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Cohen D, Greenberg A, Maliarov A, Seligman D, Backstein D. Long-term outcomes of the Nexgen © posterior stabilized knee: minimum 15 year follow-safe and effective. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2943-2949. [PMID: 36912950 PMCID: PMC10009351 DOI: 10.1007/s00590-023-03514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Studying long-term survivorship and functional outcomes for specific prostheses is critical for elucidating areas in need of design improvement. This study reports the long-term of the NexGen Posterior Stabilized (PS) Total Knee implant (TKA) (Zimmer Biomet, Warsaw IN) Performed by a single surgeon. METHODS Data from patients treated with the NexGen PS TKA between January 2003 and December 2005 with a minimal follow-up of 15 years was collected from a prospectively collected database. Survivorship rates and Oxford Knee Scores (OKS) were obtained for those patients available for follow-up. RESULTS Ninety-five patients met the inclusion criteria during the study period. OKS was available for 44 (46%) patients. Ten patients required revision surgery (10.52%). Implant-specific survivorship of all cases that were reviewed was 98%. Survivorship of implants in patients that we were able to reach, or deceased patients was 93%. The average Oxford Knee Score was 39.1 (14-48. SD ± 7.70) with 48 being the maximal score. CONCLUSION Despite some concerns about durability of this implant, good longevity and function was demonstrated. At a minimum of 15 years follow-up in this cohort. Given these results design features of this system should be considered for future generations of implants.
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Affiliation(s)
- Daniel Cohen
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - Arieh Greenberg
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - Anton Maliarov
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - David Seligman
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - David Backstein
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
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Belvedere C, Siegler S, Fortunato A, Caravaggi P, Liverani E, Durante S, Ensini A, Konow T, Leardini A. New comprehensive procedure for custom-made total ankle replacements: Medical imaging, joint modeling, prosthesis design, and 3D printing. J Orthop Res 2019; 37:760-768. [PMID: 30537247 DOI: 10.1002/jor.24198] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 11/30/2018] [Indexed: 02/04/2023]
Abstract
Many failures in total joint replacement are associated to prosthesis-to-bone mismatch. With recent additive-manufacturing, that is, 3D-printing, custom-made prosthesis can be created by laser-melting metal powders layer-by-layer. Ankle replacement is particularly suitable for this progress because of the limited number of sizes and the poor bone stock. In this study a novel procedure is presented for subject-specific ankle replacements, including medical-imaging, joint modelling, prosthesis design, and 3D-printing. Three shank-foot specimens were CT-scanned, and corresponding 3D bone models of the tibia, fibula, talus, and calcaneus were obtained. From these models, specimen-specific implant sets were designed according to three different concepts, and 3D-printed from cobalt-chromium-molybdenum powder. Accuracy of the overall procedure was assessed via distance map comparisons between original anatomical and final metal implants. Restoration of natural ankle joint mechanics was check after implantation of each of the three sets. In a special rig, a manually-driven dorsi/plantar-flexion was applied throughout the passive arc. Additionally, at three different joint positions, joint torques were imposed in the frontal and axial anatomical planes. Mean manufacturing errors were found to be smaller than 0.08 mm. Consistent motion patterns were observed over repetitions, with the mean standard deviation smaller than 1.0 degree. In each ankle specimen, mobility, and stability at the replaced joints compared well with the original natural condition. For the first time, custom-made implants for total ankle replacements were designed, manufactured with additive technology and tested. This procedure is a first fundamental step toward the development of completely personalized prostheses. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania
| | | | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Erica Liverani
- Department of Industrial Engineering, Università di Bologna, Bologna, Italy
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Ensini
- 1st Orthopaedic-Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tobias Konow
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Yin P, Li JS, Kernkamp WA, Tsai TY, Baek SH, Hosseini A, Lin L, Tang P, Li G. Analysis of in-vivo articular cartilage contact surface of the knee during a step-up motion. Clin Biomech (Bristol, Avon) 2017; 49:101-106. [PMID: 28910722 PMCID: PMC5681875 DOI: 10.1016/j.clinbiomech.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Numerous studies have reported on the tibiofemoral articular cartilage contact kinematics, however, no data has been reported on the articular cartilage geometry at the contact area. This study investigated the in-vivo tibiofemoral articular cartilage contact biomechanics during a dynamic step-up motion. METHODS Ten healthy subjects were imaged using a validated magnetic resonance and dual fluoroscopic imaging technique during a step-up motion. Three-dimensional bone and cartilage models were constructed from the magnetic resonance images. The cartilage contact along the motion path was analyzed, including cartilage contact location and the cartilage surface geometry at the contact area. FINDINGS The cartilage contact excursions were similar in anteroposterior and mediolateral directions in the medial and lateral compartments of the tibia plateau (P>0.05). Both medial and lateral compartments were under convex (femur) to convex (tibia) contact in the sagittal plane, and under convex (femur) to concave (tibia) contact in the coronal plane. The medial tibial articular contact radius was larger than the lateral side in the sagittal plane along the motion path (P<0.001). INTERPRETATIONS These data revealed that both the medial and lateral compartments of the knee experienced convex (femur) to convex (tibia) contact in sagittal plane (or anteroposterior direction) during the dynamic step-up motion. These data could provide new insight into the in-vivo cartilage contact biomechanics research, and may provide guidelines for development of anatomical total knee arthroplasties that are aimed to reproduce normal knee joint kinematics.
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Affiliation(s)
- Peng Yin
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA,Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, No. 8 GongTiNanLu, Chao-Yang District, Beijing, 100020, China
| | - Jing-Sheng Li
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Willem A. Kernkamp
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Tsung-Yuan Tsai
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Seung-Hoon Baek
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Ali Hosseini
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Lin Lin
- Institute of Sports Medicine, Peking University Third hospital, North Garden Road, Haidian District, Beijing, 100191, PR China
| | - Peifu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxin Road, Beijing 100853, P.R. China
| | - Guoan Li
- Orthopaedic Biomechanics Laboratory, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA,CORRESPONDING AUTHOR. Guoan Li, Orthopaedic Biomechanics Laboratory, Harvard Medical School and Newton-Wellesley Hospital, 159 Wells Avenue, Newton, MA 02459, USA. (G. Li)
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Pejhan S, Bohm E, Brandt JM, Wyss U. Design and virtual evaluation of a customized surface-guided knee implant. Proc Inst Mech Eng H 2016; 230:949-61. [PMID: 27574038 DOI: 10.1177/0954411916663839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
Abstract
Although total knee arthroplasty is generally a successful operation, many studies have shown that it results in significant alterations in the kinematics of the joint, which cause limitations in performing the activities of daily living. This study aimed to define the design features for a customized surface-guided total knee replacement and to evaluate the kinematic outcomes. Magnetic resonance imaging data of the knee joint are used to generate the design features as they relate to the functionality of the implant. The motion is guided by considering a partial ball and socket configuration on the medial condyle and varying radii of curvature on the lateral articulating surface. A virtual simulation of the behavior of the surface-guided total knee replacement was performed to investigate the motion patterns of this total knee replacement under gait and squatting loading conditions. Results of the virtual simulation show that flexion and extension of the knee make the center of the lateral condyle move more naturally in the posterior and anterior directions, in comparison to the center of the medial condyle. Such guidance is achieved as a result of the novel customized designed contact between the articulating surfaces. The proposed customized surface-guided total knee replacement provides patterns of motion close to the expected more natural target, not only during a gait cycle but also as the knee flexes to higher degrees during squatting. Major design features include location and orientation of the flexion and pivoting axes, the trace of the contact points on the tibia, and the radii of the guiding arcs on the lateral condyle.
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Affiliation(s)
- Shabnam Pejhan
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Eric Bohm
- Orthopaedic Innovation Centre, Winnipeg, MB, Canada Department of Surgery, Section of Orthopedic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Jan-Mels Brandt
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Urs Wyss
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB, Canada Orthopaedic Innovation Centre, Winnipeg, MB, Canada
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Abdel-Jaber S, Belvedere C, Leardini A, Affatato S. Wear simulation of total knee prostheses using load and kinematics waveforms from stair climbing. J Biomech 2015; 48:3830-6. [DOI: 10.1016/j.jbiomech.2015.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/20/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
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Ham O, Lee CY, Kim R, Lee J, Oh S, Lee MY, Kim J, Hwang KC, Maeng LS, Chang W. Therapeutic Potential of Differentiated Mesenchymal Stem Cells for Treatment of Osteoarthritis. Int J Mol Sci 2015; 16:14961-78. [PMID: 26147426 PMCID: PMC4519882 DOI: 10.3390/ijms160714961] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/24/2015] [Accepted: 06/26/2015] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a chronic, progressive, and irreversible degenerative joint disease. Conventional OA treatments often result in complications such as pain and limited activity. However, transplantation of mesenchymal stem cells (MSCs) has several beneficial effects such as paracrine effects, anti-inflammatory activity, and immunomodulatory capacity. In addition, MSCs can be differentiated into several cell types, including chondrocytes, osteocytes, endothelia, and adipocytes. Thus, transplantation of MSCs is a suggested therapeutic tool for treatment of OA. However, transplanted naïve MSCs can cause problems such as heterogeneous populations including differentiated MSCs and undifferentiated cells. To overcome this problem, new strategies for inducing differentiation of MSCs are needed. One possibility is the application of microRNA (miRNA) and small molecules, which regulate multiple molecular pathways and cellular processes such as differentiation. Here, we provide insight into possible strategies for cartilage regeneration by transplantation of differentiated MSCs to treat OA patients.
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Affiliation(s)
- Onju Ham
- Catholic Kwandong University International St. Mary's Hospital, Incheon 404-834, Korea.
| | - Chang Youn Lee
- Department of Integrated Omics for Biomedical Sciences, Yonsei University, 50 Yonsei-ro, Seodamun-gu, Seoul 120-759, Korea.
| | - Ran Kim
- Department of Biology Education, College of Education, Pusan National University, Busan 609-735, Korea.
| | - Jihyun Lee
- Department of Biology Education, College of Education, Pusan National University, Busan 609-735, Korea.
| | - Sekyung Oh
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Min Young Lee
- Department of Molecular Physiology, College of Pharmacy, Kyungpook National University, Daegu 702-701, Korea.
| | - Jongmin Kim
- Department of Life Systems, Sookmyung Women's University, Seoul 140-742, Korea.
| | - Ki-Chul Hwang
- Catholic Kwandong University International St. Mary's Hospital, Incheon 404-834, Korea.
| | - Lee-So Maeng
- Institute of Catholic Integrative Medicine, Incheon St. Mary's Hospital, the Catholic University of Korea, College of Medicine, Incheon 403-720, Korea.
| | - Woochul Chang
- Department of Biology Education, College of Education, Pusan National University, Busan 609-735, Korea.
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Suzuki A. Inverse-model-based cuffless blood pressure estimation using a single photoplethysmography sensor. Proc Inst Mech Eng H 2015; 229:499-505. [PMID: 26040284 DOI: 10.1177/0954411915587957] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/27/2015] [Indexed: 11/17/2022]
Abstract
This paper proposes an inverse-model-based cuffless method for estimating blood pressure using a single photoplethysmography sensor. The proposed method, which is based on the relationship between blood pressure and the features of pulse waves, employs an inverse estimation and uses the blood pressure as the explanatory variable. Using this method, the blood pressure can be estimated with high accuracy even in situations where the pulse wave features are scattered, as the method uses the dynamic signal-to-noise ratio of the Taguchi method. In order to verify the effectiveness of the proposed method, we employed it to measure the systolic blood pressure. It could be confirmed that the estimation accuracy of the proposed method is higher than that of similar methods.
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Affiliation(s)
- Arata Suzuki
- Faculty of Systems Engineering, Wakayama University, Japan
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8
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Molicnik A, Naranda J, Dolinar D. Patient-matched instruments versus standard instrumentation in total knee arthroplasty: a prospective randomized study. Wien Klin Wochenschr 2015; 127 Suppl 5:S235-40. [PMID: 25732915 PMCID: PMC4689773 DOI: 10.1007/s00508-015-0703-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 01/16/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Optimal positioning of implants and restoration of neutral mechanical axis are two primary surgical goals in total knee arthroplasty (TKA). Despite modern instruments and improved surgical techniques, malalignment remains an important cause of early failure after TKA. The aim of this prospective randomized study was to compare the value of a new patient-matched instrument system (PMI) (Signature(TM); Biomet, Inc, Warsaw, Indiana) to that of standard TKA surgical instrumentation (STD) in terms of coronal mechanical alignment, time of operation and blood loss. PATIENTS AND METHODS A total of 38 patients waiting for primary TKA were enrolled and randomized into two groups (19 PMI and 19 STD). Magnetic resonance imaging was performed in all patients in the PMI group, and specific instruments for the femur and tibia were designed preoperatively. All patients were operated on using the standard medial parapatellar approach with no use of tourniquet. Mechanical axis, time for the operation, and blood loss were evaluated. RESULTS Patients in both groups had comparable age, body mass index, preoperative mechanical axis, Knee Society Score, and level of hemoglobin. Postoperative results showed that the PMI group fell significantly closer to neutral mechanical axis (STD: 2.7 ± 1.7, PMI: 1.7 ± 0.9; P = 0.013) with no outliers and a reduced time for the operation. There was no difference in the evaluation blood loss. CONCLUSIONS The use of PMI can contribute in achieving better mechanical axis with reduction in outliers and decreased operation time. Due to small differences between PMI and standard instruments, additional research are needed to confirm these preliminary results, and to discover potential benefits and functional improvements in the long-term outcome.
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Affiliation(s)
- Andrej Molicnik
- Orthopaedic Department, University Clinical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
| | - Jakob Naranda
- Orthopaedic Department, University Clinical Center Maribor, Ljubljanska 5, 2000, Maribor, Slovenia.
- , Ljubljanska 3, 2000, Maribor, Slovenia.
| | - Drago Dolinar
- Departement of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška cesta 7, 1000, Ljubljana, Slovenia.
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Athwal KK, Hunt NC, Davies AJ, Deehan DJ, Amis AA. Clinical biomechanics of instability related to total knee arthroplasty. Clin Biomech (Bristol, Avon) 2014; 29:119-28. [PMID: 24332382 DOI: 10.1016/j.clinbiomech.2013.11.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 11/01/2013] [Accepted: 11/05/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Tibiofemoral instability is a common reason for total knee arthroplasty failure, and may be attributed to soft tissue deficiency and incorrect ligament balancing. There are many different designs of implant with varying levels of constraint to overcome this instability; however there is little advice for surgeons to assess which is suitable for a specific patient, and soft tissue balance testing during arthroplasty is very subjective. METHOD The current theories on primary and secondary soft tissue restraints to anterior/posterior, varus/valgus, and internal/external rotational motion of the knee are discussed. The paper reviews biomechanics literature to evaluate instability in the intact and implanted knee. FINDINGS The paper highlights important intra- and extra-capsular structures in the knee and describes the techniques used by clinicians to assess instability perioperatively. In vitro cadaveric studies were found to be a very useful tool in comparing different implants and contributions of different soft tissues. INTERPRETATION In vitro cadaveric studies can be utilised in helping less experienced surgeons with soft tissue releases and determining the correct implant. For this to happen, more biomechanical studies must be done to show the impact of release sequences on implanted cadavers, as well as determining if increasingly constrained implants restore the stability of the knee to pre-deficient conditions.
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Affiliation(s)
- Kiron K Athwal
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London SW7 2AZ, UK
| | - Nicola C Hunt
- Department of Orthopaedic Surgery, Newcastle Freeman University Hospital, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Medical School, Framlington Place Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | | | - David J Deehan
- Department of Orthopaedic Surgery, Newcastle Freeman University Hospital, Newcastle upon Tyne, UK; Institute of Cellular Medicine, Medical School, Framlington Place Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London SW7 2AZ, UK; Orthopaedic Surgery Group, Imperial College London School of Medicine, Charing Cross Hospital, London W6 8RF, UK.
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Belvedere C, Tamarri S, Notarangelo DP, Ensini A, Feliciangeli A, Leardini A. Three-dimensional motion analysis of the human knee joint: comparison between intra- and post-operative measurements. Knee Surg Sports Traumatol Arthrosc 2013; 21:2375-83. [PMID: 23114867 DOI: 10.1007/s00167-012-2271-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 10/19/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare intra-operative knee joint kinematic measurements immediately after total knee replacement with those of the same patients post-operatively at 6-month follow-up. METHODS Fifteen patients who underwent total knee arthroplasty were analysed retrospectively. Eight were implanted with one prosthesis design and seven with another. The intra-operative measurements were performed by using a standard knee navigation system. This provided accurate three-dimensional positions and orientations for the femur and tibia by corresponding trackers pinned into the bones. At 6-month follow-up, the patients were analysed by standard three-dimensional video-fluoroscopy of the replaced knee during stair climbing, chair rising and step-up. Relevant three-dimensional positions and orientations were obtained by an iterative shape-matching procedure between the silhouette contours and the CAD-model projections. A number of traditional kinematic parameters were calculated from both measurements to represent the joint motion. RESULTS Good post-operative replication of the intra-operative measurements was observed for most of the variables analysed. The statistical analysis also supported the good consistency between the intra- and post-operative measurements. CONCLUSIONS Intra-operative kinematic measurements, accessible by a surgical navigation system, are predictive of the following motion performance of the replaced knees as experienced in typical activities of daily living. LEVEL OF EVIDENCE Prognostic studies--investigating natural history and evaluating the effect of a patient characteristic, Level II.
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Affiliation(s)
- C Belvedere
- Movement Analysis Laboratory, Centro di Ricerca Codivilla-Putti, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy,
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11
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Roberts D, Khan H, Kim JH, Slover J, Walker PS. Acceleration-based joint stability parameters for total knee arthroplasty that correspond with patient-reported instability. Proc Inst Mech Eng H 2013; 227:1104-13. [PMID: 23886970 DOI: 10.1177/0954411913493724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is no universally accepted definition of human joint stability, particularly in nonperiodic general activities of daily living. Instability has proven to be a difficult parameter to define and quantify, since both spatial and temporal measures need to be considered to fully characterize joint stability. In this preliminary study, acceleration-based parameters were proposed to characterize the joint stability. Several time-statistical parameters of acceleration and jerk were defined as potential stability measures, since anomalous acceleration or jerk could be a symptom of poor control or stability. An inertial measurement unit attached at the level of the tibial tubercle of controls and patients following total knee arthroplasty was used to determine linear acceleration of the knee joint during several activities of daily living. The resulting accelerations and jerks were compared with patient-reported instability as determined through a standard questionnaire. Several parameters based on accelerations and jerks in the anterior/posterior direction during the step-up/step-down activity were significantly different between patients and controls and correlated with patient reports of instability in that activity. The range of the positive to negative peak acceleration and infinity norm of acceleration, in the anterior/posterior direction during the step-up/step-down activity, proved to be the best indicators of instability. As time derivatives of displacement, these acceleration-based parameters represent spatial and temporal information and are an important step forward in developing a definition and objective quantification of human joint stability that can complement the subjective patient report.
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Affiliation(s)
- Dustyn Roberts
- Department of Mechanical and Aerospace Engineering, Polytechnic Institute of New York University, Brooklyn, NY, USA
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Seslija P, Teeter MG, Yuan X, Naudie DDR, Bourne RB, MacDonald SJ, Peters TM, Holdsworth DW. Measurement of joint kinematics using a conventional clinical single-perspective flat-panel radiography system. Med Phys 2012; 39:6090-103. [DOI: 10.1118/1.4752205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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13
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Sancisi N, Zannoli D, Parenti-Castelli V, Belvedere C, Leardini A. A one-degree-of-freedom spherical mechanism for human knee joint modelling. Proc Inst Mech Eng H 2011; 225:725-35. [DOI: 10.1177/0954411911406951] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In-depth comprehension of human knee kinematics is necessary in prosthesis and orthosis design and in surgical planning but requires complex mathematical models. Models based on one-degree-of-freedom equivalent mechanisms have replicated well the passive relative motion between the femur and tibia, i.e. the knee joint motion in virtually unloaded conditions. In these mechanisms, fibres within the anterior and posterior cruciate and medial collateral ligaments were taken as isometric and anatomical articulating surfaces as rigid. A new one-degree-of-freedom mechanism is analysed in the present study, which includes isometric fibres within the two cruciates and a spherical pair at the pivot point of the nearly spherical motion as measured for this joint. Bounded optimization was applied to the mechanism to refine parameter first estimates from experimental measurements on four lower-limb specimens and to best-fit the experimental motion of these knees. Relevant results from computer simulations were compared with those from one previous equivalent mechanism, which proved to be very accurate in a former investigation. The spherical mechanism represented knee motion with good accuracy, despite its simple structure. With respect to the previous more complex mechanism, the less satisfactory results in terms of replication of natural motion were counterbalanced by a reduction of computational costs, by an improvement in numerical stability of the mathematical model, and by a reduction of the overall mechanical complexity of the mechanism. These advantages can make the new mechanism preferable to the previous ones in certain applications, such as the design of prostheses, orthoses, and exoskeletons, and musculoskeletal modelling of the lower limb.
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Affiliation(s)
- N Sancisi
- Department of Mechanical Engineering – DIEM, University of Bologna, Bologna, Italy
| | - D Zannoli
- Department of Mechanical Engineering – DIEM, University of Bologna, Bologna, Italy
| | - V Parenti-Castelli
- Department of Mechanical Engineering – DIEM, University of Bologna, Bologna, Italy
| | - C Belvedere
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A Leardini
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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