1
|
Kono K, Tomita T, Yamazaki T, Inui H, Tanaka S, D'Lima DD. In Vivo Kinematics and Cruciate Ligament Tension Are Not Restored to Normal After Bicruciate-Preserving Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00300-0. [PMID: 38552864 DOI: 10.1016/j.arth.2024.03.060] [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: 10/13/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Whether cruciate ligament forces in cruciate-preserving designs, such as unicompartmental knee arthroplasty (UKA) or bi-cruciate-retaining total knee arthroplasty (BCR-TKA), differ from those in normal knees remains unknown. The purpose of this study was to compare the in vivo kinematics and cruciate ligament force in knees before and after UKA or BCR-TKA to those in normal knees during high-flexion activity. METHODS Overall, twenty normal knees, 17 knees with medial UKA, and 15 knees with BCR-TKA were fluoroscopically examined while performing a squatting activity. A 2-dimensional or 3-dimensional registration technique was employed to measure tibio-femoral kinematics. Ligament strains and tensions in the anteromedial bundle of the anterior cruciate ligament and posterolateral bundle of the anterior cruciate ligament and the anterolateral bundle of the posterior cruciate ligament (aPCL) and posteromedial bundle of the posterior cruciate ligament (pPCL) during knee flexion were analyzed. RESULTS Tension in both bundles of the anterior cruciate ligament decreased with flexion. At 60° of flexion, anteromedial bundle of the anterior cruciate ligament tension in postoperative UKA knees was greater than that in normal knees. At 30° of flexion, posterolateral bundle of the anterior cruciate ligament tension in postoperative UKA knees was greater than that in normal knees. On the other hand, aPCL and pPCL tensions increased with flexion. From 40 to 110° of flexion, the postoperative aPCL tension in UKA knees was greater than that in normal knees. At 110° of flexion, the preoperative pPCL tension in UKA knees was greater than that in normal knees. In addition, the postoperative pPCL tension in UKA knees was larger than that in normal knees beyond 20° of flexion. Furthermore, the pPCL tension of postoperative BCR-TKA knees was larger than that in normal knees from 20 to 50° and beyond 90° of flexion. CONCLUSIONS The cruciate ligament tensions, especially posterior cruciate ligament tension in knees after UKA, were greater than those in the normal knees. Surgeons performing bi-cruciat-preserving knee arthroplasties should therefore balance cruciate ligament tension more carefully in flexion and extension.
Collapse
Affiliation(s)
- Kenichi Kono
- Faculty of Medicine, Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan; Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Tomita
- Department of Orthopedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Health Science, Graduate School of Health Science, Morinomiya University of Medical Sciences, Osaka, Japan
| | - Takaharu Yamazaki
- Faculty of Engineering, Department of Information Systems, Saitama Institute of Technology, Fukaya, Saitama, Japan
| | - Hiroshi Inui
- Faculty of Medicine, Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan; Department of Orthopedic Surgery, Saitama Medical University, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Sakae Tanaka
- Faculty of Medicine, Department of Orthopedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research & Education, Scripps Health, La Jolla, California
| |
Collapse
|
2
|
Nedopil AJ, Hernandez AM, Boone JM, Howell SM, Hull ML. Correcting for distal femoral asymmetry is necessary to determine postoperative alignment deviations from planned alignment of the femoral component. Knee 2023; 42:193-199. [PMID: 37054496 DOI: 10.1016/j.knee.2023.01.013] [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: 02/23/2022] [Revised: 08/07/2022] [Accepted: 01/26/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND One method for assessing the accuracy of manual, patient-specific, navigational, and robotic-assisted total knee arthroplasty (TKA) instrumentation is to use a post-operative computer tomogram and determine the deviation of the femoral component alignment relative to the planned alignment in the native (i.e. healthy) contralateral distal femoral epiphysis. However, side-to-side asymmetry might introduce errors which inflate alignment deviations. This study quantified asymmetry in the distal femoral epiphysis. METHODS High resolution CT images (0.5 mm slice thickness) were acquired from bilateral lower limb specimens of 13 skeletally mature subjects with no skeletal abnormalities. Images were segmented to generate 3D femur models. Asymmetry was quantified by differences in positions and orientations required to shape-match the distal epiphysis of the mirror 3D femur model to the distal epiphysis of the contralateral 3D femur model. RESULTS Asymmetry was due to random rather than systematic differences. Random differences (i.e. standard deviations) in proximal-distal (P-D) and anterior-posterior (A-P) positions were 1.1 mm and in varus-valgus (V-V) and internal-external (I-E) orientations were 0.9° and 1.3°, respectively. These represented substantial relative errors of up to 50 % in previously reported overall alignment deviations. CONCLUSIONS Although small in an absolute sense, asymmetry of the distal femur epiphysis introduced substantial relative errors when assessing accuracy of femoral component alignment in TKA. When post-operative computer tomograms are used to assess the accuracy of manual, patient specific, navigational, and robotic-assisted TKA instrumentation, the overall deviation should be corrected for asymmetry to better indicate the accuracy of the surgical technique.
Collapse
Affiliation(s)
- Alexander J Nedopil
- Department of Orthopaedic Surgery, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97074 Würzburg, Germany.
| | - Andrew M Hernandez
- Department of Radiology, University of California at Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - John M Boone
- Department of Radiology, University of California at Davis, 4860 Y Street, Suite 3100, Sacramento, CA 95817, USA
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California at Davis, 451 E. Health Sciences Drive, Room 2303, Davis, CA 95616, United States.
| | - Maury L Hull
- Department of Biomedical Engineering, University of California at Davis, 451 E. Health Sciences Drive, Room 2303, Davis, CA 95616, United States; Department of Mechanical Engineering, University of California at Davis, One Shields Avenue, Davis, CA 95616 USA; Department of Orthopaedic Surgery, University of California at Davis Medical Center, Sacramento, CA 95817 USA.
| |
Collapse
|
3
|
Tay ML, Carter M, Bolam SM, Zeng N, Young SW. Robotic-arm assisted unicompartmental knee arthroplasty system has a learning curve of 11 cases and increased operating time. Knee Surg Sports Traumatol Arthrosc 2023; 31:793-802. [PMID: 34981161 DOI: 10.1007/s00167-021-06814-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE UKA has higher revision risk, particularly for lower volume surgeons. While robotic-arm assisted systems allow for increased accuracy, introduction of new systems has been associated with learning curves. The aim of this study was to determine the learning curve of a UKA robotic-arm assisted system. The hypothesis was that this may affect operative times, patient outcomes, limb alignment, and component placement. METHODS Between 2017 and 2021, five surgeons performed 152 consecutive robotic-arm assisted primary medial UKA, and measurements of interest were recorded. Patient outcomes were measured with Oxford Knee Score, EuroQol-5D, and Forgotten Joint Score at 6 weeks, 1 year, and 2 years. Surgeons were grouped into 'low' and 'high' usage groups based on total UKA (manual and robotic) performed per year. RESULTS A learning curve of 11 cases was found with operative time (p < 0.01), femoral rotation (p = 0.02), and insert sizing (p = 0.03), which highlighted areas that require care during the learning phase. Despite decreased 6-week EQ-5D-5L VAS in the proficiency group (77 cf. 85, p < 0.01), no difference was found with implant survival (98.2%) between phases (p = 0.15), or between 'high' and 'low' usage surgeons (p = 0.23) at 36 months. This suggested that the learning curve did not lead to early adverse effects in this patient cohort. CONCLUSION Introduction of a UKA robotic-arm assisted system showed learning curves for operative times and insert sizing but not for implant survival at early follow-up. The short learning curve regardless of UKA usage indicated that robotic-arm assisted UKA may be particularly useful for low-usage surgeons. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
Collapse
Affiliation(s)
- Mei Lin Tay
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand. .,Department of Orthopaedic Surgery, North Shore Hospital, Waitematā DHB, Auckland, New Zealand.
| | | | - Scott M Bolam
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, Auckland DHB, Auckland, New Zealand
| | - Nina Zeng
- Department of Orthopaedic Surgery, North Shore Hospital, Waitematā DHB, Auckland, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, 85 Park Road, Grafton, 1023, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Waitematā DHB, Auckland, New Zealand
| |
Collapse
|
4
|
Zhang D, Zhang X. Safety and Efficacy of Unicondylar Knee Prosthesis Treatment for Unicompartmental Osteoarthritis of the Knee Joint. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2938380. [PMID: 35872952 PMCID: PMC9307368 DOI: 10.1155/2022/2938380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
Background Knee osteoarthritis (KOA) is a chronic disease that seriously endangers the health of the elderly. Choosing appropriate surgery for knee osteoarthritis patients is especially important. Objective To investigate the safety and efficacy of unicondylar knee prosthesis treatment for unicompartmental osteoarthritis of the knee. Materials and Methods One hundred patients with unicondylar osteoarthritis of the knee treated in our hospital from June 2019 to June 2021 were selected as retrospective study subjects and were divided into 50 cases each in the comparison group and the observation group according to the different surgical methods. Among them, the comparison group was treated with unicondylar knee arthroplasty (UKA), and the observation group was treated with unicondylar knee prosthesis replacement, and the differences in AKS score, knee flexion angle, tibial angle orthosis, joint mobility, and postoperative recovery were compared between the two groups. Results The AKS score and knee flexion angle score of the observation group were higher than those of the comparison group after surgery. However, the tibial angle orthopedic score of the observation group was significantly lower than that of the comparison group after surgery for comparison, and the VAS score of the observation group was lower than that of the comparison group. However, the Lysholm score of the observation group was higher than that of the control group after surgery (P < 0.05). The complication rate of patients in the observation group was significantly lower than that of the comparison group, and the HSS score, VAS score, and knee mobility (ROM) of the two groups were statistically significant (P < 0.05) when compared at 7 d after surgery and 6 months after surgery. Conclusion The clinical efficacy of unicondylar knee prosthesis replacement for osteoarthritis of the knee is better than that of unicondylar knee arthroplasty (UKA) treatment.
Collapse
Affiliation(s)
- Dahua Zhang
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Medical University, 710000, China
| | - Xiang Zhang
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Medical University, 710000, China
| |
Collapse
|
5
|
Kono K, Inui H, Tomita T, D'Lima DD, Yamazaki T, Konda S, Taketomi S, Yamagami R, Kawaguchi K, Sameshima S, Kage T, Tanaka S. Cruciate ligament force of knees following mobile-bearing unicompartmental knee arthroplasty is larger than the preoperative value. Sci Rep 2021; 11:18233. [PMID: 34521921 PMCID: PMC8440682 DOI: 10.1038/s41598-021-97655-z] [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] [Received: 04/10/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022] Open
Abstract
We analyzed the implantation effects on cruciate ligament force in unicompartmental knee arthroplasty (UKA) and determined whether kinematics is associated with the cruciate ligament force. We examined 16 patients (17 knees) undergoing medial UKA. Under fluoroscopy, each participant performed a deep knee bend before and after UKA. A two-dimensional/three-dimensional registration technique was employed to measure tibiofemoral kinematics. Forces in the anteromedial and posterolateral bundles of both the anterior cruciate ligament (aACL and pACL) and the anterolateral and posteromedial bundles of the posterior cruciate ligament (aPCL and pPCL) during knee flexion were analyzed pre- and post-UKA. Correlations between changes in kinematics and ligament forces post-UKA were also analyzed. Preoperatively, the aACL forces were highly correlated with anteroposterior (AP) translation of the lateral condyles (Correlation coefficient [r] = 0.59). The pPCL forces were highly correlated with the varus–valgus angulation (r = − 0.57). However, postoperatively, the PCL forces in both bundles were highly correlated with the AP translation of the medial femoral condyle (aPCL: r = 0.62, pPCL: r = 0.60). The ACL and PCL forces of the knees post-UKA were larger than those of the knees pre-UKA. Kinematic changes were significantly correlated with the cruciate ligament force changes.
Collapse
Affiliation(s)
- Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Darryl D D'Lima
- Department of Molecular Medicine Arthritis Research, The Scripps Research Institute, La Jolla, CA, 92037, USA.,Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, 92121, USA
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, 1690 Fusaiji, Fukaya, Saitama, 369-0293, Japan
| | - Shoji Konda
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| |
Collapse
|