = 0.04). CONCLUSION Medial UKA surgery using an IBRA system was associated with a higher degree of accuracy in implant positioning and postoperative limb alignment as compared to an ILRA system. This is a valuable contribution to help communicate the advantages of using this surgical technique and improve its reproducibility. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Stefano Gaggiotti
- COT Rafaela - COT Santa Fe, Rafaela-Santa Fe, Argentina
- Sanatorio Mayo, Santa Fe, Argentina
| | - Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | | | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Gabriel Gaggiotti
- COT Rafaela - COT Santa Fe, Rafaela-Santa Fe, Argentina
- Sanatorio Mayo, Santa Fe, Argentina
| | - Santino Gaggiotti
- COT Rafaela - COT Santa Fe, Rafaela-Santa Fe, Argentina
- Sanatorio Mayo, Santa Fe, Argentina
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
- EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
- IFSTTAR, LBMC UMR_T9406, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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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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Watrinet J, Blum P, Maier M, Klingbeil S, Regenbogen S, Augat P, Schipp R, Reng W. Undersizing of the tibial component in Oxford unicompartmental knee arthroplasty (UKA) increases the risk of periprosthetic fractures. Arch Orthop Trauma Surg 2024; 144:1353-1359. [PMID: 38214714 DOI: 10.1007/s00402-023-05142-z] [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: 03/30/2023] [Accepted: 11/11/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Tibial periprosthetic fractures (TPF) after unicompartmental knee arthroplasty (UKA) are a rare condition that affects about 1% of cases. Known risk factors include age, sex, body mass index (BMI), and bone density, as well as surgical technique and prosthesis design. The purpose of the study was to determine if undersizing of the tibial component in relation to the femoral component increases the risk of tibial periprosthetic fractures. MATERIAL AND METHODS Over a 6-year-period 1542 patients with cemented (n = 363) and uncemented (n = 1179) medial UKA were retrospectively evaluated. Tibial periprosthetic fractures were identified and classified, and epidemiologic data were documented at follow-up. Undersizing was defined as a smaller tibial component compared to the femoral implant. The association of potential risk factors for TPF with the incidence of TPF was investigated with binominal logistic regression. RESULTS Fourteen patients (0.9%) suffered from TPF at a median of 1 month after surgery. The mean follow-up period was 5.9 ± 1.7 years. Fractures were more common in cases with undersized tibial components [odds ratio (OR) 3.2, p < 0.05]. Furthermore, older age (OR 1.1, p < 0.05) and female sex (OR 6.5, p < 0.05) were identified as significant risk factors, while BMI (p = 0.8) and cemented implantation (p = 0.2) had no effect on fracture rate. Revision surgery included open reduction and internal fixation or conversion to total knee arthroplasty. CONCLUSIONS Undersizing of implant sizes in UKA increases the risk for TPF especially in patients with small tibial implants. Therefore, mismatched implants should be avoided for UKA particularly when risk factors like obesity, older age, or female gender are present. Tibial periprosthetic fractures were successfully treated by open reduction and internal fixation or conversion to total knee arthroplasty.
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Affiliation(s)
- Julius Watrinet
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany.
- Department Trauma Surgery, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany.
| | - Philipp Blum
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
- Department Trauma Surgery, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Michael Maier
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
| | - Steffen Klingbeil
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
| | - Stephan Regenbogen
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
- Department Trauma Surgery, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
| | - Peter Augat
- Institute Institute for Biomechanics, BG Unfallklinik Murnau, Prof. Küntscher Str. 8, 82418, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Strubergasse 21, 5020, Salzburg, Austria
| | - Rolf Schipp
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
| | - Wolfgang Reng
- Endogap Joint Replacement Institute, Auenstraße 7, 82467, Garmisch-Partenkirchen, Germany
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Yan M, Liang T, Zhao H, Bi Y, Wang T, Yu T, Zhang Y. Model Properties and Clinical Application in the Finite Element Analysis of Knee Joint: A Review. Orthop Surg 2024; 16:289-302. [PMID: 38174410 PMCID: PMC10834231 DOI: 10.1111/os.13980] [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: 08/22/2023] [Revised: 11/21/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
The knee is the most complex joint in the human body, including bony structures like the femur, tibia, fibula, and patella, and soft tissues like menisci, ligaments, muscles, and tendons. Complex anatomical structures of the knee joint make it difficult to conduct precise biomechanical research and explore the mechanism of movement and injury. The finite element model (FEM), as an important engineering analysis technique, has been widely used in many fields of bioengineering research. The FEM has advantages in the biomechanical analysis of objects with complex structures. Researchers can use this technology to construct a human knee joint model and perform biomechanical analysis on it. At the same time, finite element analysis can effectively evaluate variables such as stress, strain, displacement, and rotation, helping to predict injury mechanisms and optimize surgical techniques, which make up for the shortcomings of traditional biomechanics experimental research. However, few papers introduce what material properties should be selected for each anatomic structure of knee FEM to meet different research purposes. Based on previous finite element studies of the knee joint, this paper summarizes various modeling strategies and applications, serving as a reference for constructing knee joint models and research design.
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Affiliation(s)
- Mingyue Yan
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China
| | - Ting Liang
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China
| | - Haibo Zhao
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China
| | - Yanchi Bi
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China
| | - Tianrui Wang
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tengbo Yu
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China
- Department of Orthopedic Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, China
| | - Yingze Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Kamenaga T, Hiranaka T, Suda Y, Fujishiro T, Okamoto K, Kuroda R, Matsumoto T. Varus placement of the tibial component reduces the potential risk of fracture with adequate bony coverage in the Oxford unicompartmental knee arthroplasty. Sci Rep 2024; 14:1274. [PMID: 38218913 PMCID: PMC10787735 DOI: 10.1038/s41598-023-48659-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/29/2023] [Indexed: 01/15/2024] Open
Abstract
A short keel-cortex distance (KCD), especially to the posterior cortex, is a potential risk factor for tibial plateau fracture after Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). This study aimed to evaluate the effect of tibial component alignment in the coronal plane and tibial proximal morphology on the KCD. Included in this study were 51 patients scheduled for primary Oxford medial unicompartmental knee arthroplasty (UKA). The anterior and posterior KCD were preoperatively assessed using 3D simulation software with the component set perpendicular to the tibial mechanical axis (neutral), 3° valgus, 3° varus, and 6° varus, relative to neutral alignment. We evaluated the existence of overhanging medial tibial condyle where the medial eminence line, the line including the medial tibial eminence parallel to the tibial axis, passes outside of the tibial shaft. In all component alignments, patients with a medial overhanging condyle had significantly shorter posterior KCD than those without. In patients with a medial overhanging condyle, the posterior KCD significantly increased when the tibial component was placed in 3° varus (4.6 ± 1.5 mm, P = 0.003 vs neutral, P < 0.001 vs 3° valgus) and 6° varus (5.0 ± 1.4 mm, P < 0.001 vs neutral, P < 0.001 vs 3° valgus) compared with in neutral (3.5 ± 1.9 mm) or 3° valgus (2.8 ± 1.8 mm). In OUKA, varus implantation increased the KCD. This could potentially decrease the risk of fracture, even in knees with the overhanging medial condyle. Conversely, valgus implantation of the tibial component shortened the KCD, and should therefore be avoided.
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Affiliation(s)
- Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan.
| | - Yoshihito Suda
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Center, Takatsuki General Hospital, 1-3-13, Kosobe-Cho, Takatsuki, Osaka, 569-1192, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
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Wang Y, Xu C, Yang B, Yu F, Guo A. Finite Element Analysis of the Effect of Femoral Prosthesis Varus and Valgus Angle Installation on the Lateral Compartment in Unicompartmental Knee Arthroplasty. J NIPPON MED SCH 2024; 91:88-98. [PMID: 38462443 DOI: 10.1272/jnms.jnms.2024_91-110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
BACKGROUND This study used finite element analysis (FEA) to investigate the effect of varus and valgus angle on the lateral compartment in unicompartmental knee arthroplasty (UKA). METHODS One patient who underwent UKA was enrolled as the subject. Thirteen working conditions of the femoral prosthesis were simulated at varus and valgus angles of 0°, 2°, 4°, 6°, 8°, 10°, and 12°. A load of 1,000 N was applied downward along the mechanical axis of the femur, and the highest stress values on the surface of the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus, and tibial lateral plateau cartilage in each model were recorded. The six highest points were used to calculate the mean value. RESULTS The highest stress values on the surface of the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus, and tibial lateral plateau cartilage increased with an increase in the femoral prosthesis varus/valgus angle. As compared with the standard position of the femoral prosthesis, there was no significant difference in the surface stress values of the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus and tibial lateral plateau cartilage when the femoral prosthesis varus/valgus angle was less than 4° (p > 0.05). In addition, the stress magnitude on the polyethylene liner, cancellous bone under the tibial prosthesis, cartilage of femur lateral condyle, lateral meniscus, and tibial lateral plateau cartilage significantly increased when the femoral prosthesis varus/valgus angle was greater than 4° (p < 0.001). CONCLUSIONS The optimal femoral prosthesis varus/valgus angle in UKA was less than 4°.
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Affiliation(s)
- Yonggui Wang
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
- Department of Orthopedics, Xiangyang No. 1 People's Hospital, Hubei University of Medicine
| | - Chongyang Xu
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
| | - Bo Yang
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
| | - Fei Yu
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
| | - Ai Guo
- Department of Orthopedic Surgery, Beijing Friendship Hospital, Capital Medical University
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Hiranaka T, Fujishiro T, Koide M, Okamoto K. Kinematically Aligned Oxford Unicompartmental Knee Arthroplasty Using the Microplasty Instrumentation System. Clin Orthop Surg 2023; 15:690-694. [PMID: 37529198 PMCID: PMC10375823 DOI: 10.4055/cios22205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 08/03/2023] Open
Abstract
This technical note demonstrates kinematically aligned Oxford unicompartmental knee arthroplasty using the Microplasty instrumentation system with custom-made devices. The medial joint line is evaluated preoperatively; if it is aligned and parallel with the lateral joint line, they are considered to comprise the coronal knee joint line (CJL). In this case, the coronal inclination of a spoon gauge inserted into the medial joint space indicates the CJL. Otherwise, an accessory spoon is inserted and connected to the medial spoon to refer to the posterior condylar line, which is considered the CJL. The tibial cutting block is then connected without changing the inclination of the spoon and the coronal tilt of the tibial extramedullary rod is adjusted, which is implemented with a custom-made ankle yoke. The remainder of the steps is then identical to the conventional Microplasty procedure. This technique can imitate the cutting line to the CJL, which might be considered ideal from mechanical and kinematic perspectives.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Motoki Koide
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
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Zheng Z, Liu Y, Zhang A, Chen H, Wan Q, Zhong L, Wang X, Han Q, Wang J. Medial-lateral translational malalignment of the prosthesis on tibial stress distribution in total knee arthroplasty: A finite element analysis. Front Bioeng Biotechnol 2023; 11:1119204. [PMID: 36937745 PMCID: PMC10017773 DOI: 10.3389/fbioe.2023.1119204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Background: Poor prosthesis alignment during total knee arthroplasty could cause problems such as polyethylene spacer wear, leading to surgical failure and revision surgery. The problems caused by the malalignment of the tibial plateau prosthesis in the medial and lateral planes are unclear. We aimed to investigate the stress distribution and micromotion of the tibia when the tibial plateau prosthesis is translated 1 and 2 mm medially and laterally, respectively, using finite element analysis (FEA). Method: A non-homogeneous tibia model was created and load conditions when standing on two legs were applied using FEA to simulate the misaligned prosthesis. The stresses, stress distribution, and micromotion of the proximal tibia were analyzed in five positions of the tibial plateau prosthesis: Lateral-2 mm; Lateral-1 mm; Medium; Medial-2 mm; Medial-1 mm. Result: The maximum stress in the five groups with different misalignments of the platform was 47.29 MPa (Lateral-2 mm). The maximum micromotion among the five groups in different positions was 7.215 μm (Lateral-2 mm). Conclusion: When placing the tibial plateau prosthesis during total knee arthroplasty, an error of 2 mm or less is acceptable as long as it does not overhang.
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Affiliation(s)
| | | | | | | | | | | | | | - Qing Han
- *Correspondence: Qing Han, ; Jincheng Wang,
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Suda Y, Hiranaka T, Kamenaga T, Koide M, Fujishiro T, Okamoto K, Matsumoto T. Varus placement of the tibial component of Oxford unicompartmental knee arthroplasty decreases the risk of postoperative tibial fracture. Bone Joint J 2022; 104-B:1118-1125. [PMID: 36177640 DOI: 10.1302/0301-620x.104b10.bjj-2021-1508.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS A fracture of the medial tibial plateau is a serious complication of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). The risk of these fractures is reportedly lower when using components with a longer keel-cortex distance (KCDs). The aim of this study was to examine how slight varus placement of the tibial component might affect the KCDs, and the rate of tibial plateau fracture, in a clinical setting. METHODS This retrospective study included 255 patients who underwent 305 OUKAs with cementless tibial components. There were 52 males and 203 females. Their mean age was 73.1 years (47 to 91), and the mean follow-up was 1.9 years (1.0 to 2.0). In 217 knees in 187 patients in the conventional group, tibial cuts were made orthogonally to the tibial axis. The varus group included 88 knees in 68 patients, and tibial cuts were made slightly varus using a new osteotomy guide. Anterior and posterior KCDs and the origins of fracture lines were assessed using 3D CT scans one week postoperatively. The KCDs and rate of fracture were compared between the two groups. RESULTS Medial tibial fractures occurred after surgery in 15 patients (15 OUKAs) in the conventional group, but only one patient (one OUKA) had a tibial fracture after surgery in the varus group. This difference was significant (6.9% vs 1.1%; p = 0.029). The mean posterior KCD was significantly shorter in the conventional group (5.0 mm (SD 1.7)) than in the varus group (6.1 mm (SD 2.1); p = 0.002). CONCLUSION In OUKA, the distance between the keel and posterior tibial cortex was longer in our patients with slight varus alignment of the tibial component, which seems to decrease the risk of postoperative tibial fracture.Cite this article: Bone Joint J 2022;104-B(10):1118-1125.
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Affiliation(s)
- Yoshihito Suda
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takafumi Hiranaka
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Motoki Koide
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Takaaki Fujishiro
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Koji Okamoto
- Department of Orthopedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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12
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Fitch AA, Terhune EB, Cohn MR, Wright-Chisem J, Weatherford BM, Williams JC. Periprosthetic Tibial Plateau Fractures After Unicompartmental Knee Arthroplasty Are Successfully Treated With Open Reduction and Internal Fixation. Orthopedics 2022; 45:287-292. [PMID: 35485885 DOI: 10.3928/01477447-20220425-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Periprosthetic tibial fractures after unicompartmental knee arthroplasty (UKA) are rare but devastating events. Given the relative infrequency of these injuries, treatment strategies are not well defined. The goal of this retrospective case series is to report the findings for a series of patients who underwent open reduction and internal fixation (ORIF) of periprosthetic fracture after UKA, including radiographic alignment, Knee Society Score (KSS), and failure rate. Patients were identified by the International Classification of Diseases code for periprosthetic tibial plateau fractures. Electronic medical records and radiographs were retrospectively reviewed. Fracture patterns and coronal and sagittal alignment of UKA components were measured on radiographs. Clinical outcomes, including range of motion assessment, visual analog scale pain score, and KSS, were collected at final follow-up. Eight patients satisfied the inclusion criteria for this study. Fractures occurred at a median of 14 days (range, 5-52 days) after UKA, and all showed a vertical shear pattern that exited at the meta-diaphyseal junction. Of the 8 fractures, 7 (87.5%) healed to radiographic and clinical union after the initial ORIF. One patient required reoperation for hardware failure. Mean visual analog scale pain score and KSS at final follow-up were 3 and 85±14, respectively. Periprosthetic tibial plateau fractures after UKA commonly occur as a vertical shear fracture exiting at the metadiaphyseal junction. The use of ORIF with a 3.5-mm plate in buttress mode is a reliable method for treatment of these fractures. Restoration of alignment and motion is achievable, but residual pain may affect patient-reported outcome scores. [Orthopedics. 2022;45(5):287-292.].
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13
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Hiranaka T, Fujishiro T, Koide M, Okamoto K. Kinematic Alignment Bi-unicompartmental Knee Arthroplasty With Oxford Partial Knees: A Technical Note. Cureus 2022; 14:e28556. [PMID: 36059371 PMCID: PMC9423885 DOI: 10.7759/cureus.28556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
Bi-unicompartmental knee arthroplasty (BiUKA) is an alternative to total knee arthroplasty for selected patients. Although it is thought to be technically demanding, the technique has not been previously described in detail. Kinematic alignment (KA) implantation and bone cuts parallel to the native joint line would be beneficial to ensure optimal mechanical loading. Here, we detail a technique for KA-BiUKA using the Oxford partial knees. The joint line is identified using the spoon of the microplasty instrumentation system with/without the accessory spoons. The tibia is cut parallel with the joint line using a side-slidable ankle yoke so that the inclination of the cutting block is parallel with the spoon surface. After defining the horizontal bone-cutting lines, the predominantly affected condyle is operated upon, followed by the lesser affected condyle. Although custom-made devices are required, the technique is useful and reproducible in the performance of KA-BiUKA with the Oxford partial knees.
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14
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Stoddart JC, Garner A, Tuncer M, Cobb JP, van Arkel RJ. The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty : a finite element analysis. Bone Joint Res 2022; 11:575-584. [PMID: 35920206 PMCID: PMC9396920 DOI: 10.1302/2046-3758.118.bjr-2021-0533.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The aim of this study was to determine the risk of tibial eminence avulsion intraoperatively for bi-unicondylar knee arthroplasty (Bi-UKA), with consideration of the effect of implant positioning, overstuffing, and sex, compared to the risk for isolated medial unicondylar knee arthroplasty (UKA-M) and bicruciate-retaining total knee arthroplasty (BCR-TKA). METHODS Two experimentally validated finite element models of tibia were implanted with UKA-M, Bi-UKA, and BCR-TKA. Intraoperative loads were applied through the condyles, anterior cruciate ligament (ACL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), and the risk of fracture (ROF) was evaluated in the spine as the ratio of the 95th percentile maximum principal elastic strains over the tensile yield strain of proximal tibial bone. RESULTS Peak tensile strains occurred on the anterior portion of the medial sagittal cut in all simulations. Lateral translation of the medial implant in Bi-UKA had the largest increase in ROF of any of the implant positions (43%). Overstuffing the joint by 2 mm had a much larger effect, resulting in a six-fold increase in ROF. Bi-UKA had ~10% increased ROF compared to UKA-M for both the male and female models, although the smaller, less dense female model had a 1.4 times greater ROF compared to the male model. Removal of anterior bone akin to BCR-TKA doubled ROF compared to Bi-UKA. CONCLUSION Tibial eminence avulsion fracture has a similar risk associated with Bi-UKA to UKA-M. The risk is higher for smaller and less dense tibiae. To minimize risk, it is most important to avoid overstuffing the joint, followed by correctly positioning the medial implant, taking care not to narrow the bone island anteriorly.Cite this article: Bone Joint Res 2022;11(8):575-584.
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Affiliation(s)
- Jennifer C Stoddart
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Amy Garner
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK.,Dunhill Medical Trust and Royal College of Surgeons of England Joint Research Fellowship, London, UK.,Health Education Kent, Surrey and Sussex Higher Surgical Training Programme, London, UK
| | | | - Justin P Cobb
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
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15
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Thoreau L, Morcillo Marfil D, Thienpont E. Periprosthetic fractures after medial unicompartmental knee arthroplasty: a narrative review. Arch Orthop Trauma Surg 2022; 142:2039-2048. [PMID: 34268614 DOI: 10.1007/s00402-021-04063-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/03/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION On rare occasions, fractures of the tibial plateau may occur after uni-compartmental knee arthroplasty (UKA) and account for 2% of total UKA failures. The purpose of this narrative review is to identify and discuss potential risk factors that might lead to prevention of this invalidating complication. MATERIALS AND METHODS Electronic database of Pubmed, Scopus, Cochrane and Google Scholar were searched. A total of 457 articles related to the topic were found. Of those, 86 references were included in this narrative review. RESULTS UKA implantation acts as a stress riser in the medial compartment. To avoid fractures, surgeons need to balance load and bone stock. Post-operative lower limb alignment, implant positioning, level of resection and sizing of the tibial tray have a strong influence on load distribution of the tibial bone. Pain on weight-bearing signals bone-load imbalance and acts as an indicator of bone remodeling and should be a trigger for unloading. The first three months after surgery are critical because of transient post-operative osteoporosis and local biomechanical changes. Acquired osteoporosis is a growing concern in the arthroplasty population. Split fractures require internal fixation, while subsidence fractures differ in their management depending of the amount of bone impaction. Loose implants require revision knee arthroplasty. CONCLUSION Peri-prosthetic fracture is a rare, but troublesome event, which can lead to implant failure and revision surgery. Better knowledge of the multifactorial risk factors in association with a thorough surgical technique is key for prevention.
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Affiliation(s)
- L Thoreau
- Department of Orthopedic Surgery, Cliniques Universistaires Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - D Morcillo Marfil
- Department of Orthopedic Surgery, Cliniques Universistaires Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - E Thienpont
- Department of Orthopedic Surgery, Cliniques Universistaires Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
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16
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Plancher KD, Brite JE, Briggs KK, Petterson SC. Pre-Arthritic/Kinematic Alignment in Fixed-Bearing Medial Unicompartmental Knee Arthroplasty Results in Return to Activity at Mean 10-Year Follow-up. J Bone Joint Surg Am 2022; 104:1081-1089. [PMID: 36149243 DOI: 10.2106/jbjs.21.00801] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The optimal alignment strategy in unicompartmental knee arthroplasty (UKA) is debated. Recent studies have suggested that kinematic alignment may lead to improved biomechanics and outcomes. The aim of the present study was to determine if pre-arthritic/kinematic alignment of knees would result in sustained long-term restoration of function, without conversion to total knee arthroplasty (TKA), following non-robotically assisted, fixed-bearing medial UKA. METHODS A total of 236 UKAs were performed from 2000 to 2015. Of these, a total of 150 medial UKAs met the inclusion criteria and were included in the study. There were 76 UKAs performed in female patients. The mean age was 65 ± 10 years and the mean body mass index was 28.6 ± 5 kg/m2. Patients with ≥15° of varus alignment preoperatively were excluded. Varus deformity was evaluated with use of the hip-knee-ankle angle (HKAA). Pre-arthritic/kinematic alignment was estimated with use of an arithmetic HKAA (aHKA, calculated as the medial proximal tibial angle minus the lateral distal femoral angle). We defined pre-arthritic/kinematic alignment as a postoperative HKAA within 3° of the aHKA. The primary outcome measures were the Knee Injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living and Sport subscales, including the percentage of patients who met the patient acceptable symptom state (PASS) for these measures. Failure was defined as conversion to TKA. RESULTS The mean follow-up was 10 years (range, 4 to 20 years), with a mean survival time estimate of 18.3 years (95% confidence interval [CI], 17.8 to 18.8). The rate of conversion to TKA was 3% (5 of 150 UKAs). Postoperatively, 127 (85%) of 150 knees were pre-arthritic/kinematically aligned, and 23 knees (15%) were not. Patients with compared to those without pre-arthritic/kinematically aligned knees had significantly longer mean survival (18.6 years; 95% CI, 18.2 to 19) compared with 15.4 years; 95% CI, 13.4 to 17.5, respectively; p = 0.008) and higher KOOS Activities of Daily Living (92 compared with 74; p < 0.001) and Sport subscale scores (74 compared with 36; p < 0.001). A greater proportion of knees in the pre-arthritic/kinematically aligned cohort met the PASS for the KOOS Activities of Daily Living (85%, 106 of 125 knees) and Sport subscales (109 of 125, 87%) compared with the non-pre-arthritic/kinematically aligned cohort (28% and 57%, respectively; p < 0.01). CONCLUSIONS Pre-arthritic/kinematically aligned knees in this non-robotically assisted fixed-bearing medial UKA cohort had superior outcomes, including the KOOS Activities of Daily Living and Sport subscales and achievement of the PASS for these measures, compared with non-pre-arthritic/kinematically aligned at an average of 10 years after UKA. Knees that fell within 3° of a simple aHKA measurement on a 3-foot (1-m)-long standing radiograph had greater longevity and return to activities. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kevin D Plancher
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.,Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, NY.,Plancher Orthopaedics & Sports Medicine, New York, NY.,Orthopaedic Foundation, Stamford, Connecticut
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17
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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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18
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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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19
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Rivière C, Sivaloganathan S, Villet L, Cartier P, Lustig S, Vendittoli PA, Cobb J. Kinematic alignment of medial UKA is safe: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:1082-1094. [PMID: 33743031 DOI: 10.1007/s00167-021-06462-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 01/18/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE Owing to the improved understanding of knee kinematics and the successful introduction of the kinematic alignment (KA) technique for implanting total knee arthroplasty (TKA), it was recently understood that the "Cartier angle technique" corresponds to a kinematic implantation of the uni-compartmental knee arthroplasty (UKA) components. When compared to the universally spread mechanical alignment (MA) technique for implanting UKA, the KA method generates a more anatomic prosthetic knee that may be clinically advantageous. The aims of this study are to determine if KA UKAs are associated with acceptable functional performance and patient satisfaction (question 1), rates of residual pain and tibia plateau fracture (question 2), and rates of reoperation and revision (question 3), and to define the component orientation and limb alignment as measured on radiograph (question 4), and the stress shielding related bone loss in the proximal tibia (question 5) with KA UKA, and where possible to compare with MA UKA. STUDY HYPOTHESIS KA UKA generates good clinical outcomes, similar or superior to the ones of MA UKA. METHOD Systematic review of literature databases were primarily searched using Healthcare Databases Advanced Search (HDAS). Two primary searches were conducted using the electronic databases MEDLINE, EMBASE, and PubMed, and a secondary search was conducted using review articles and bibliography of obtained papers in order to ascertain more material. RESULTS Nine eligible non-comparative prospective (3) or retrospective (6) cohort studies, which cumulated 593 KA UKAs with follow-up between 3.2 and 12 years, fulfilled the inclusion criteria for this systematic review. The findings demonstrated high Knee Society Score (KSS) (from 87 to 95) and function scores (from 81 to above 91) in addition to patient satisfaction scores of 88%. There was no revision for tibia plateau fracture, 0.8% (5 cases) for unexplained pain tibia, 2.0% (12 cases) for component loosening, and 5.6% (33 cases) for any causes of aseptic failures reported for KA UKA. The prosthetic lower limb and tibia implant alignments were both found to be in slight varus (means between 3 and 5°), and the postoperative joint line and tibia component was shown to be parallel to the floor when standing. The KA UKA components migration, as measured on radiostereometry, was acceptable. DISCUSSION/CONCLUSION The KA technique is an alternative, personalised, more physiological method for implanting UKA, which could be clinically advantageous when compared to the MA technique. The literature supports the good mid- to long-term clinical safety and good efficacy of KA UKA; however, comparison between KA and MA techniques for UKA was not performed due to limited literature. Further investigations are needed to better define the clinical impact of KA UKA, and the acceptable limits for KA of the UKA tibial component. LEVEL OF EVIDENCE Level 4; systematic review of level 4 studies.
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Affiliation(s)
- Charles Rivière
- MSK Lab-Imperial College London, White City Campus, London, W12 0BZ, UK. .,The Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK. .,Centre de L'Arthrose-Clinique de Sport, 4 Rue Georges Negrevergne, 33700, Mérignac, France. .,Personalized Arthroplasty Society, London, UK.
| | | | - Loic Villet
- Centre de L'Arthrose-Clinique de Sport, 4 Rue Georges Negrevergne, 33700, Mérignac, France.,Personalized Arthroplasty Society, London, UK
| | | | - Sébastien Lustig
- Personalized Arthroplasty Society, London, UK.,Centre Albert Trillat, Groupement Hospitalier Nord, Université Lyon 1, Villeurbanne, France
| | - Pascal-André Vendittoli
- Personalized Arthroplasty Society, London, UK.,Département de Chirurgie, Université de Montréal, Hôpital Maisonneuve-Rosemont, 5415 Boul L'Assomption, Montréal, Québec, H1T 2M4, Canada
| | - Justin Cobb
- MSK Lab-Imperial College London, White City Campus, London, W12 0BZ, UK.,Personalized Arthroplasty Society, London, UK
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20
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Hu J, Xiong R, Chen X, Chen Z, Jin Z. Effect of components mal-alignment on biomechanics in fixed unicompartmental knee arthroplasty using multi-body dynamics model during a walking cycle. Med Eng Phys 2022; 100:103747. [DOI: 10.1016/j.medengphy.2021.103747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/23/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
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21
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Burger JA, Jager T, Dooley MS, Zuiderbaan HA, Kerkhoffs GMMJ, Pearle AD. Comparable incidence of periprosthetic tibial fractures in cementless and cemented unicompartmental knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:852-874. [PMID: 33528591 PMCID: PMC8901491 DOI: 10.1007/s00167-021-06449-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/11/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE (I) To determine the incidence of periprosthetic tibial fractures in cemented and cementless unicompartmental knee arthroplasty (UKA) and (II) to summarize the existing evidence on characteristics and risk factors of periprosthetic fractures in UKA. METHODS Pubmed, Cochrane and Embase databases were comprehensively searched. Any clinical, laboratory or case report study describing information on proportion, characteristics or risk factors of periprosthetic tibial fractures in UKA was included. Proportion meta-analysis was performed to estimate the incidence of fractures only using data from clinical studies. Information on characteristics and risk factors was evaluated and summarized. RESULTS A total of 81 studies were considered to be eligible for inclusion. Based on 41 clinical studies, incidences of fractures were 1.24% (95%CI 0.64-2.41) for cementless and 1.58% (95%CI 1.06-2.36) for cemented UKAs (9451 UKAs). The majority of fractures in the current literature occurred during surgery or presented within 3 months postoperatively (91 of 127; 72%) and were non-traumatic (95 of 113; 84%). Six different fracture types were observed in 21 available radiographs. Laboratory studies revealed that an excessive interference fit (press fit), excessive tibial bone resection, a sagittal cut too deep posteriorly and low bone mineral density (BMD) reduce the force required for a periprosthetic tibial fracture to occur. Clinical studies showed that periprosthetic tibial fractures were associated with increased body mass index and postoperative alignment angles, advanced age, decreased BMD, female gender, and a very overhanging medial tibial condyle. CONCLUSION Comparable low incidences of periprosthetic tibial fractures in cementless and cemented UKA can be achieved. However, surgeons should be aware that an excessive interference fit in cementless UKAs in combination with an impaction technique may introduce an additional risk, and could therefore be less forgiving to surgical errors and patients who are at higher risk of periprosthetic tibial fractures. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Joost A Burger
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA.
| | - Tjeerd Jager
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Matthew S Dooley
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA
| | - Hendrik A Zuiderbaan
- Department of Orthopaedic Surgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences (AMS), Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Computer Assisted Surgery Center, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th St, New York, NY, 10021, USA
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22
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Mori S, Akagi M, Moritake A, Tsukamoto I, Yamagishi K, Inoue S, Nakagawa K, Togawa D. The Medial Tibial Plateau Can Be Used as a Direct Anatomical Reference for the Posterior Tibial Slope in Medial Unicompartmental Knee Arthroplasty. J Knee Surg 2021; 36:555-561. [PMID: 34921377 DOI: 10.1055/s-0041-1740384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There has been no consensus about how to determine the individual posterior tibial slope (PTS) intraoperatively. The purpose of this study was to investigate whether the tibial plateau could be used as a reference for reproducing individual PTS during medial unicompartmental knee arthroplasty (UKA). Preoperative computed tomography (CT) data from 48 lower limbs for medial UKA were imported into a three-dimensional planning software. Digitally reconstructed radiographs were created from the CT data as the lateral knee plain radiographs and the radiographic PTS angle was measured. Then, the PTS angles on the medial one-quarter and the center of the MTP (¼ and ½ MTP, respectively), and that on the medial tibial eminence (TE) were measured on the sagittal multiplanar reconstruction image. Finally, 20 lateral knee radiographs with an arthroscopic probe placed on the ¼ and the ½ MTP were obtained intraoperatively, and the angle between the axis of the probe and the tangent line of the plateau was measured. The mean radiographic PTS angle was 7.9 ± 3.0 degrees (range: 1.7-13.6 degrees). The mean PTS angles on the ¼ MTP, the ½ MTP, and the TE were 8.1 ± 3.0 degrees (1.2-13.4 degrees), 9.1 ± 3.0 degrees (1.4-14.7 degrees), and 9.9 ± 3.1 degrees (3.1-15.7 degrees), respectively. The PTS angles on the ¼ MTP and the ½ MTP were strongly correlated with the radiographic PTS angle (r =0.87 and 0.80, respectively, p < 0.001). A statistically significant difference was observed between the mean angle of the radiographic PTS and the PTS on the TE (p < 0.01). The mean angle between the axis of the probe and the tangent line of the tibial plateau was -0.4 ± 0.9 degrees (-2.3-1.3 degrees) on the ¼ MTP and -0.1 ± 0.7 degrees (-1.5-1.2 degrees) on the ½ MTP, respectively. An area from the medial one-quarter to the center of the MTP could be used as an anatomical reference for the individual PTS.
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Affiliation(s)
- Shigeshi Mori
- Department of Orthopaedic Surgery and Rheumatology, Kindai University Nara Hospital, Ikoma City, Nara Prefecture, Japan
| | - Masao Akagi
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Akihiro Moritake
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Ichiro Tsukamoto
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Kotaro Yamagishi
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Shinji Inoue
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Daisuke Togawa
- Department of Orthopaedic Surgery and Rheumatology, Kindai University Nara Hospital, Ikoma City, Nara Prefecture, Japan
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Slaven SE, Cody JP, Sershon RA, Ho H, Hopper RH, Fricka KB. Alignment in Medial Fixed-Bearing Unicompartmental Knee Arthroplasty: The Limb Has a Leg Up on the Component. J Arthroplasty 2021; 36:3883-3887. [PMID: 34489145 DOI: 10.1016/j.arth.2021.08.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/23/2021] [Accepted: 08/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To assess how implant alignment affects unicompartmental knee arthroplasty (UKA) outcome, we compared tibial component alignment of well-functioning UKAs against 2 groups of failed UKAs, revised for progression of lateral compartment arthritis ("Progression") and aseptic loosening ("Loosening"). METHODS We identified 37 revisions for Progression and 61 revisions for Loosening from our prospective institutional database of 3351 medial fixed-bearing UKAs performed since 2000. Revision cohorts were matched on age, gender, body mass index, and postoperative range of motion with "Successful" unrevised UKAs with minimum 10-year follow-up and Knee Society Score ≥70. Tibial component coronal (TCA) and sagittal (TSA) plane alignment was measured on postoperative radiographs. Limb alignment was quantified by hip-knee-ankle (HKA) angle on long-leg radiographs. In addition to directly comparing groups, a multivariate logistic regression examined how limb and component alignments were associated with UKA revision. RESULTS In the Progression group, component alignment was similar to the matched successes (TCA 3.6° ± 3.5° varus vs 5.1° ± 3.5° varus, P = .07; TSA 8.4° ± 4.4° vs 8.8° ± 3.6°, P = .67), whereas HKA angle was significantly more valgus (0.3° ± 3.6° valgus vs 4.4° ± 2.6° varus, P < .001). Loosening group component alignment was also similar to the matched successes (TCA 6.1° ± 3.7° varus vs 5.9° ± 3.1° varus, P = .72; TSA 8.4° ± 4.6° vs 8.1° ± 3.9°, P = .68), and HKA was significantly more varus (6.1° ± 3.1° varus vs 4.0° ± 2.7° varus, P < .001). Using a multivariate logistic regression, HKA angle was the most significant factor associated with revision (P < .001). CONCLUSION In this population of revised UKAs and long-term successes, limb alignment was a more important determinant of outcome than tibial component alignment. LEVEL OF EVIDENCE Level III case-control study.
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Affiliation(s)
- Sean E Slaven
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - John P Cody
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Robert A Sershon
- Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA; Anderson Orthopaedic Research Institute, Alexandria, VA
| | - Henry Ho
- Anderson Orthopaedic Research Institute, Alexandria, VA
| | | | - Kevin B Fricka
- Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA; Anderson Orthopaedic Research Institute, Alexandria, VA
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Janssen SJ, van Oost I, Breugem SJM, van Geenen RCI. A structured evaluation of the symptomatic medial Oxford unicompartmental knee arthroplasty (UKA). EFORT Open Rev 2021; 6:850-860. [PMID: 34760285 PMCID: PMC8559574 DOI: 10.1302/2058-5241.6.200105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Unicompartmental knee arthroplasty (UKA) has several advantages over total knee arthroplasty; however, in many reports, the risk of revision remains higher after UKA.Many reasons for failure of UKA exist.Successful treatment starts with accurate assessment of the symptomatic UKA as a specific mode of failure requires a specific solution.A structured and comprehensive evaluation aids assessment of the symptomatic UKA.This review provides an overview of the causes for a symptomatic medial UKA, its risk factors, diagnostic modalities that can be used, and briefly discusses treatment options. Cite this article: EFORT Open Rev 2021;6:850-860. DOI: 10.1302/2058-5241.6.200105.
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Affiliation(s)
- Stein J Janssen
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Iris van Oost
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Breda, The Netherlands
| | - Stefan J M Breugem
- Department of Orthopaedic Surgery, Bergman Clinics, Naarden, The Netherlands
| | - Rutger C I van Geenen
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Breda, The Netherlands
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Yamagami R, Inui HI, Taketomi S, Kono K, Kawaguchi K, Takagi K, Kage T, Sameshima S, Tanaka S. Implant Alignment and Patient Factors Affecting the Short-Term Patient-Reported Clinical Outcomes after Oxford Unicompartmental Knee Arthroplasty. J Knee Surg 2021; 34:1413-1420. [PMID: 32356292 DOI: 10.1055/s-0040-1709678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aims at clarifying implant alignment and other patient factors' influence on clinical outcomes, particularly on patient-reported outcomes (PRO), following Oxford unicompartmental knee arthroplasty (OUKA). A total of 142 patients after OUKA were divided into two groups according to the validated Japanese version of the knee injury and osteoarthritis outcome score (KOOS) for each subscale of pain, symptoms, and activities of daily living (ADL) at postoperative year 1 and 2: group 1 had ≥80 scores and group 2 had <80 scores. Postoperative clinical and radiographical findings were then compared among groups in each subscale. Using postoperative year 1 and 2 data, a multivariable logistic regression analysis was conducted to clarify factors for clinical outcomes' improvement. In the analysis of KOOS subscale of symptoms at postoperative year 1, gender distribution, preoperative body mass index, and postoperative maximum knee flexion angles differed significantly among groups. In the analysis for KOOS subscale of ADL, significant differences were observed in postoperative tibial component varus angles. Multivariable logistic regression analysis revealed that all of these parameters significantly related to ≥80 KOOS scores of each subscale at postoperative year 1. Additionally, at postoperative year 2, larger postoperative knee flexion angles and tibial component varus angles related to ≥80 KOOS subscale of symptoms and ADL were observed. In conclusion, tibial component's larger varus alignment was associated with the better PRO at both 1 and 2 years after OUKA. Importantly, larger postoperative knee flexion angle helped achieve good short-term PRO after OUKA.
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Affiliation(s)
- Ryota Yamagami
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - HIroshi Inui
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kentaro Takagi
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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26
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Inoue S, Hashimoto K, Yamagishi K, Nakagawa K, Akagi M. Rapidly progressive osteoarthritis in the medial patellar facet due to lateral femoral placement after medial unicompartmental knee arthroplasty. A case report. Int J Surg Case Rep 2021; 88:106483. [PMID: 34666253 PMCID: PMC8602739 DOI: 10.1016/j.ijscr.2021.106483] [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: 08/25/2021] [Revised: 09/29/2021] [Accepted: 10/03/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction and importance Factors that affect patellofemoral (PF) osteoarthritis (OA) after unicompartmental knee arthroplasty (UKA) remain unclear. We report a case in which the lateral placement of the femoral component resulted in rapidly progressive OA in the medial patellar facet. Case presentation The patient was an 84-year-old woman who had increased pain in the left knee due to varus knee OA for 1 year and underwent medial UKA. One month after the surgery, the patient complained of limited knee flexion of 90° with anterior knee pain, and around 7-mm lateral placement of the femoral component was observed on a postoperative radiograph and computed tomography scan. Six months after the surgery, rapidly progressive OA with subchondral bone depression in the medial facet was observed and this has been ongoing till the last follow-up of 3 years. The knee flexion is limited 105° now, and the patient complains of quadriceps weakness with anterior knee pain when stair-climbing and standing up from a chair. Clinical discussion Lateral placement of the femoral component in medial UKA may cause progressive PF OA with limited knee flexion and anterior knee pain, which could be attributed to impingement between the femoral component and the medial patellar facet. Conclusion Surgeons should be careful regarding the lateral placement to prevent symptomatic PF OA from occurring after medial UKA. Factors that affect patellofemoral (PF) osteoarthritis (OA) after UKA have been rarely reported. An 84-year-old woman with rapidly progressive symptomatic PF OA after medial UKA is presented. Impingement between the femoral component placed laterally and the medial patellar facet seems attributable to the PF OA. The lateral placement would be one of risk factors for PF OA after medial UKA.
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Affiliation(s)
- Shinji Inoue
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Kotaro Yamagishi
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Koichi Nakagawa
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan.
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Yang G, Jiao X, Li Q, Li Z, An S, Feng M, Gao G, Huang J, Cao G. Hybrid Oxford unicompartmental knee arthroplasty has lower residual cement extrusion than cemented arthroplasty in treating end-stage unicompartmental knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:833. [PMID: 34587940 PMCID: PMC8479987 DOI: 10.1186/s12891-021-04720-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Hybrid Oxford unicompartmental knee arthroplasty (OUKA) consists of cementless femoral prostheses and cemented tibial prostheses. Although a hybrid OUKA has been used in clinical practice, the clinical outcome has not been reported. The purpose of this study was to compare the short-term clinical outcomes and rate of residual bone cement extrusion between hybrid and cemented prostheses and analyse the possible reasons for differences between outcomes. Methods A total of 128 knees (118 patients) with end-stage osteoarthritis were included in this study, of which underwent consecutive operations using unicondylar Oxford phase 3 implants from July 2017 and September 2019 in our centre. Follow-up was performed at 6 weeks, 3 and 6 months, 1 year and every year after operation, and complications and changes in the Oxford knee score (OKS) were recorded. The OKS of the two groups was analysed by the generalized estimating equation approach. Prosthesis-based standard fluoroscopy was performed in a timely manner after each operation, and the rate of residual cement extrusion of the two groups was estimated using T-tests and a multivariate regression analysis. Results Excluding the cases that lost follow-up, a total of 120 knees (65 in hybrid group and 55 in cemented group) were included in the analysis. There was no statistically significant difference in patient characteristics between the two groups (p > 0.05). The average follow-up time was 23.4 months (and ranged from 12 to 38 months). As of the last follow-up, there were no complications, such as dislocation, fracture, prosthesis loosening and subsidence, but one patient in the cemented group experienced symptoms caused by residual loose cement. Postoperative OKS in both groups improved significantly (p < 0.001). There was no significant difference in the OKS at any point during the follow-up or in the improvement of the OKS between the two groups (p > 0.05). Residual cement was mainly extruded behind the tibial prosthesis. The rate of hybrid periprosthetic residual cement extrusion was significantly lower in the hybrid group than in the cemented group, and the difference was statistically significant (OR = 3.38; p = 0.014). Conclusions Hybrid OUKA is as effective as cemented OUKA in the short term after operation and can significantly reduce the residual cement extrusion rate around the tibial prosthesis.
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Affiliation(s)
- Guangzhong Yang
- Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100032, China
| | - Xufeng Jiao
- Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100032, China
| | - Qianli Li
- Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100032, China
| | - Zheng Li
- Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100032, China
| | - Shuai An
- Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100032, China
| | - Mingli Feng
- Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100032, China
| | - Guanghan Gao
- Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100032, China
| | - Jiang Huang
- Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100032, China
| | - Guanglei Cao
- Xuanwu Hospital of Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100032, China.
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Nishida R, Hiranaka T. Response to Letter to the Editor "Nishida et al.: Impact of joint line orientation on clinical outcomes in bilateral Oxford mobile-bearing unicompartmental knee arthroplasty". Knee 2021; 31:195-197. [PMID: 33867251 DOI: 10.1016/j.knee.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ryota Nishida
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Japan.
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Kuroda Y, Takayama K, Ishida K, Hayashi S, Hashimoto S, Tsubosaka M, Kamenaga T, Matsushita T, Niikura T, Kuroda R, Matsumoto T. Radiographic Comparison of the Mechanical Axis Including Calcaneus to the Conventional Mechanical Axis in Medial Unicompartmental Knee Arthroplasty. J Knee Surg 2021; 34:930-935. [PMID: 31887764 DOI: 10.1055/s-0039-3402044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since a hindfoot alignment is not included in the conventional mechanical axis (hip-ankle [HA] line), a mechanical axis including the calcaneus (hip-calcaneus [HC] line) has recently attracted attention as an alternative weight-bearing line. However, there are few reports on unicompartmental knee arthroplasty (UKA) regarding the HC line. Therefore, this study aimed to compare postoperative alignments after UKA between the HA line and the HC line. Postoperatively, HC radiographs were taken in 88 consecutive patients who underwent medial UKA. The hip-knee-ankle (HKA) and hip-knee-calcaneus (HKC) angles were compared in the same patient. Regarding tibial inclination, the conventional tibial component-ankle (TCA) angle was compared with reference to the HC line (tibial component-calcaneus [TCC] angle). The mean postoperative HKA and HKC angles were 2.8 ± 2.7 and 2.0 ± 2.5 degree, respectively. The mean postoperative TCA and TCC angles were 87.7 ± 2.1 and 88.5 ± 2.1 degree, respectively. There were significant differences between the two groups in both lower limb alignment and tibial component angle. The present study indicated that the HKC and the TCC angles significantly decreased the varus alignment by approximately 1 degree compared with the HKA and TCA angles. Neutral in the HA line corresponds to valgus in reference to the HC line, which may result in overcorrection. Surgeons should consider evaluating the HC line in place of the HA line, which may affect preoperative planning and postoperative outcome during UKA. This is a Level II, diagnostic study.
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Affiliation(s)
- Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Nie Y, Yu Q, Shen B. Impact of Tibial Component Coronal Alignment on Knee Joint Biomechanics Following Fixed-bearing Unicompartmental Knee Arthroplasty: A Finite Element Analysis. Orthop Surg 2021; 13:1423-1429. [PMID: 34018326 PMCID: PMC8274147 DOI: 10.1111/os.12927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/11/2020] [Accepted: 12/20/2020] [Indexed: 02/05/2023] Open
Abstract
Objective Unicompartmental knee arthroplasty (UKA) has indicated a higher rate of revision than total knee arthroplasty (TKA). The success of UKA depends on UKA component alignment, fixation, and soft tissue integrity. The purpose of this study was to investigate the effects of different tibial component alignments in the coronal plane on the stress distribution in UKA. It was hypothesized that the stress distribution would approach native knee when the tibial component was neutrally positioned. Methods The left legs from two healthy volunteers were considered to represent the geometric native knee models. All bones within the knee joint were extracted from the three‐dimensional (3D) computed tomography (CT). MRI was used to generate cartilage, menisci, and four major ligaments. The UKA components were virtually implanted in the medial compartment of the knee model using MIMICS. A total of five different configurations of UKA tibial obliquity in the coronal plane (neutral, 3° varus, 6° varus, 3° valgus, and 6° valgus) were adopted and investigated. Subject‐specific inhomogeneous material properties of bones were used in the finite element analysis (FEA) model. The von Mises stress in the tibia platform and proximal tibia, and the load distribution between the medial and lateral compartments were extracted and compared among the five different configurations. Results The inhomogeneous material properties of the trabecular bone were closer to real physics than traditional homogeneous methods. Neutral and 3° varus alignments of the tibial component in the coronal plane have better stress distribution between medial and lateral compartment as healthy knee models, and less stress‐shielding effects than other UKA configurations. The stress pathway under the medial tibia platform in neutral and 3° varus UKA configurations was similar and more obvious than the other three UKA configurations. Notably, the stress of the medial tibia platform in the 3° varus UKA models was more homogenous than the neutral UKA configuration. The 6° varus, 3° valgus, and 6° valgus UKA models had higher stress at the location of anterolateral and posterolateral tibia platform than other UKA configurations. Conclusion Neutral or 3° varus positioned in the coronal plane for the tibial component could be the optimal alignment for UKA. Excessive varus or valgus obliquity in the coronal plane lead to significant differences in bone stress transfer and load distribution in the knee, and increase the risk of UKA failure.
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Affiliation(s)
- Yong Nie
- Department of Orthopaedic Surgery and Orthopaedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Qiang Yu
- Department of Orthopaedic Surgery and Orthopaedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, China.,Department of Orthopaedic Surgery, Chengdu 7th people's Hospital, Chengdu, China
| | - Bin Shen
- Department of Orthopaedic Surgery and Orthopaedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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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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Koh YG, Hong HT, Lee HY, Kim HJ, Kang KT. Influence of Variation in Sagittal Placement of the Femoral Component after Cruciate-Retaining Total Knee Arthroplasty. J Knee Surg 2021; 34:444-451. [PMID: 31499566 DOI: 10.1055/s-0039-1696958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Prosthetic alignment is an important factor for long-term survival in cruciate-retaining (CR) total knee arthroplasty (TKA). The purpose of this study is to investigate the influence of sagittal placement of the femoral component on tibiofemoral (TF) kinematics and kinetics in CR-TKA. Five sagittal placements of femoral component models with -3, 0, 3, 5, and 7 degrees of flexion are developed. The TF joint kinematics, quadriceps force, patellofemoral contact force, and posterior cruciate ligament force are evaluated using the models under deep knee-bend loading. The kinematics of posterior TF translation is found to occur with the increase in femoral-component flexion. The quadriceps force and patellofemoral contact force decrease with the femoral-component flexion increase. In addition, extension of the femoral component increases with the increase in posterior cruciate ligament force. The flexed femoral component in CR-TKA provides a positive biomechanical effect compared with a neutral position. Slight flexion could be an effective alternative technique to enable positive biomechanical effects with TKA prostheses.
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Affiliation(s)
- Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
| | - Hyoung-Taek Hong
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul, Republic of Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul, Republic of Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, Seoul, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul, Republic of Korea
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Finite element analysis of the influence of the posterior tibial slope on mobile-bearing unicompartmental knee arthroplasty. Knee 2021; 29:116-125. [PMID: 33610118 DOI: 10.1016/j.knee.2021.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 11/30/2020] [Accepted: 01/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The most common modes of failure reported in unicompartmental knee arthroplasty (UKA) in its first two decades were wear on the polyethylene (PE) insert, component loosening, and progressive osteoarthritis in the other compartment. The rates of implant failure due to poor component positioning in patients who have undergone UKA have been reported. However, the effect of the posterior tibial slope on the biomechanical behavior of mobile-bearing Oxford medial UKA remains unknown. METHODS We applied finite element (FE) analysis to evaluate the effects of the posterior tibial slope in mobile-bearing UKA on the contact stresses in the superior and inferior surfaces of PE inserts and articular cartilage as well as the forces exerted on the anterior cruciate ligament (ACL). Seven FE models for posterior tibial slopes of -1°, 1°, 3°, 5°, 7°, 9°, and 11° were developed and analyzed under normal-level walking conditions based on this approach. RESULTS The maximum contact stresses on both the superior and inferior surfaces of the PE insert decreased as the posterior tibial slope increased. However, the maximum contact stress on the lateral articular cartilage and the force exerted on the ACL increased as the posterior tibial slope increased. CONCLUSIONS Increasing the tibial slope led to a reduction in the contact stress on the PE insert. However, a high contact stress on the other compartment and increased ACL force can cause progressive osteoarthritis in the other compartment and failure of the ACL.
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Beckmann J, Hirschmann MT, Matziolis G, Holz J, V Eisenhart-Rothe R, Becher C. [Recommendations for unicondylar knee replacement in the course of time : A current inventory]. DER ORTHOPADE 2021; 50:104-111. [PMID: 33346867 DOI: 10.1007/s00132-020-04054-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A higher patient satisfaction stands in contrast to higher revision rates of unicondylar knee joint endoprosthetics (UKE) compared to total knee joint endoprosthetics (TKE). Furthermore, old "dogmas" regarding indications and contraindications persist, which is still reflected in the significantly different case numbers. AIM The aim of this article is to provide an overview of the current literature regarding 1. indication and contraindication (BMI, age, sport, arthrosis of other compartments, ligament status) and 2. the "eternal rival" fixed or mobile bearing for UKE. RESULTS The choice of the right patient remains essential, even if all the old "dogmas" of contraindications have been relativized or even outdated. Arthroses of the contralateral (in medial UKE correspondingly lateral) compartment and advanced arthroses of the lateral patella facet remain the only persistent contraindications. In contrast, a high BMI, age, chondrocalcinosis, medial patella facet and a defective (but particularly functionally stable) ACL are not contraindications; however, severe obesity is responsible for a significantly higher complication rate and probably a higher rate of loosening. Rather, the experience and thus the number of UKEs of the individual surgeon is decisive for the outcome, to which the discussion about mobile or fixed inlays must also be completely subordinated. CONCLUSION The indications for UKE can, therefore, be extended with a clear conscience on the basis of literature, and the current 1:10 UKE:TKE ratio in Germany can be shifted significantly.
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Affiliation(s)
- J Beckmann
- Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland.
| | | | - G Matziolis
- Waldkliniken Eisenberg, Eisenberg, Deutschland
| | - J Holz
- OrthoCentrum Hamburg, Hamburg, Deutschland
| | - R V Eisenhart-Rothe
- Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - C Becher
- IZO - Internationales Zentrum für Orthopädie, ATOS Klinik Heidelberg, Heidelberg, Deutschland
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Hiranaka T, Tanaka T, Fujishiro T, Okimura K, Shigemoto R, Araki S, Okada R, Nako R, Okamoto K. A Novel Technique for Varus Tibial Cutting for Oxford Unicompartmental Knee Arthroplasty. Clin Orthop Surg 2020; 12:554-557. [PMID: 33274035 PMCID: PMC7683191 DOI: 10.4055/cios20191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/14/2020] [Indexed: 01/23/2023] Open
Abstract
To reduce the stress on the medial tibial cortex and to decrease the risk of fracture, a varus cut of the tibia appears to be a reasonable alternative to the orthogonal cut by conventional methods. We present a new instrument and procedure, which enables a varus tibial cut for Oxford unicompartmental knee arthroplasty. We used a custom-made, slidable fixator instead of the standard fixator to set the extramedullary rod on the leg. We also made a numeric formula and a chart to arrange the varus cutting angle using the length of the mediolateral shift of the distal end and the longitudinal extension length of the extramedullary tibial rod. A varus cut up to 4.5° can be controlled. This technique is a simple and useful means of obtaining a varus tibial cut for Oxford unicompartmental knee arthroplasty.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Toshikazu Tanaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Kenjiro Okimura
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Rika Shigemoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Shotaro Araki
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Ryo Okada
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Ryohei Nako
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Takatsuki, Japan
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Kwon HM, Lee JA, Koh YG, Park KK, Kang KT. Effects of contact stress on patellarfemoral joint and quadriceps force in fixed and mobile-bearing medial unicompartmental knee arthroplasty. J Orthop Surg Res 2020; 15:517. [PMID: 33168023 PMCID: PMC7653850 DOI: 10.1186/s13018-020-02047-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 10/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Unicompartmental knee arthroplasty (UKA) is an effective treatment for end-stage, symptomatic unicompartmental osteoarthritis of the knee joint. However, patellofemoral joint degeneration is a contraindication to medial UKA. Therefore, the objective of this study was to evaluate the biomechanical effect of medial UKA using fixed-bearing (FB) and mobile-bearing (MB) design prostheses on the patellofemoral joint. Methods A three-dimensional finite-element model of a normal knee joint was developed using medical image data. We performed statistical analysis for each model. The differences in contact stress on the patellofemoral joint and the quadriceps force between the FB and MB designs were evaluated under a deep-knee-bend condition. Results At an early flexion angle, the results of contact stress showed no significant difference between the FB and MB medial UKA models compared with the intact model. However, at high flexion angles, we observed a significant increase in contact stress with the FB models compared with the intact model. On the contrary, in the case of the MB models, we found no statistically significant increment compared with the intact model. A larger quadriceps force was needed to produce an identical flexion angle for both the FB and MB UKA designs than for the intact model. At high flexion angles, a significant increase quadriceps force whit the FB model compared with the intact model. Conclusions Our results indicate that with medial UKA, the contact stress increased and greater quadriceps force was applied to the patellofemoral joint. However, performing UKA on a patellofemoral joint with osteoarthritis should not be difficult, unless anterior knee pain is present, because the increase in contact stress is negligible.
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Affiliation(s)
- Hyuck Min Kwon
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, 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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Lee JA, Koh YG, Kim PS, Kang KW, Kwak YH, Kang KT. Biomechanical effect of tibial slope on the stability of medial unicompartmental knee arthroplasty in posterior cruciate ligament-deficient knees. Bone Joint Res 2020; 9:593-600. [PMID: 33014352 PMCID: PMC7510939 DOI: 10.1302/2046-3758.99.bjr-2020-0128.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aims Unicompartmental knee arthroplasty (UKA) has become a popular method of treating knee localized osteoarthritis (OA). Additionally, the posterior cruciate ligament (PCL) is essential to maintaining the physiological kinematics and functions of the knee joint. Considering these factors, the purpose of this study was to investigate the biomechanical effects on PCL-deficient knees in medial UKA. Methods Computational simulations of five subject-specific models were performed for intact and PCL-deficient UKA with tibial slopes. Anteroposterior (AP) kinematics and contact stresses of the patellofemoral (PF) joint and the articular cartilage were evaluated under the deep-knee-bend condition. Results As compared to intact UKA, there was no significant difference in AP translation in PCL-deficient UKA with a low flexion angle, but AP translation significantly increased in the PCL-deficient UKA with high flexion angles. Additionally, the increased AP translation became decreased as the posterior tibial slope increased. The contact stress in the PF joint and the articular cartilage significantly increased in the PCL-deficient UKA, as compared to the intact UKA. Additionally, the increased posterior tibial slope resulted in a significant decrease in the contact stress on PF joint but significantly increased the contact stresses on the articular cartilage. Conclusion Our results showed that the posterior stability for low flexion activities in PCL-deficient UKA remained unaffected; however, the posterior stability for high flexion activities was affected. This indicates that a functional PCL is required to ensure normal stability in UKA. Additionally, posterior stability and PF joint may reduce the overall risk of progressive OA by increasing the posterior tibial slope. However, the excessive posterior tibial slope must be avoided. Cite this article: Bone Joint Res 2020;9(9):593–600.
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Affiliation(s)
- Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea
| | - Paul Shinil Kim
- Department of Orthopaedic Surgery, The Bone Hospital, Seoul, South Korea
| | - Ki Won Kang
- Gaja Yonsei Orthopaedic Clinic, Incheon, South Korea
| | - Yoon Hae Kwak
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
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Charng JR, Chen ACY, Chan YS, Hsu KY, Wu CT. Proximal tibial morphology and risk of posterior tibial cortex impingement in patients with AA-sized Oxford unicompartmental knee arthroplasty tibial implants. J Orthop Surg Res 2020; 15:380. [PMID: 32883334 PMCID: PMC7470608 DOI: 10.1186/s13018-020-01900-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background In cases of Oxford unicompartmental knee arthroplasty (UKA), an increase in anteroposterior and medial-lateral length is usually disproportional when comparing AA and A-sized tibial components. Asynchronous increments may cause tibial keel impingement leading to complications. Methods Radiographic measurements were performed in five patients with AA-sized tibial implants. The posterior cortex of proximal tibia had two angles recorded as ∠ M1 and ∠ M2. The minimum distance between the tibial component keel and outer margin of the posterior tibial cortex (mDKC) was measured, and the correlation between the preoperative posterior slope angle (PSA), ∠ M1, and mDKC was analyzed. Results All patients showed an acceptable component positioning. Only one patient had an mDKC of < 4 mm that fulfilled the criteria for the posterior tibial cortex at risk. The patient had an increased PSA and ∠ M1 compared to other patients. A negative correlation was found between preoperative PSA and mDKC (r = − 0.935, p = 0.0193); and ∠ M1 and mDKC (r = − 0.969, p = 0.0032). However, no stem tip pain, periprosthetic fracture, or component loosening were observed. Conclusions The distance between the tibial keel and posterior tibial cortex was reduced in AA-sized patients with a large PSA and ∠M1; therefore, the risk of the tibial cortex injury should be considered.
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Affiliation(s)
- Jiun-Ran Charng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan, Taoyuan, Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan, Taoyuan, Taiwan
| | - Yi-Shen Chan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan, Taoyuan, Taiwan
| | - Kuo Yao Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Kweishan, Taoyuan, Taiwan
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, No. 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.
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Koh YG, Lee JA, Chung HS, Kim HJ, Kang KT. Restoration of normal knee kinematics with respect to tibial insert design in mobile bearing lateral unicompartmental arthroplasty using computational simulation. Bone Joint Res 2020; 9:421-428. [PMID: 32864113 PMCID: PMC7437519 DOI: 10.1302/2046-3758.97.bjr-2019-0384.r1] [Citation(s) in RCA: 3] [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] [Indexed: 11/27/2022] Open
Abstract
Aims Mobile-bearing unicompartmental knee arthroplasty (UKA) with a flat tibial plateau has not performed well in the lateral compartment, leading to a high rate of dislocation. For this reason, the Domed Lateral UKA with a biconcave bearing was developed. However, medial and lateral tibial plateaus have asymmetric anatomical geometries, with a slightly dished medial and a convex lateral plateau. Therefore, the aim of this study was to evaluate the extent at which the normal knee kinematics were restored with different tibial insert designs using computational simulation. Methods We developed three different tibial inserts having flat, conforming, and anatomy-mimetic superior surfaces, whereas the inferior surface in all was designed to be concave to prevent dislocation. Kinematics from four male subjects and one female subject were compared under deep knee bend activity. Results The conforming design showed significantly different kinematics in femoral rollback and internal rotation compared to that of the intact knee. The flat design showed significantly different kinematics in femoral rotation during high flexion. The anatomy-mimetic design preserved normal knee kinematics in femoral rollback and internal rotation. Conclusion The anatomy-mimetic design in lateral mobile UKA demonstrated restoration of normal knee kinematics. Such design may allow achievement of the long sought normal knee characteristics post-lateral mobile UKA. However, further in vivo and clinical studies are required to determine whether this design can truly achieve a more normal feeling of the knee and improved patient satisfaction. Cite this article: Bone Joint Res 2020;9(7):421–428.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Hyun-Seok Chung
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, Seoul, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
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Hiranaka T, Yoshikawa R, Yoshida K, Michishita K, Nishimura T, Nitta S, Takashiba K, Murray D. Tibial shape and size predicts the risk of tibial plateau fracture after cementless unicompartmental knee arthroplasty in Japanese patients. Bone Joint J 2020; 102-B:861-867. [PMID: 32600131 DOI: 10.1302/0301-620x.102b7.bjj-2019-1754.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Cementless unicompartmental knee arthroplasty (UKA) has advantages over cemented UKA, including improved fixation, but has a higher risk of tibial plateau fracture, particularly in Japanese patients. The aim of this multicentre study was to determine when cementless tibial components could safely be used in Japanese patients based on the size and shape of the tibia. METHODS The study involved 212 cementless Oxford UKAs which were undertaken in 174 patients in six hospitals. The medial eminence line (MEL), which is a line parallel to the tibial axis passing through the tip of medial intercondylar eminence, was drawn on preoperative radiographs. Knees were classified as having a very overhanging medial tibial condyle if this line passed medial to the medial tibial cortex. They were also classified as very small if a size A/AA tibial component was used. RESULTS The overall rate of fracture was 8% (17 out of 212 knees). The rate was higher in knees with very overhanging condyles (Odds ratio (OR) 13; p < 0.001) and with very small components (OR 7; p < 0.001). The OR was 21 (p < 0.001) in those with both very overhanging condyles and very small components. In all, 69% of knees (147) had neither very overhanging nor very small components, and the fracture rate in these patients was 1.4% (2 out of 147 knees). Males had a significantly reduced risk of fracture (OR 0.13; p = 0.002), probably because no males required very small components and females were more likely to have very overhanging condyles (OR 3; p = 0.013). 31% of knees (66) were in males and in these the rate of fracture was 1.5% (1 out of 66 knees). CONCLUSION The rate of tibial plateau fracture in Japanese patients undergoing cementless UKA is high. We recommend that cemented tibial fixation should be used in Japanese patients who require very small components or have very overhanging condyles, as identified from preoperative radiographs. In the remaining 69% of knees cementless fixation can be used. This approach should result in a low rate of fracture. Cite this article: Bone Joint J 2020;102-B(7):861-867.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Ryo Yoshikawa
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | | | - Kazuhiko Michishita
- Department of Orthopaedic Surgery, Japan Community Healthcare Organization, Yugawara Hospital, Yugawara, Kanagawa, Japan
| | - Takehiro Nishimura
- Department of Orthopaedic Surgery, Suita Municipal Hospital, Osaka, Japan
| | | | - Kenichiro Takashiba
- Department of Joint Reconstruction Center, Souseikai Fukuoka Mirai Hospital, Fukuoka, Japan
| | - David Murray
- Nuffield Department of Orthopaedic Surgery, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Rd, Oxford, UK
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Koh YG, Lee JA, Lee HY, Chun HJ, Kim HJ, Kang KT. Anatomy-mimetic design preserves natural kinematics of knee joint in patient-specific mobile-bearing unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2020; 28:1465-1472. [PMID: 31123794 DOI: 10.1007/s00167-019-05540-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 05/13/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aims to evaluate whether different tibial-femoral conformities for patient-specific mobile-bearing unicompartmental knee arthroplasties (UKAs) preserve natural knee kinematics, using computational simulations. METHODS Different designs for patient-specific mobile-bearing UKAs were evaluated using finite element analysis. Three designs for the identical femoral component were considered: flat (non-conforming design), anatomy-mimetic, and conforming for the tibial insert. RESULTS The conforming design for the patient-specific mobile-bearing UKAs exhibited a 1.2 mm and 0.7° decrease in the translation and rotation, respectively, in the swing phase compared with those of the natural knee. In addition, the femoral rollback and internal rotation were 2.6 mm and 1.2° lower, respectively, than those of the natural knee, for the conforming design under the deep-knee-bend condition. The flat design for the patient-specific mobile-bearing UKAs exhibited a 2.2 mm and 1.4° increase in the femoral rollback and rotation compared with the natural knee under the deep-knee-bend condition. The anatomy-mimetic patient-specific mobile-bearing UKAs best preserved the natural knee kinematics under the gait and deep-knee-bend loading conditions. CONCLUSIONS The kinematics of the loading conditions in patient-specific mobile-bearing UKAs was determined to closely resemble those of a native knee. In additional, by replacing the anatomy-mimetic design with a mobile-bearing, natural knee kinematics during gait and deep-knee-bend motions is preserved. These results confirm the importance of tibiofemoral conformity in preserving native knee kinematics in patient-specific mobile-bearing UKA.
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Affiliation(s)
- Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, South Korea
| | - Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Heoung-Jae Chun
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, 1239 Yangjae-dearo, Songpa-gu, Seoul, 05541, South Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Finite Element Study on the Preservation of Normal Knee Kinematics with Respect to the Prosthetic Design in Patient-Specific Medial Unicompartmental Knee Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1829385. [PMID: 32258105 PMCID: PMC7109557 DOI: 10.1155/2020/1829385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/07/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022]
Abstract
Alterations in native knee kinematics in medial unicompartmental knee arthroplasty (UKA) are caused by the nonanatomic articular surface of conventional implants. Technology for an anatomy mimetic patient-specific (PS) UKA has been introduced. However, there have been no studies on evaluating the preservation of native knee kinematics with respect to different prosthetic designs in PS UKA. The purpose of this study was to evaluate the preservation of native knee kinematics with respect to different UKA designs using a computational simulation. We evaluated three different UKA designs: a nonconforming design, an anatomy mimetic design, and a conforming design for use under gait and squat loading conditions. The results show that the anatomy mimetic UKA design achieves closer kinematics to those of a native knee compared to the other two UKA designs under such conditions. The anatomy memetic UKA design exhibited a 0.39 mm and 0.36° decrease in the translation and rotation, respectively, in the swing phase compared with those of the natural knee. In addition, under the gait and squat loading conditions, the conforming UKA design shows limited kinematics compared to the nonconforming UKA design. Our results show that the conformity of each component in PS UKA is an important factor in knee joint kinematics; however, the anatomy mimetic UKA design cannot restore perfect native kinematics.
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Huo Y, Xu G, Yin Z, Yu J, Sun X, Li L, Gu G, Sheng L, Sun H. Effects of surgical approaches and morphological characteristics on the follow up outcomes of patients with posterolateral tibial plateau fractures. Medicine (Baltimore) 2020; 99:e19854. [PMID: 32332643 PMCID: PMC7220780 DOI: 10.1097/md.0000000000019854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study aimed to study the effects of surgical approaches and identify the morphological characteristics associated with the 1-year follow-up outcome of patients with posterolateral tibial plateau fractures after successful surgery.We followed 200 postoperative patients for 1 year. The modified Hospital for Special Knee Surgery score (HSS score) was used to evaluate the functional recovery of the knee. We supposed 4 morphological characteristics in CT images acting as possible risk factors, including the anteroposterior diameters of posterolateral broken bone fragments (fragment-diameter), the damage to the posterolateral cortex of the tibial head (cortex-damage), the combinational fracture of the proximal fibula (fibula-fracture) or fracture of the medial tibial condyle (medial-condyle-fracture). Multivariate regression models were used to analyze the effect of these factors on the HSS score after adjusting the 2 surgical approaches and other confounders.The average HSS score was 85.1 ± 5.8 for all the patients. We treated 155 patients with the anterolateral approach and 45 patients with the posterolateral approach. The surgical approach, fragment-diameter, fibula-fracture, and medial-condyle-fracture were correlated with the HSS scores (P < .05). After adjusting for the above factors, the Schatzker type, age and gender, compared with anterolateral approach, the posterolateral approach could improve the HSS scores by an average of 3.7 points. The fragment-diameter <20 mm and posterolateral approach interacted on the HSS scores. Comparing posterolateral and anterolateral approaches, we found that the HSS scores of patients with fragment-diameter <20 mm increased by 6.1 points (95% CI: 4.1-8.2) in the posterolateral approach, while those with fragment-diameter ≥20 mm did not significantly improve the HSS scores.The surgical approach, fragment-diameter, fibula-fracture, and medial-condyle-fracture were independent risk factors associated with the follow-up outcome of patients with posterolateral tibial plateau fractures after successful surgery. The posterolateral approach could significantly improve the HSS score in the studied hospital.
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Affiliation(s)
- Yongfeng Huo
- First People's Hospital of Lianyungang City, Lianyungang
| | - Gang Xu
- First People's Hospital of Lianyungang City, Lianyungang
| | - Zhaoyang Yin
- First People's Hospital of Lianyungang City, Lianyungang
| | - Jian Yu
- First People's Hospital of Lianyungang City, Lianyungang
| | - Xiao Sun
- First People's Hospital of Lianyungang City, Lianyungang
| | - Leiming Li
- First People's Hospital of Lianyungang City, Lianyungang
| | - Guangxue Gu
- First People's Hospital of Lianyungang City, Lianyungang
| | - Luxin Sheng
- First People's Hospital of Lianyungang City, Lianyungang
| | - Hong Sun
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
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Sano M, Oshima Y, Murase K, Sasatani K, Takai S. Finite-Element Analysis of Stress on the Proximal Tibia After Unicompartmental Knee Arthroplasty. J NIPPON MED SCH 2020; 87:260-267. [PMID: 32009074 DOI: 10.1272/jnms.jnms.2020_87-504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because the indications for unicompartmental knee arthroplasty (UKA) are limited, few patients have undergone the procedure. Therefore, it is difficult to decide the acceptable range of variation in the details of UKA on the basis of the available clinical data. The objective of this study was to identify factors that affect the distribution of stress on the proximal tibia after UKA. METHODS Two-dimensional finite-element analysis of the proximal tibia was used to assess four factors: 1) two types of implants-all ultra-high-molecular-weight polyethylene (UHMWPE) and metal-backed implants, 2) postoperative alignment, 3) coverage of tibial bone, 4) level of the tibial osteotomy. RESULTS In cases of varus alignment, high stress values and large areas of deformation were observed on and beneath the implant. In cases of valgus alignment, stress was concentrated at the lateral portion of tibial tray. In comparison with the standard model, stress concentration was greater at the medial edge of the medial condyle in a narrow-coverage model. Stress distribution for the low-osteotomy-level model did not differ markedly differ from that for the standard model. Stress distribution was better for metal-backed implants than for UHMWPE implants. CONCLUSIONS Proper postoperative alignment must be achieved in UKA. The osteotomy level should be set at the cancellous bone close to the joint line, and preservation of bone stock should be maximized.
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Affiliation(s)
- Mihoro Sano
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Kohei Murase
- Center for Industry-University Collaboration, Graduate School of Engineering Science, Osaka University
| | | | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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Koh YG, Park KM, Lee HY, Park JH, Kang KT. Prediction of wear performance in femoral and tibial conformity in patient-specific cruciate-retaining total knee arthroplasty. J Orthop Surg Res 2020; 15:24. [PMID: 31969195 PMCID: PMC6977248 DOI: 10.1186/s13018-020-1548-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/06/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Articular surface curvature design is important in tibiofemoral kinematics and the contact mechanics of total knee arthroplasty (TKA). Thus far, the effects of articular surface curvature have not been adequately discussed with respect to conforming, nonconforming, and medial pivot designs in patient-specific TKA. Therefore, this study evaluates the underlying relationship between the articular surface curvature geometry and the wear performance in patient-specific TKA. METHODS We compare the wear performances between conventional and patient-specific TKA under gait loading conditions using a computational simulation. Patient-specific TKAs investigated in the study are categorized into patient-specific TKA with conforming articular surfaces, medial pivot patient-specific TKA, and bio-mimetic patient-specific TKA with a patient's own tibial and femoral anatomy. The geometries of the femoral components in patient-specific TKAs are identical. RESULTS The anterior-posterior and internal-external kinematics change with respect to different TKA designs. Moreover, the contact pressure and area did not directly affect the wear performance. In particular, conforming patient-specific TKAs exhibit the highest volumetric wear and wear rate. The volumetric wear in a conforming patient-specific TKA is 29% greater than that in a medial pivot patient-specific TKA. CONCLUSION The findings in this study highlight that conformity changes in the femoral and tibial inserts influence the wear performance in patient-specific TKA. Kinematics and contact parameters should be considered to improve wear performance in patient-specific TKA. The conformity modification in the tibiofemoral joint changes the kinematics and contact parameters, and this affects wear performance.
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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
| | - Kyoung-Mi Park
- 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
| | - Joon-Hee Park
- Department of Anesthesiology & Pain Medicine, Hallym University College of Medicine and Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul, 05355, 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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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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Koh YG, Lee JA, Lee HY, Kim HJ, Chung HS, Kang KT. Reduction in tibiofemoral conformity in lateral unicompartmental knee arthroplasty is more representative of normal knee kinematics. Bone Joint Res 2019; 8:593-600. [PMID: 31934330 PMCID: PMC6946914 DOI: 10.1302/2046-3758.812.bjr-2019-0114.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Commonly performed unicompartmental knee arthroplasty (UKA) is not designed for the lateral compartment. Additionally, the anatomical medial and lateral tibial plateaus have asymmetrical geometries, with a slightly dished medial plateau and a convex lateral plateau. Therefore, this study aims to investigate the native knee kinematics with respect to the tibial insert design corresponding to the lateral femoral component. METHODS Subject-specific finite element models were developed with tibiofemoral (TF) and patellofemoral joints for one female and four male subjects. Three different TF conformity designs were applied. Flat, convex, and conforming tibial insert designs were applied to the identical femoral component. A deep knee bend was considered as the loading condition, and the kinematic preservation in the native knee was investigated. RESULTS The convex design, the femoral rollback, and internal rotation were similar to those of the native knee. However, the conforming design showed a significantly decreased femoral rollback and internal rotation compared with that of the native knee (p < 0.05). The flat design showed a significant difference in the femoral rollback; however, there was no difference in the tibial internal rotation compared with that of the native knee. CONCLUSION The geometry of the surface of the lateral tibial plateau determined the ability to restore the rotational kinematics of the native knee. Surgeons and implant designers should consider the geometry of the anatomical lateral tibial plateau as an important factor in the restoration of native knee kinematics after lateral UKA.Cite this article: Bone Joint Res 2019;8:593-600.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea
| | - Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, Seoul, South Korea
| | - Hyun-Seok Chung
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, South Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, South Korea
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48
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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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Koh YG, Lee JA, Chun HJ, Baek C, Kang KT. Effect of insert material on forces on quadriceps, collateral ligament, and patellar tendon after rotating platform mobile-bearing total knee arthroplasty. Asian J Surg 2019; 43:742-749. [PMID: 31648867 DOI: 10.1016/j.asjsur.2019.09.010] [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] [Received: 07/15/2019] [Revised: 09/18/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND There is a gradual increase in the number of patients for total knee arthroplasty (TKA), and TKA demonstrates reliable clinical outcomes. The orthopaedic biomaterials community continuously attempted over the past decades to improve the longevity of UHMWPE in TKA by using various improved technologies. Polyetheretherketone (PEEK) and carbon fiber reinforced-PEEK(CFR-PEEK) are suggested as potential tibial insert materials to replace UHMWPE in some applications. The aim of this study involves evaluating the biomechanical effects of UHMWPE and CFR-PEEK tibial materials on mobile-bearing TKA. METHODS The finite element (FE) model was obtained by conducting computed tomography and magnetic resonance imaging. The FE investigation included three types of loading conditions corresponding to the loads used in the experiments for FE model validation and model predictions under deep-knee bend loading conditions. We investigated forces on quadriceps, collateral ligament and patellar tendon with UHMWPE and CCFR-PEEK tibial insert materials under the deep-knee-bend condition. RESULTS Quadriceps force decreased with flexion for CFR-PEEK when compared to that for UHMWPE. A similar trend was observed in terms of the patellar tendon force. An opposite trend was observed in the collateral ligament. Medial collateral ligament force in the CFR-PEEK exceeded that in the UHMWPE, and lateral collateral ligament force in the UHMWPE exceeded that in the CFR-PEEK. CONCLUSION The CFR-PEEK represents an alternative insert material given its superior biomechanical effect after mobile-bearing total knee arthroplasty. However, a balance between the medial and lateral ligaments is considered as an important factor in the CFR-PEEK tibial insert due to its opposite biomechanical effect.
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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
| | - Heoung-Jae Chun
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Changhyun Baek
- Department of Mechanical and Control Engineering, The Cyber University of Korea, 106 Bukchon-ro, Jongnogu, Seoul, 03051, 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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50
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Sasatani K, Majima T, Murase K, Takeuchi N, Matsumoto T, Oshima Y, Takai S. Three-Dimensional Finite Analysis of the Optimal Alignment of the Tibial Implant in Unicompartmental Knee Arthroplasty. J NIPPON MED SCH 2019; 87:60-65. [PMID: 31611507 DOI: 10.1272/jnms.jnms.2020_87-202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although unicompartmental knee arthroplasty (UKA) has become more common because of its good outcomes, several complications have been reported. Tibial implant alignment, an important cause of such complications, has been investigated; however, the optimal alignment of the tibial implant has not been determined. This study used 3-dimensional finite element analysis to investigate changes in stress distribution in the proximal tibia after UKA at multiple tibial implant alignments. METHODS A 3-dimensional finite element model was created with CT digital imaging and communications in medicine (CT-DICOM) data from a medial osteoarthritic knee. Change in stress distribution of the tibial implant alignment on the coronal plane (middle position, varus 5°, valgus 5°) and sagittal plane (0°, 5°, 10°) under conditions of a loose boundary between implant and bone and no loosening was analyzed with 3-dimensional finite analysis. RESULTS In the absence of loosening, the stress distribution was high at the lateral rim of the subchondral bone in the varus alignment model, and the high stress distribution moved from the anterior to the posterior position with posterior tilting from 0° to 10°. With loosening, the stress distribution was high at the proximal tibial medial cortex in the valgus alignment model. CONCLUSIONS To reduce UKA complications, the present findings indicate that the optimal alignment of the tibial implant is at the middle position on the coronal plane, with a posterior inclination similar to the original inclination on the sagittal plane.
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Affiliation(s)
| | | | - Kohei Murase
- Center for Industry-University Collaboration, Graduate School of Engineering Science, Osaka University
| | - Naoki Takeuchi
- Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University
| | - Takeo Matsumoto
- Department of Mechanical Science and Engineering, Graduate School of Engineering, Nagoya University
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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