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Kowalski E, Pelegrinelli ARM, Ryan N, Dervin G, Lamontagne M. Muscle Activity and Biomechanics While Descending a Staircase After Total Knee Arthroplasty: A Study Comparing Different Posterior Stabilized and Medial Ball-and-Socket Designs. J Arthroplasty 2024:S0883-5403(24)00620-X. [PMID: 38901712 DOI: 10.1016/j.arth.2024.06.022] [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: 11/28/2023] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Many patients report more difficulty when descending stairs compared to level walking after total knee arthroplasty (TKA). Different implant designs can affect knee biomechanics and muscle activity during gait, but their effect during stair descent is unclear. The purpose of this study was to evaluate knee biomechanics and muscle activations of quadriceps, hamstrings, and gastrocnemius muscles during a stair descent task in patients who underwent TKA with either a posterior stabilized (PS) or medial ball-and-socket (MBS) implant and to compare them to a group of healthy controls. METHODS There were 28 TKA patients who were randomized to either an MBS (n = 14) or PS (n = 14) implant and were compared with 14 controls. Patients visited the biomechanics lab approximately 12 months after TKA, where knee biomechanics and muscle activity were measured as they descended a three-step staircase. RESULTS Compared to the MBS and control groups, the PS group descended the stairs with a reduced knee flexion angle and greater hamstring muscle activation throughout single limb support. Knee joint moments and power were similar between the MBS and PS groups, but neither reached the level of the control group. CONCLUSION Lower knee flexion angles and increased hamstring muscle activity indicated that the PS group descended the stairs with a stiffer knee gait pattern than the MBS group. The MBS implant design may provide additional stability as patients require less muscle activity than the PS group.
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Affiliation(s)
- Erik Kowalski
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Canada
| | - Alexandre R M Pelegrinelli
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Canada; Laboratory of Applied Biomechanics, State University of Londrina, Londrina, Brazil
| | - Nicholas Ryan
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Canada
| | - Geoffrey Dervin
- Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada
| | - Mario Lamontagne
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Canada; Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Canada.
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San Martín Valenzuela C, Tabarés-Seisdedos R, Payá Rubio A, Correa-Ghisays P, Pedrero-Sánchez JF, Silvestre Muñoz A. Efficiency assessment of follow-up methodology of patients with knee replacement to predict post-surgical functionality: a protocol for randomised control PROKnee trial. BMJ Open 2024; 14:e077942. [PMID: 38719321 PMCID: PMC11086404 DOI: 10.1136/bmjopen-2023-077942] [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: 07/25/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Even when total knee arthroplasty (TKA) is an extended treatment, most patients experience a suboptimal evolution after TKA. The objectives of this study are the following: (1) to determine the effectiveness of two different prosthesis stabilisation systems on the functionality in activities of daily life, and (2) to determine prognostic biomarkers of knee prosthesis function based on radiological information, quantification of cytokines, intra-articular markers and biomechanical functional evaluation to predict successful evolution. METHODS AND ANALYSIS The PROKnee trial was designed as a randomised controlled patient-blinded trial with two parallel groups that are currently ongoing. The initial recruitment will be 99 patients scheduled for their first TKA, without previous prosthesis interventions in lower limbs, who will be randomly divided into two groups that differed in the stabilisation methodology incorporated in the knee prosthesis: the MEDIAL-pivot group and the CENTRAL-pivot group. The maximum walking speed will be reported as the primary outcome, and the secondary results will be patient-reported questionnaires related to physical status, cognitive and mental state, radiological test, laboratory analysis and biomechanical instrumented functional performance, such as the 6-minute walking test, timed up-and-go test, gait, sit-to-stand, step-over, and ability to step up and down stairs. All the results will be measured 1 week before TKA and at 1.5, 3, 6 and 12 months after surgery. ETHICS AND DISSEMINATION All procedures were approved by the Ethical Committee for Research with Medicines of the University Clinical Hospital of Valencia on 8 October 2020 (order no. 2020/181). Participants are required to provide informed consent for the study and for the surgical procedure. All the data collected will be treated confidentially since they will be blinded and encrypted. The results from the trial will be published in international peer-reviewed scientific journals, regardless of whether these results are negative or inconclusive. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04850300).
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Affiliation(s)
- Constanza San Martín Valenzuela
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rafael Tabarés-Seisdedos
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Medicine, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Alfonso Payá Rubio
- Department of Rehabilitation, University Clinical Hospital of Valencia / INCLIVA Health Research Institute, Valencia, Spain
| | - Patricia Correa-Ghisays
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | - Antonio Silvestre Muñoz
- Department of Orthopedic Surgery, University Clinical Hospital of Valencia / INCLIVA Health Research Institute, Valencia, Spain
- Department of Surgery, Faculty of Medicine, University of Valencia, Valencia, Spain
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León-Román VE, García-Mato D, López-Torres II, Vaquero-Martín J, Calvo-Haro JA, Pascau J, Sanz-Ruíz P. Is a greater degree of constraint really harmful? Clinical biomechanical comparative study between condylar constrained knee and rotating hinge prosthesis. Clin Biomech (Bristol, Avon) 2024; 111:106149. [PMID: 37976691 DOI: 10.1016/j.clinbiomech.2023.106149] [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: 07/31/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The real degree of constraint of rotating hinge knee and condylar constrained prostheses is a matter of discussion in revision knee arthroplasty. The objective of this study is to compare the tibial rotation between implants in the clinical settings. METHODS An investigator blinded experimental study was designed including 20 patients: in 10 of them a rotating hinge knee prosthesis (Endomodel®, LINK) was implanted and in the remaining 10 a constrained condylar knee prosthesis (LCCK®, Zimmer) was used. A medial parapatellar approach was performed and implantation was performed according to conventional surgical technique. Tibial rotation was measured with two accelerometers in full extension and at 30°, 60° and 90° of flexion. Pre and postoperative Knee Injury and Osteoarthritis Outcome Score was recorded. FINDINGS Both groups were homogenous in age (73.4 years in rotating hinge knee prosthesis vs 74 years in constrained condylar knee group), sex, laterality and preoperative Knee Injury and Osteoarthritis Outcome Score (p > 0.05). The postoperative Knee Injury and Osteoarthritis Outcome Score was significantly higher in the rotating hinge knee prosthesis group (80.98 vs 76.28). The degrees of tibial rotation measured by inertial sensors in the rotating hinge knee prosthesis group were also significantly higher than those measured in the constrained condylar knee group (5.66° vs 2.1°) with p = 0.001. INTERPRETATION Rotating hinge knee prosthesis appears to represent a lower rotational constraint degree than constrained condylar knee systems in clinical practice and it may increase the clinical satisfaction. The clinical significance: Rotating hinge knee prosthesis appears to represent a lower constraint degree than constrained condylar knee systems in clinical practice.
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Affiliation(s)
- Víctor-Estuardo León-Román
- Villalba General Hospital, Carretera de Alpedrete a Moralzarzal M-608 km 41, 28400 Collado Villalba, Madrid, Spain.
| | - David García-Mato
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avda. de la Universidad, 30, 28911 Leganés, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | | | - Javier Vaquero-Martín
- Gregorio Marañón General Hospital, C/ Doctor Esquerdo 46, 28007, Madrid, Spain; Surgery Department, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - José Antonio Calvo-Haro
- Gregorio Marañón General Hospital, C/ Doctor Esquerdo 46, 28007, Madrid, Spain; Surgery Department, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040, Madrid, Spain
| | - Javier Pascau
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avda. de la Universidad, 30, 28911 Leganés, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain.
| | - Pablo Sanz-Ruíz
- Gregorio Marañón General Hospital, C/ Doctor Esquerdo 46, 28007, Madrid, Spain; Surgery Department, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Calle Dr. Esquerdo, 46, 28007, Madrid, Spain
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Ohmi T, Aizawa J, Hirohata K, Ohji S, Mitomo S, Ohara T, Yagishita K. Biomechanical characteristics of the lower extremities during running in male long-distance runners with a history of medial tibial stress syndrome: a case control study. BMC Musculoskelet Disord 2023; 24:103. [PMID: 36750819 PMCID: PMC9903575 DOI: 10.1186/s12891-023-06216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Medial tibial stress syndrome (MTSS) is a running-related injury of the lower extremities. After returning to competition, there are often recurring episodes of MTSS. Therefore, it is important to prevent the onset and recurrence of MTSS among long-distance runners. This case-control study aimed to compare the kinematics and kinetics of runners with and without previous MTSS during running to clarify the biomechanical characteristics of the lower extremity of runners with previous MTSS. METHODS Thirteen male long-distance runners aged over 18 years and asymptomatic at the time of measurement were divided into an MTSS group and a non-MTSS group based on their history of MTSS as reported in a questionnaire. The kinetics and kinematics of running were analyzed when participants ran at a speed of 2.0 ± 0.2 m/s by a three-dimensional motion analysis system and two force plates. Data regarding the joint angles, moments, and powers of the ankle, knee, and hip during the stance phase while running were extracted and compared between the two groups using the Mann-Whitney U test. RESULTS Of the 13 participants, 5 and 8 were included in the MTSS (10 legs) and non-MTSS (16 legs) groups, respectively. The ankle maximum eversion moment was significantly larger in the MTSS group than in the non-MTSS group (p = 0.04). There were no significant differences in other parameters. CONCLUSIONS This study found that the ankle maximum eversion moment during the stance phase of running was larger in the MTSS group than in the non-MTSS group. Even after the disappearance of the symptoms of MTSS, the running biomechanics of participants with previous MTSS differed from those of participants without previous MTSS.
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Affiliation(s)
- Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku, 113-8519, Japan.
| | - Junya Aizawa
- grid.258269.20000 0004 1762 2738Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Kenji Hirohata
- grid.265073.50000 0001 1014 9130Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku 113-8519 Japan
| | - Shunsuke Ohji
- grid.265073.50000 0001 1014 9130Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku 113-8519 Japan
| | - Sho Mitomo
- grid.265073.50000 0001 1014 9130Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku 113-8519 Japan
| | - Toshiyuki Ohara
- grid.265073.50000 0001 1014 9130Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku 113-8519 Japan
| | - Kazuyoshi Yagishita
- grid.265073.50000 0001 1014 9130Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, Bunkyo-Ku 113-8519 Japan
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Kour RYN, Guan S, Dowsey MM, Choong PF, Pandy MG. Kinematic function of knee implant designs across a range of daily activities. J Orthop Res 2022; 41:1217-1227. [PMID: 36317847 DOI: 10.1002/jor.25476] [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: 05/16/2022] [Revised: 08/28/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
The aim of this randomized controlled trial was to measure and compare six-degree-of-freedom (6-DOF) knee joint motion of three total knee arthroplasty (TKA) implant designs across a range of daily activities. Seventy-five TKA patients were recruited to this study and randomly assigned a posterior-stabilized (PS), cruciate-retaining (CR), or medial-stabilized (MS) implant. Six months after surgery, patients performed five activities of daily living: level walking, step-up, step-down, sit-to-stand, and stand-to-sit. Mobile biplane X-ray imaging was used to measure 6-DOF knee kinematics and the center of rotation of the knee in the transverse plane for each activity. Mean 6-DOF knee kinematics were consistently similar for PS and CR, whereas MS was more externally rotated and abducted, and lateral shift was lower across all activities. Peak-to-peak anterior drawer for MS was also significantly lower during walking, step-up, and step-down (p < 0.017). The center of rotation of the knee in the transverse plane was located on the medial side for MS, whereas PS and CR rotated about the lateral compartment or close to the tibial origin. The kinematic function of MS was more similar to that of the healthy knee than PS and CR based on reduced paradoxical anterior translation at low flexion angles and a transverse center of rotation located in the medial compartment. Overall, 6-DOF knee joint motion for PS and CR were similar across all daily activities, whereas that measured for MS was appreciably different. The kinematic patterns observed for MS reflects a highly conforming medial articulation in the MS design.
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Affiliation(s)
- R Y Nigel Kour
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Shanyuanye Guan
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
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Tang S, Zheng L, Luo Y, Wu R, Tian Q, Wang L. Validation of an MRI Technique for the 6-DOF Knee Kinematics Measurement. Front Bioeng Biotechnol 2022; 10:904012. [PMID: 36601392 PMCID: PMC9806800 DOI: 10.3389/fbioe.2022.904012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/09/2022] [Indexed: 01/07/2023] Open
Abstract
Background: For total knee arthroplasty (TKA), the optimal rotational position of the femoral component is felt to be critically important. The current knee joint kinematics measurement technology is unable to identify the exact rotation axis of the knee joint, the main reasons being low measurement accuracy and insufficient three-dimensional data (2D-3D image matching technology). In order to improve the effect of TKA surgery, we proposed a knee joint kinematics measurement method, based on the MRI technology, and verified its measurement accuracy. We then employed this method to identify the personalized optimal rotation axis of the knee joint for TKA patients. Purposes: The purpose of the study was 1) to propose a method for measuring knee joint kinematics and verify its accuracy and 2) to propose a method for determining the optimal rotation axis of knee joint for TKA surgery, based on accurate kinematic measurement results. Materials and Methods: The experiment was divided into two parts: in vitro and in vivo. The purpose of the in vitro experiment was to verify the measurement accuracy of our method. We fixed two aquarium stones (approximately 10 cm * 10 cm * 10 cm in size, close to the size of the distal femur and proximal tibia) firmly on the fixed and moving arms of the goniometer/vernier caliper with glue and immersed the aquarium stones in the water to capture MRI images. The MRI images were then processed with MATLAB software, and the relative motion of the two aquarium stones was measured. The measurement accuracy of our method was verified via the scale reading of the moving arm on the goniometer/vernier caliper. In vivo, 36 healthy elderly participants (22 females, 14 males) were recruited from the local community; our method was then employed to measure the relative motion of the tibia and femur and to observe the rollback and screw home motion of the medial/lateral condyle of the femur, which was identified as specific kinematic features of the knee joint. Results: In vitro, all measurements were accurate to <1 mm and <1°. In vivo, all knee measurements showed rollback motion (the rollback distance of the medial femoral condyle was 18.1 ± 3.7 mm and that of the lateral condyle was 31.1 ± 7.3 mm) and screw home motion. Conclusion: In the application scenario of knee joint kinematics measurement, our method has an accuracy of <1° of rotation angle and <1 mm of translation for all reference points, and it can be employed to identify the most stable axis of the knee joint. Significance: Using our method to accumulate data on the knee rotation axis of more subjects to establish an average rotation axis of a given population may help in knee prosthesis design and reduce the patient dissatisfaction rate. Individually measuring the patient's rotation axis before TKA surgery and adjusting the prosthesis installation in TKA may further reduce the patient dissatisfaction rate, and automatic computer measurement may be realized in the future, but it is still time-consuming for now.
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Affiliation(s)
- Shixiong Tang
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China,Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
| | - Liwen Zheng
- Department of Rehabilitation, The Second Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Liwen Zheng,
| | - Yongheng Luo
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ren Wu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qunyan Tian
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lei Wang
- School of Information Science and Engineering, Central South University, Changsha, China
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Batailler C, Foissey C, Fary C, Naaim A, Servien E, Lustig S. Similar kinematic patterns between revision total stabilized (TS) and primary posterior stabilized (PS) knee prostheses: a prospective case-controlled study with gait assessment. Knee Surg Sports Traumatol Arthrosc 2022; 30:2714-2722. [PMID: 33948674 DOI: 10.1007/s00167-021-06591-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE There are increased surgical considerations when revising total knee arthroplasty (TKA) in active patients. Few studies have assessed if a semi-constrained [Total Stabilized (TS)] prostheses has similar knee biomechanics to a primary posterior stabilized (PS) prosthesis. The aim was to compare the gait parameters in patients with PS or TS TKA and normal controls. METHODS 32 patients with TKA were prospectively included with either a primary PS (n = 15) or a revision TS (n = 17) prosthesis. Gait analysis was performed at 6 months postoperatively for each patient, with an optoelectronic knee assessment device (KneeKG®) assessing the displacement of the tibia relative to the femur during the different gait phases (flexion/extension, anterior/posterior translation, adduction/abduction, internal/external rotation). A control group (n = 12) of healthy knees was compared with the TKA groups. RESULTS There were no significant kinematic differences between PS and TS groups. The maximum knee flexion during gait was 53° ± 8.1° in the PS group vs 52° ± 8.7° in the TS group. The antero-posterior translation was similar in both group (2.3 ± 0.5 mm vs 2.6 ± 0.9 mm, respectively). Peak varus angle during loading and swing phase was slightly higher in the TS group (2.7° ± 0.7° and 5.2° ± 0.9°) than in the PS group (2.9° ± 0.6° and 5.6° ± 1.2°), without significant difference. The ranges in internal/external rotation were similar between PS and TS TKA (3.7° ± 0.5° vs 3.3° ± 0.6°, respectively). Both designs approached closely the normal gait patterns of the control group except in the frontal plane. CONCLUSION Single radius TS TKA has gait parameters similar to single radius PS TKA. Use of a single radius TS TKA in revision TKA is not detrimental to a patient's gait pattern. Both designs approached closely the normal gait patterns of the control group. LEVEL OF EVIDENCE Prospective, case-control study; Level III.
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Affiliation(s)
- Cécile Batailler
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France.
| | - Constant Foissey
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Camdon Fary
- Orthopaedic Department, Western Health, Melbourne, Australia
| | - Alexandre Naaim
- Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Elvire Servien
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
| | - Sébastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004, Lyon, France
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Li C, Dong M, Yang D, Zhang Z, Shi J, Zhao R, Wei X. Comparison of posterior cruciate retention and substitution in total knee arthroplasty during gait: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:152. [PMID: 35264236 PMCID: PMC8906002 DOI: 10.1186/s13018-022-03047-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background To compare the gait patterns between posterior cruciate retention and substitution in total knee arthroplasty (TKA). Methods Electronic databases including the PubMed, Embase, CINAHL, Web of Science, and Cochrane databases were searched to identify clinical trials investigating posterior cruciate retention versus substitution in TKA. The outcome measurements were the kinematic gait parameters (flexion at heel strike, maximum flexion during loading response, flexion range during loading, minimal flexion at terminal stance, maximal flexion at the swing, and total flexion during the gait cycle), Knee Society Score (KSS), knee flexion, knee extension, and walking speed. Statistical software Review Manager 5.4 and Stata 14.0 were used for data analysis. Results There were finally 9 studies included in this meta-analysis. The results did not reveal differences between posterior cruciate retention (CR) and posterior cruciate substitution (PS) groups in TKA, in terms of kinematic gait parameters, knee extension, walking speed, and KSS. However, the PS group had a significantly larger knee flexion angle than that in the CR group [weighted mean difference = − 3.20, 95% CI − 6.13 to − 0.28, P = 0.03]. Conclusion Both the posterior cruciate retention and posterior cruciate substitution lead to obvious improvements in patient function and have their advantages in getting a good cup position. The PS design is significantly better on the knee flexion, while there are no statistical differences in kinematic gait parameters and outcome scores between them. This might indicate that surgeons do not necessarily need a PS design to substitute the posterior cruciate ligament during TKA.
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Affiliation(s)
- Chunjiang Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, China
| | - Mingjie Dong
- Department of Orthopaedics, The Second Clinical Medical College of Shanxi Medical University, Taiyuan, 030001, China
| | - Dinglong Yang
- Department of Orthopaedics, The Second Clinical Medical College of Shanxi Medical University, Taiyuan, 030001, China
| | - Zhiqiang Zhang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, China
| | - Junjun Shi
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, China
| | - Ruipeng Zhao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, China
| | - Xiaochun Wei
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, China.
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Ohmi T, Yamada T, Misaki S, Tazawa T, Shimamura R, Kato J, Sugimoto K. Differences in gait kinetics and kinematics between patients with rotating hinge knee and cruciate-retaining prostheses: a cross-sectional study. J Phys Ther Sci 2022; 34:635-641. [PMID: 36118659 PMCID: PMC9444520 DOI: 10.1589/jpts.34.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University: 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Takumi Yamada
- Faculty of Health Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Japan
| | - Sadaya Misaki
- Department of Rehabilitation Medicine, Sonoda Daiichi Hospital, Japan
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Elbardesy H, Salamah HM, McLeod A, Thada PK, Mohammed ER, Hanifa FA, Roshdy M, Guerin S. Medial pivot versus (cam post) posterior stabilised total knee arthroplasty, systematic review and meta-analysis of 3837 knees. Acta Orthop Belg 2021; 87:665-680. [PMID: 35172434 DOI: 10.52628/87.4.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the current literature, there is no consensus as to whether the medial pivot (MP) or posterior-stabilised (PS) knee provides the best result for the patient in the context of post-operative range of motion (ROM) and patient reported outcome measures (PROMs). The aim of this systematic review is to provide this equipoise with some clarity. We conducted this study following both the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies comparing the MP and PS knees from all regions and written in any language were included. Twenty- one studies were included in this meta-analysis. They were prepared and analysed using Review Manager V5.0 [Computer Program] (RevMan5). We calculated the risk ratio to measure the treatment effect, taking the heterogeneity of the studies into consideration. Random-effect models were also utilised. MP knees were found to have a significant advantage over PS knees in terms of WOMAC score at the midterm follow up, and insignificant advantages over PS knees in terms of ROM and FJS at one and two years follow- up. Additionally, the PS knees demonstrated an in significantly higher Knee Society Score (KSS) at short and midterm follow up. In terms of ROM, KSS, OKS and FJS this meta-analysis suggests a non-significant advantages for the MP knee compared with the PS prothesis in the short term. The MP implant also showed a significantly superior WOMAC score at short-term follow-up. An extended follow-up period is required to evaluate whether the MP knee is superior than the PS in the long-term.
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Jenny JY, Bercovy M, Cazenave A, Gaillard T, Châtain F, Jolles BE, Rouvillain JL, Saragaglia D. No difference in 13-year survival after medial pivot or central pivot mobile bearing total knee arthroplasty. A propensity matched comparative analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3648-3653. [PMID: 33165636 DOI: 10.1007/s00167-020-06355-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The present study was designed to evaluate the long-term results (more than 10 years) of mobile bearing total knee arthroplasty (TKA) and to compare the survival of medial pivot axis (MPA) and central pivot axis (CPA) TKAs. The primary hypothesis was that the 10- to 15-year survival rate of MPA TKAs will be better than CPA TKAs. METHODS A national, multicenter, retrospective study was performed in France. In this case-control design, 1154 TKAs were paired into the CPA group (control group: 577 cases) and MPA group (study group: 577 cases) based on a logistic regression analysis of age, gender, body mass index and severity of the coronal deformity, defining the propensity score for each case. Final survival information follow-up was obtained for 946 cases (82%). RESULTS There was no significant difference between the control and study groups for any baseline data. Twenty-two prosthetic revisions (2%) were performed for mechanical reasons during the follow-up period. There was no significant difference between the 13-year survival rates of CPA (98%) and MPA (97%) TKAs. There was no significant difference between groups in their final Oxford and Knee Society scores. CONCLUSION Our findings do not support the assumption that medialization of the pivot axis of a mobile bearing TKA improves clinical results or survival. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jean-Yves Jenny
- University Hospital Strasbourg, CCOM, 10 avenue Baumann, 67400, Illkirch, France.
| | - Michel Bercovy
- Clinique Arago, 187A Rue Raymond Losserand, 75014, Paris, France
| | - Alain Cazenave
- Institut CALOT, Department of Orthopedic Surgery, 52 rue du Dr Calot, 62600, Berck-sur-Mer, France
| | - Thierry Gaillard
- Polyclinique du Beaujolais, 120 Ancienne Route de Beaujeu, 69400, Arnas, France
| | - Frédéric Châtain
- Pole Santé Axone, 75 Avenue Gabriel Péri, 38400, Saint-Martin-d'Hères, France
| | - Brigitt E Jolles
- Swiss BioMotion Lab, Department of Musculoskeletal Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Avenue Louis-Ruchonnet 57, 1003, Lausanne, Switzerland.,Institute of Micro Engineering, Ecole Polytechnique Fédérale de Lausanne, Route Cantonale, 1015, Lausanne, Switzerland
| | - Jean-Louis Rouvillain
- Department of Orthopaedic and Trauma Surgery, Hôpital Zobda Quitman, 97261, Fort-de-France, France
| | - Dominique Saragaglia
- Department of Osteoarthritis and Sport Surgery, Traumatology of the Limbs, Grenoble-Alpes South Teaching Hospital, 38130, Echirolles, France
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