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Febrer-Nafría M, Dreyer MJ, Maas A, Taylor WR, Smith CR, Hosseini Nasab SH. Knee kinematics are primarily determined by implant alignment but knee kinetics are mainly influenced by muscle coordination strategy. J Biomech 2023; 161:111851. [PMID: 37907050 DOI: 10.1016/j.jbiomech.2023.111851] [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: 02/10/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/02/2023]
Abstract
Implant malalignment has been reported to be a primary reason for revision total knee arthroplasty (TKA). In addition, altered muscle coordination patterns are commonly observed in TKA patients, which is thought to alter knee contact loads. A comprehensive understanding of the influence of surgical implantation and muscle recruitment strategies on joint contact mechanics is crucial to improve surgical techniques, increase implant longevity, and inform rehabilitation protocols. In this study, a detailed musculoskeletal model with a 12 degrees of freedom knee was developed to represent a TKA subject from the CAMS-Knee datasets. Using motion capture and ground reaction force data, a level walking cycle was simulated and the joint movement and loading patterns were estimated using a novel technique for concurrent optimization of muscle activations and joint kinematics. In addition, over 12'000 Monte Carlo simulations were performed to predict knee contact mechanics during walking, considering numerous combinations of implant alignment and muscle activation scenarios. Validation of our baseline simulation showed good agreement between the model kinematics and loading patterns against the in vivo data. Our analyses reveal a considerable impact of implant alignment on the joint kinematics, while variation in muscle activation strategies mainly affects knee contact loading. Moreover, our results indicate that high knee compressive forces do not necessarily originate from extreme kinematics and vice versa. This study provides an improved understanding of the complex inter-relationships between loading and movement patterns resulting from different surgical implantation and muscle coordination strategies and presents a validated framework towards population-based modelling in TKA.
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Affiliation(s)
- Míriam Febrer-Nafría
- Institute for Biomechanics, ETH Zürich, Switzerland; Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Spain
| | - Michael J Dreyer
- Institute for Biomechanics, ETH Zürich, Switzerland; Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - Allan Maas
- Department of Orthopaedic and Trauma Surgery, Ludwig Maximilians University Munich, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany; Research and Development, Aesculap AG, Tuttlingen, Germany
| | | | - Colin R Smith
- Institute for Biomechanics, ETH Zürich, Switzerland; Steadman Philippon Research Institute, Vail, USA
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Dreyer MJ, Weisse B, Contreras Raggio JI, Zboray R, Taylor WR, Preiss S, Horn N. The influence of implant design and limb alignment on in vivo wear rates of fixed-bearing and rotating-platform knee implant retrievals. J Orthop Res 2023. [PMID: 37975250 DOI: 10.1002/jor.25734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/11/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Analysis of polyethylene (PE) wear in knee implants is crucial for understanding the factors leading to revision in total knee arthroplasty. Importantly, current experimental and computational methods for predicting insert wear can only be validated against true in vivo measurements from retrievals. This study quantitatively investigated in vivo PE wear rates in fixed-bearing (FB) (n = 21) and rotating-platform (n = 53) implant retrievals. 3D surface geometry of the retrievals was measured using a structured light scanner. Then, a reference surface that included the deformation, but not the wear that the retrievals had experienced in vivo, was constructed using a fully automatic surface reconstruction algorithm. Finally, wear volume was calculated from the deviation between the worn and reconstructed surfaces. The measurement and analysis techniques were validated and the algorithm was found to produce errors of only 0.2% relative to the component volumes. In addition to quantifying cohort-level wear rates, the effect of mechanical axis limb alignment on mediolateral wear distribution was examined for a subset of the retrievals (n = 14 + 26). Our results show that FB implants produce significantly (p = 0.04) higher topside wear rates (24.6 ± 10.1 mm3 /year) than rotating-platform implants (15.3 ± 8.0 mm3 /year). This effect was larger than that of limb alignment, which had a smaller and nonsignificant influence on overall wear rates (+4.5 ± 11.6 mm3 /year, p = 0.43). However, increased varus alignment was associated significantly with greater medial compartment wear in both the FB and rotating-platform designs (+1.7 ± 1.3%/° and +1.8 ± 1.6%/°). Our findings emphasize the importance of implant design and limb alignment on wear outcomes, providing reference data for improving implant performance and longevity.
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Affiliation(s)
- Michael J Dreyer
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - Bernhard Weisse
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
| | - José Ignacio Contreras Raggio
- Laboratory for Mechanical Systems Engineering, Empa, Dübendorf, Switzerland
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibáñez, Viña del Mar, Chile
| | - Robert Zboray
- Center for X-ray Analytics, Empa, Dübendorf, Switzerland
| | - William R Taylor
- Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Stefan Preiss
- Department of Lower Extremities, Schulthess Clinic, Zürich, Switzerland
| | - Nils Horn
- Department of Lower Extremities, Schulthess Clinic, Zürich, Switzerland
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Jenny JY, Baldairon F. The coronal alignment technique impacts deviation from native knee anatomy after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 31:1427-1432. [PMID: 36125511 DOI: 10.1007/s00167-022-07157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to analyze and quantify the changes in native coronal alignment of a population of TKA patients according to different alignment goals. METHODS Five hundred and twenty TKAs were analyzed. The following angles were measured using an image-free navigation system prior to prosthetic implantation: medial femorotibial mechanical angle without stress and with maximum manual stress to reduce the deformity, medial distal femoral mechanical angle, medial proximal tibial mechanical angle. The native angles were derived from the osteoarthritic knee angles using a validated correction technique, and the overall, femoral and tibial coronal phenotypes were defined. Five different coronal alignment techniques were simulated: mechanical (MA), restricted mechanical (RMA), anatomical (AA), kinematic (KA) and restricted kinematic (RKA). The overall, femoral and tibial coronal phenotypes were compared before and after TKA. The primary endpoint was the binary criterion of whether or not TKA restored the natural overall phenotype. Secondary endpoints were the binary criteria of whether or not the natural femoral and tibial phenotypes were restored by TKA. The rates of restored and non restored phenotypes were compared with a Chi-square test at a 0.05 level of significance, with post hoc tests between all pairs of techniques at a 0.01 level of significance. RESULTS The overall phenotype was restored significantly differently by the five alignment techniques: 15% for MA, 23% for RMA, 2% for AA, 100% for KA and 79% for RKA (p < 0.001). There was a significant difference between each of the technique pairs (p < 0.01 to p < 0.001), except for the mechanical alignment-restricted mechanical alignment pair. The femoral phenotype was restored significantly differently by the five alignment techniques: 37% for MA, 58% for RMA, 19% for AA, 100% for KA and 85% for RKA (p < 0.001). The tibial phenotype was restored significantly differently by the five alignment techniques: 36% for MA, 36% for RMA, 17% for AA, 100% for KA and 88% for RKA (p < 0.001). There was a significant difference between each pair of techniques for both femoral and tibial phenotypes (p < 0.01 to p < 0.001). CONCLUSION Except for the kinematic alignment technique, the various alignment techniques induce significant changes in the pre-arthritic anatomy of the TKA patient. The surgeon must be aware of these modifications. The clinical relevance of this alteration still needs to be defined. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jean-Yves Jenny
- Locomax Unit, University Hospital, 1 avenue Molière, 67200, Strasbourg, France.
| | - Florent Baldairon
- Locomax Unit, University Hospital, 1 avenue Molière, 67200, Strasbourg, France
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Hothi H, Cerquiglini A, Büel L, Henckel J, Moser LB, Hirschmann MT, Hart A. SPECT/CT Assessment of In-Vivo Loading of the Knee Correlates with Polyethylene Deformation in Retrieved Total Knee Arthroplasty. Tomography 2022; 8:180-188. [PMID: 35076625 PMCID: PMC8788541 DOI: 10.3390/tomography8010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/18/2021] [Accepted: 01/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: SPECT/CT distribution patterns in patients with total knee replacements have previously been correlated with factors such as time of implantation, implant type and alignment. It is unknown, however, if an increased and more extended bone tracer uptake (BTU) in SPECT/CT, representing loading of the joint, correlates with findings from retrieval studies. The aim of this study was to further understand this subject. Materials and Methods: 62 retrieved TKA were included. SPECT/CT was performed prior to revision. Quantitative and qualitative medio-lateral comparisons of BTU intensity and distribution in the tibia were performed. Retrieval analysis was performed with a micro-CT method to assess the thickness differences between medial and lateral sides of polyethylene inserts with symmetrical designs. Results: In the subgroup of TKA with asymmetrical SPECT/CT distribution, there was a significant correlation between retrieval and medical imaging data (p = 0.0355): patients showing a more extended BTU in the medial compartment also had a significantly thinner insert in the medial compartment, and vice versa in the lateral side. Conclusion: This is the first study comparing BTU distribution patterns and retrieval findings. Our results support the hypothesis that SPECT/CT is able to identify bone activity due to implant position and loading.
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Affiliation(s)
- Harry Hothi
- The Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK; (A.C.); (J.H.); (A.H.)
- Correspondence:
| | - Arianna Cerquiglini
- The Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK; (A.C.); (J.H.); (A.H.)
| | - Lukas Büel
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland; (L.B.); (L.B.M.); (M.T.H.)
- Department of Orthopaedics, University of Basel, 4001 Basel, Switzerland
| | - Johann Henckel
- The Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK; (A.C.); (J.H.); (A.H.)
| | - Lukas B. Moser
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland; (L.B.); (L.B.M.); (M.T.H.)
| | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland; (L.B.); (L.B.M.); (M.T.H.)
| | - Alister Hart
- The Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK; (A.C.); (J.H.); (A.H.)
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Li Z, Chen X, Zhang X, Yan J, Song Y, Huo Y, Lin J. Better precision of a new robotically assisted system for total knee arthroplasty compared to conventional techniques: A sawbone model study. Int J Med Robot 2021; 17:e2263. [PMID: 33837616 DOI: 10.1002/rcs.2263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of this study was to compare the accuracy of this new HURWA robotic-assisted total knee arthroplasty (TKA) technique to the accuracy of the conventional technique in a sawbone model. METHODS The HURWA robotic-assisted TKA system was applied in the robotic group. After bone resection, all of these sawbones were scanned by the use of a structured light scanning system. Measurements of bone resections, femoral coronal and sagittal measurements, and tibial coronal and sagittal measurements were recorded. RESULTS Compared to the conventional technique, the HURWA robotic-assisted system significantly improved the accuracy of the bone resection levels and angles. In the robotic group, the accuracy of all of the bone resection levels was below 0.6 mm (with standard deviation [SD] below 0.6 mm), and all of the bone resection angles were below 0.6° (with SD below 0.4°). CONCLUSION Our data suggest that this novel HURWA robotic-assisted system can significantly improve the accuracy of bone resection levels and angles.
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Affiliation(s)
- Zheng Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Chen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Zhang
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Jun Yan
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Youdong Song
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Yujia Huo
- BEIJING HURWA-ROBOT Medical Technology Co.Ltd, Beijing, China
| | - Jin Lin
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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CORR Insights®: Are Serum Metal Ion Levels a Concern at Mid-term Followup of Revision Knee Arthroplasty With a Metal-on-metal Hinge Design? Clin Orthop Relat Res 2019; 477:2015-2016. [PMID: 31107322 PMCID: PMC7000092 DOI: 10.1097/corr.0000000000000706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Retrieval analysis of contemporary antioxidant polyethylene: multiple material and design changes may decrease implant performance. Knee Surg Sports Traumatol Arthrosc 2019; 27:2111-2119. [PMID: 30740622 DOI: 10.1007/s00167-019-05387-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/28/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE With the introduction of the Attune Knee System (DePuy) in March 2013, a new polyethylene formulation incorporating anti-oxidants was used. Although several in vitro studies have demonstrated the positive effects of antioxidants on UHMWPE, no retrieval study has looked at polyethylene damage of this system yet. It was the aim of this study to investigate the in vivo performance of this new design, by comparing it with its predecessors in retrieval analysis. METHODS 24 PFC (18 fixed bearing and 6 rotating platform designs) and 17 Attune (8 fixed bearing and 9 rotating platform designs) implants were retrieved. For retrieval analysis, a macroscopic analysis of polyethylene components, using a peer-reviewed damage grading method was used. Medio-lateral polyethylene thickness difference was measured with a peer-reviewed micro-CT based method. The roughness of metal components was measured. All findings were compared between the two designs. RESULTS Attune tibial inserts with fixed bearings showed significantly higher hood scores on the backside surface when compared with their PFC counterparts (p = 0.01), no other significant differences were found in the polyethylene damage of all the other surfaces analysed, in the surface roughness of metal components and in medio-lateral linear deformations. CONCLUSION A significant difference between PFC and Attune fixed bearing designs was found in terms of backside surface damage: multiple changes in material and design features could lead to a potential decrease of implant performance. Results from the present study may help to understand how the new Attune Knee System performs in vivo, impacting over 600,000 patients.
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