1
|
Nakamura E, Okamoto N, Masuda T, Hisanaga S, Yugami M, Oniki Y, Miyamoto T. Medial-pivot design does not provide superior clinical results compared to posterior-stabilized total knee arthroplasty despite kinematic differences during step-up and lunge activities: A prospective randomized controlled trial under medial tight soft tissue balance. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39101251 DOI: 10.1002/ksa.12399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/19/2024] [Accepted: 07/21/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE This study aimed to compare in vivo kinematics during weight-bearing daily activities and determine the relationship with clinical outcomes in patients undergoing total knee arthroplasty (TKA) with a medial-pivot (MP, Evolution™) versus a posterior-stabilized (PS, Persona®) design under constant conditions of intraoperative soft tissue balance. METHODS Forty patients undergoing MP or PS-TKA under similar conditions of soft tissue balance were enrolled in this prospective randomized controlled trial. Outcome measures included clinical knee society scores (KSS) and knee injury and osteoarthritis outcome scores (KOOS). A kinematic assessment was conducted while the participants performed lunge and step-up activities under fluoroscopic guidance. RESULTS Eighteen patients in each arm completed 1-year follow-up and were included in the analysis. All patients experienced pain relief and satisfactory knee function postoperatively. In kinematics, in the MP arm, the medial femoral condyle remained consistent, whereas the lateral femoral condyle gradually shifted posteriorly with increasing knee flexion. Conversely, in the PS arm, paradoxical anterior movement of the medial femoral condyle accompanied the lateral pivot motion. During lunge and step-up activities, a medial-pivot motion was observed in 83% and 72% of knees in the MP arm, respectively, compared with 22% and 11% in the PS arm. Despite these differences in kinematics, there were no statistically significant differences in the KSS and KOOS between the two groups. CONCLUSION Under weight-bearing conditions during flexion, knees that underwent Evolution™ MP-TKA did not show superior clinical results compared to Persona® PS-TKA, despite exhibiting in vivo kinematics closely resembling the normal in vivo pattern. LEVEL OF EVIDENCE Therapeutic studies-Level I.
Collapse
Affiliation(s)
- Eiichi Nakamura
- Department of Orthopedic Surgery, Kumamoto Kaiseikai Hospital, Kumamoto, Japan
- Department of Orthopedic Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Nobukazu Okamoto
- Department of Orthopedic Surgery, Kumamoto Kaiseikai Hospital, Kumamoto, Japan
| | - Tetsuro Masuda
- Department of Orthopedic Surgery, Kumamoto Kaiseikai Hospital, Kumamoto, Japan
| | - Satoshi Hisanaga
- Department of Orthopedic Surgery, Kumamoto Kaiseikai Hospital, Kumamoto, Japan
| | - Masaki Yugami
- Department of Orthopedic Surgery, Kumamoto Kaiseikai Hospital, Kumamoto, Japan
| | - Yasunari Oniki
- Department of Orthopedic Surgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Kumamoto Kaiseikai Hospital, Kumamoto, Japan
| |
Collapse
|
2
|
Li M, Fu G, Huang W, Lin B, Zhang R, Zhang Y, Ma Y, Zheng Q. Alterations of kinematics in knees after single versus multiple radius femoral prostheses total knee arthroplasty: a retrospective study. BMC Musculoskelet Disord 2020; 21:434. [PMID: 32622357 PMCID: PMC7334846 DOI: 10.1186/s12891-020-03425-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Design modifications in prostheses may cause alterations in gait kinematics, thus influencing functional restoration of knees after total knee arthroplasty (TKA). The aim of the study was to investigate the differences in gait kinematics and clinical outcomes after single radius (SR) versus multiple radius (MR) TKA. METHOD The present retrospective study included 38 unilateral TKA involving 20 knees using MR design implant and 18 knees using SR design implant. Thirty-six healthy volunteers were also recruited. The mean follow-up time was 16 ± 3 months. At the end of follow-up, the 6 degrees of freedom (DOF) kinematics of knees and range of motion (ROM) were measured with a portable optical tracking system. Knee society score (KSS) and knee injury, and osteoarthritis outcome score (KOOS) were also collected. RESULTS Patients in the SR group had significantly higher scores in activities of daily living (84.7 ± 15.9) and sports and recreation (67.5 ± 25.2) KOOS sub-score than MR group (69.9 ± 17.6, P = 0.012; 50.0 ± 20.8, P = 0.027, respectively). Significant differences were detected between MR knees and SR knees (1.82° ± 3.11° vs 4.93° ± 3.58°, P = 0.009), and MR knees and healthy knees (1.82° ± 3.11° vs 3.62° ± 3.52°, P = 0.032) in adduction/abduction ROM. The proximal/distal translation was significantly smaller in MR knees (0.58 ± 0.54 cm) compared with SR knees (1.03 ± 0.53 cm, P = 0.003) or healthy knees (0.84 ± 0.45 cm, P = 0.039). SR knees (0.24 ± 0.40 cm) had smaller translation compared with the MR group (0.54 ± 0.33 cm, P = 0.017) and control group (0.67 ± 0.36 cm, P = 0.028). No significant difference was detected in the other DOFs during the gait cycle. Significant difference was detected in extension/flexion, internal/external rotation, adduction/abduction, proximal/distal and medial/lateral among MR, SR and healthy knees. CONCLUSION After TKA, patients have altered gait kinematics compared with the control group. MR and SR design showed varied characteristics in 6 DOF gait kinematics, which could be the cause of the difference in functional outcome.
Collapse
Affiliation(s)
- Mengyuan Li
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Guangtao Fu
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Wenhan Huang
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Bofu Lin
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
- Shantou University Medical College, Shantou, 515063, PR China
| | - Ruiying Zhang
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Yu Zhang
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China
| | - Yuanchen Ma
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China.
| | - Qiujian Zheng
- Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080, PR China.
| |
Collapse
|