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Kono K, Yamazaki T, Tamaki M, Inui H, Tanaka S, Tomita T. In Vivo Kinematic Analysis of Mobile-Bearing Unicompartmental Knee Arthroplasty during High Flexion Activities. J Knee Surg 2024; 37:649-655. [PMID: 38191008 DOI: 10.1055/a-2240-3482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Mobile-bearing (MB) unicompartmental knee arthroplasty (UKA) has high conformity between the femoral articular surface and the meniscal bearing; therefore, the surface and subsurface contact stress is reduced. Additionally, the survival rate is high. However, the in vivo kinematics of MB UKA knees during high-flexion activities of daily living remain unknown. The aim of this study was to investigate in vivo the three-dimensional kinematics of MB UKA knees during high-flexion activities of daily living. A total of 17 knees of 17 patients who could achieve kneeling after MB UKA were examined. Under fluoroscopy, each patient performed squatting and kneeling motions. To estimate the spatial position and orientation of the knee, a two-dimensional/three-dimensional registration technique was used. We evaluated the femoral rotation and varus-valgus angle relative to the tibia and the anteroposterior translation of the medial sulcus (medial side) and lateral epicondyle (lateral side) of the femur on the plane perpendicular to the tibial mechanical axis in each flexion angle. From 130° to 140° of flexion, the femoral external rotation during squatting was significantly smaller than that during kneeling. Additionally, the medial side of the femur during squatting was significantly more posteriorly located compared with that during kneeling. There was no significant difference between squatting and kneeling in terms of the lateral side of the femur and the varus-valgus position in each flexion angle. At high flexion angle, the kinematics of MB UKA knees may differ depending on the performance.
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Affiliation(s)
- Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, Fukaya, Saitama, Japan
| | - Masashi Tamaki
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Medical Science, Graduate School of Medicine, Morinomiya University of Medical Sciences, Suminoe-ku, Osaka, Japan
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Kono K, Konda S, Yamazaki T, Taketomi S, Tamaki M, Inui H, Tanaka S, Tomita T. Sitting Sideways Causes Different Femoral-Tibial Rotations in Each Knee. Cureus 2024; 16:e59678. [PMID: 38836162 PMCID: PMC11149726 DOI: 10.7759/cureus.59678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/06/2024] Open
Abstract
Purpose According to a previous study, asymmetrical kneeling, such as sitting sideways, does not exhibit asymmetrical movements. Rotational analyses of each femur and tibia help explain why rotational knee kinematics while sitting sideways do not exhibit asymmetrical movement. We aimed to assess the rotation of the femur and tibia in normal knees while sitting sideways. Methods Each volunteer sat sideways under fluoroscopy. Two-dimensional and three-dimensional registration techniques were used. After evaluating the femoral rotation angle relative to the tibia at each flexion angle, the femoral and tibial sole rotation angles at each flexion angle were compared between the ipsilateral and contralateral knees. Results While sitting sideways, both knees showed femoral external rotation relative to the tibia with flexion. In the ipsilateral knees, the femurs exhibited an external rotation of 26.3 ± 8.0°, from 110° to 150° of flexion. Conversely, the tibia exhibited an external rotation of 12.2 ± 7.8°, from 110° to 150° of flexion. From 110° to 150° of flexion, femoral external rotation was significantly larger than tibial external rotation. In the contralateral knees, the femurs exhibited an internal rotation of 23.8 ± 6.3°, from 110° to 150° of flexion (110°, p < 0.001; 120°, p < 0.001; 130°, p < 0.001; 140°, p < 0.001; and 150°, p < 0.001). Contrastingly, the tibia exhibited an internal rotation of 30.4 ± 8.8°, from 110° to 150° of flexion, which was significantly larger than femoral internal rotation (110°, p = 0.002; 120°, p < 0.001; 130°, p < 0.001; 140°, p < 0.001; and 150°, p < 0.001). Conclusions Although bilateral knees exhibited femoral external rotation relative to the tibia while sitting sideways, the ipsilateral and contralateral knees showed femoral and tibial sole rotations in opposite directions. In particular, the contralateral knees might show a strained movement because both femurs and tibias exhibited internal rotation with flexion. Patients who have undergone guided-motion total knee arthroplasty (TKA) or medial-pivot TKAs might be advised to avoid sitting sideways.
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Affiliation(s)
- Kenichi Kono
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo, JPN
| | - Shoji Konda
- Department of Health and Sport Sciences, Osaka University, Suita, JPN
| | - Takaharu Yamazaki
- Department of Information Systems, Saitama Institute of Technology, Fukaya, JPN
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo, JPN
| | - Masashi Tamaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Osaka, JPN
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Saitama Medical University, Kawagoe, JPN
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo, JPN
| | - Tetsuya Tomita
- Department of Medical Sciences, Morinomiya University of Medical Sciences, Osaka, JPN
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Ueyama H, Nakagawa S, Fukunaga K, Koyanagi J, Takemura S, Nakamura S, Yamamura M, Minoda Y. Improvement of rotational arc during deep flexion range of a novel designed polyethylene insert for posterior-stabilised total knee arthroplasty. Knee 2024; 46:108-116. [PMID: 38071923 DOI: 10.1016/j.knee.2023.11.007] [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: 06/07/2023] [Revised: 09/29/2023] [Accepted: 11/13/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND One of the remaining issues in total knee arthroplasty (TKA) is achieving sufficient rotational arc during deep flexion range of the knee for specific postures such as the 'seiza' or cross-legged sitting. This study aimed to evaluate whether there was a change in the actual in vivo rotational arc during deep flexion range before and after a design change of polyethylene (PE) inserts. METHODS In 50 posterior-stabilised TKA cases, knee kinematics, including rotational movement, were measured intraoperatively using an image-free navigation system to compare a newly designed PE insert with reduced the posterior lip with a conventional PE insert. Femoral-tibial rotational angles at 30°, 45°, 60°, 90°, 120°, and 130° knee flexion were evaluated. Varus/valgus instability, knee range of motion, and femoral rollback were also measured. Obtained parameters were compared between new and conventional PE inserts. The independent factors associated with rotational arc during deep flexion range (120° and 130° knee flexion) were analysed using multivariate analysis. RESULTS The newly designed PE insert demonstrated a significant increase in the rotational arc at 120° (22.9 ± 8.7° vs. 30.1 ± 11.9°, P < 0.001) and 130° (24.3 ± 9.5° vs. 32.5 ± 12.4°, P < 0.001) knee flexion compared with that with the conventionally designed posterior-stabilised insert. Multivariate analysis demonstrated that using the newly designed PE insert was an independent predictor of improved rotational arc during deep flexion range: regression coefficient was 11.2 (95% confidence interval 7.1-15.3, P < 0.001). CONCLUSION The design change, which reduced the posterior lip of the PE insert, contributed to improved rotational arc in 120° and 130° deep flexion ranges.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.
| | - Shigeru Nakagawa
- Department of Orthopaedic Surgery, Hanwa Memorial Hospital, Osaka, Japan
| | - Kenji Fukunaga
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | | | - Susumu Takemura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Suguru Nakamura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | | | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine Osaka, Japan
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Nakagawa Y, Mukai S, Satomi K, Shinya Y, Nakamura R, Takahashi M. Autologous Osteochondral Grafts for Knee Osteochondral Diseases Result in Good Patient-Reported Outcomes in Patients Older Than 60 Years. Arthrosc Sports Med Rehabil 2023; 5:100774. [PMID: 37564902 PMCID: PMC10410132 DOI: 10.1016/j.asmr.2023.100774] [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: 08/19/2022] [Accepted: 06/15/2023] [Indexed: 08/12/2023] Open
Abstract
Purpose This study aims to examine the clinical autologous osteochondral grafts (AOG) outcomes for knee osteochondral diseases at operative ages >60 years, and to determine whether patients are able to sit straight in Japanese style after AOG. Methods All patients who underwent AOG for knee osteochondral diseases between November 2001 and April 2018 were retrospectively identified. The inclusion criteria were AOG only without osteotomy, operative ages between 60 and 79 years, >2 years of follow-up, and involved femorotibial angle between 169° and 179° (normal alignment). Patients who underwent osteotomy to improve knee alignment and patients with inflammatory diseases such as rheumatoid arthritis were excluded. The patients' knee symptoms and their clinical outcome were evaluated according to the criteria of the knee scoring system of the Japanese Orthopedic Association (JOA), International Knee Documentation Committee (IKDC) subjective score, and the ability of straight sitting in Japanese style. Results This study enrolled 57 cases and 60 knee joints during the study period. The follow-up ratio was 85.1%. Moreover, 14 men and 43 women and 29 right and 31 left knee joints were included in this study. The mean operative age and mean follow-up period were 67.8 years (range 60-76 years) and 81.1 months (range 24-167 months), respectively. In addition, the study involved 30 cases and 32 knee joints (60s group), and 27 cases and 28 knee joints (70s group). Moreover, 34 cases and 36 knee joints had osteonecrosis (ON group), and 23 cases and 24 knee joints had cartilage injury (CI group). The IKDC subjective and JOA scores in both the 60s and 70s groups showed significant differences: 2 years after AOG >at the follow-up period, >at the preoperative period. The scores in both the CI and ON groups showed similar significant differences. Furthermore, 8.3% and 53.5% of the patients could sit straight in Japanese style at the preoperative period and 2 years after AOG, respectively. Conclusion Even if the patient's operative age was >60 years, the AOG only for their knee osteochondral diseases had good clinical outcomes, including the ability to sit straight in Japanese style. Level of Evidence IV, Therapeutic case series Key words: autologous osteochondral grafts, aged patients, clinical outcome, knee joint, straight sitting in Japanese style.
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Affiliation(s)
- Yasuaki Nakagawa
- Clinical Research Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Department of Orthopaedic Surgery, Japan Baptist Medical Foundation, Kyoto, Japan
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Kentaro Satomi
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Yuki Shinya
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Ryota Nakamura
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Motoi Takahashi
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
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Yamagami R, Inui HI, Taketomi S, Kono K, Kawaguchi K, Takagi K, Kage T, Sameshima S, Tanaka S. Implant Alignment and Patient Factors Affecting the Short-Term Patient-Reported Clinical Outcomes after Oxford Unicompartmental Knee Arthroplasty. J Knee Surg 2021; 34:1413-1420. [PMID: 32356292 DOI: 10.1055/s-0040-1709678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aims at clarifying implant alignment and other patient factors' influence on clinical outcomes, particularly on patient-reported outcomes (PRO), following Oxford unicompartmental knee arthroplasty (OUKA). A total of 142 patients after OUKA were divided into two groups according to the validated Japanese version of the knee injury and osteoarthritis outcome score (KOOS) for each subscale of pain, symptoms, and activities of daily living (ADL) at postoperative year 1 and 2: group 1 had ≥80 scores and group 2 had <80 scores. Postoperative clinical and radiographical findings were then compared among groups in each subscale. Using postoperative year 1 and 2 data, a multivariable logistic regression analysis was conducted to clarify factors for clinical outcomes' improvement. In the analysis of KOOS subscale of symptoms at postoperative year 1, gender distribution, preoperative body mass index, and postoperative maximum knee flexion angles differed significantly among groups. In the analysis for KOOS subscale of ADL, significant differences were observed in postoperative tibial component varus angles. Multivariable logistic regression analysis revealed that all of these parameters significantly related to ≥80 KOOS scores of each subscale at postoperative year 1. Additionally, at postoperative year 2, larger postoperative knee flexion angles and tibial component varus angles related to ≥80 KOOS subscale of symptoms and ADL were observed. In conclusion, tibial component's larger varus alignment was associated with the better PRO at both 1 and 2 years after OUKA. Importantly, larger postoperative knee flexion angle helped achieve good short-term PRO after OUKA.
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Affiliation(s)
- Ryota Yamagami
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - HIroshi Inui
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kentaro Takagi
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Han HS, Kim JS, Lee B, Won S, Lee MC. A high degree of knee flexion after TKA promotes the ability to perform high-flexion activities and patient satisfaction in Asian population. BMC Musculoskelet Disord 2021; 22:565. [PMID: 34154538 PMCID: PMC8215776 DOI: 10.1186/s12891-021-04369-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/17/2021] [Indexed: 02/25/2023] Open
Abstract
Background This study investigated whether achieving a higher degree of knee flexion after TKA promoted the ability to perform high-flexion activities, as well as patient satisfaction and quality of life. Methods Clinical data on 912 consecutive primary TKA cases involving a single high-flexion posterior stabilized fixed-bearing prosthesis were retrospectively analyzed. Demographic and clinical data were collected, including knee flexion angle, the ability to perform high-flexion activities, and patient satisfaction and quality of life. Results Of the cases, 619 (68%) achieved > 130° of knee flexion after TKA (high flexion group). Knee flexion angle and clinical scores showed significant annual changes, with the maximum improvement seen at 5 years and slight deterioration observed at 10 years postoperatively. In the high flexion group, more than 50% of the patients could not kneel or squat, and 35% could not stand up from on the floor. Multivariate analysis revealed that > 130° of knee flexion, the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient satisfaction after TKA, while the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient quality of life after TKA. Conclusions High knee flexion angle (> 130°) after TKA increased the ease of high-flexion activities and patient satisfaction. The ease of high-flexion activities also increased quality of life after TKA in our Asian patients, who frequently engage in these activities in daily life.
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Affiliation(s)
- Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Jong Seop Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Bora Lee
- Department of Statistics, Graduate School of Chung-Ang University, Seoul, South Korea
| | - Sungho Won
- Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Watanabe T, Gamada K, Koga H, Sekiya I, Muneta T, Jinno T. Characteristic kinematics of floor-sitting activities after posterior-stabilized total knee arthroplasty determined using model-based shape-matching techniques. Knee 2021; 29:571-579. [PMID: 33602618 DOI: 10.1016/j.knee.2020.12.028] [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: 05/17/2020] [Revised: 08/12/2020] [Accepted: 12/22/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Detailed kinematics of floor-sitting activities after total knee arthroplasty (TKA) have not been well explored. Knee kinematics of cross-legged sitting, seiza-sitting, and side-sitting after TKA were examined to clarify the differences in tibiofemoral kinematics of each activity. METHODS Subjects were 40 knees in 20 osteoarthritic patients who underwent bilateral TKA with a high-flexion fixed-bearing posterior-stabilized prosthesis. Dynamic radiographs of floor-sitting activities were taken, and the knee kinematics were compared among the three activities. The patients were also divided into two groups (possible/easy group and impossible/no-try group) for each activity, and group comparisons were conducted. RESULTS The maximum implant flexion angle was significantly greater in seiza-sitting. In valgus/varus rotation, seiza-sitting demonstrated neutral rotation, while cross-legged sitting showed varus of about 10°, and side-sitting exhibited valgus. In tibial internal/external rotation, seiza-sitting demonstrated a constant rotational angle, while cross-legged sitting showed tibial internal rotation with flexion, and side-sitting exhibited tibial external rotation with flexion. The kinematic pathway during deep flexion illustrated the medial pivot pattern in cross-legged sitting, a small amount of bicondylar rollback in seiza-sitting, and the weak lateral pivot pattern in side-sitting. A greater flexion angle was the important factor for the performance of each floor-sitting activity followed by varus laxity at 10° knee flexion. CONCLUSIONS This study successfully revealed characteristic kinematic patterns of TKA knees in three floor-sitting activities. Obtaining a greater knee flexion with adequate lateral laxity is the key to enhancing postoperative floor-sitting activities.
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Affiliation(s)
- Toshifumi Watanabe
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
| | - Kazuyoshi Gamada
- Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Hiroshima, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takeshi Muneta
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Tetsuya Jinno
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Lynch JT, Scarvell JM, Galvin CR, Smith PN, Perriman DM. Influence of component design on in vivo tibiofemoral contact patterns during kneeling after total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:446-466. [PMID: 32242268 DOI: 10.1007/s00167-020-05949-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Modern TKR prostheses are designed to restore healthy kinematics including high flexion. Kneeling is a demanding high-flexion activity. There have been many studies of kneeling kinematics using a plethora of implant designs but no comprehensive comparisons. Visualisation of contact patterns allows for quantification and comparison of knee kinematics. The aim of this systematic review was to determine whether there are any differences in the kinematics of kneeling as a function of TKR design. METHODS A search of the published literature identified 26 articles which were assessed for methodologic quality using the MINORS instrument. Contact patterns for different implant designs were compared at 90° and maximal flexion using quality-effects meta-analysis models. RESULTS Twenty-five different implants using six designs were reported. Most of the included studies had small-sample sizes, were non-consecutive, and did not have a direct comparison group. Only posterior-stabilised fixed-bearing and cruciate-retaining fixed-bearing designs had data for more than 200 participants. Meta-analyses revealed that bicruciate-stabilised fixed-bearing designs appeared to achieve more flexion and the cruciate-retaining rotating-platform design achieved the least, but both included single studies only. All designs demonstrated posterior-femoral translation and external rotation in kneeling, but posterior-stabilised designs were more posterior at maximal flexion when compared to cruciate retaining. However, the heterogeneity of the mean estimates was substantial, and therefore, firm conclusions about relative behaviour cannot be drawn. CONCLUSION The high heterogeneity may be due to a combination of variability in the kneeling activity and variations in implant geometry within each design category. There remains a need for a high-quality prospective comparative studies to directly compare designs using a common method. LEVEL OF EVIDENCE Systematic review and meta-analysis Level IV.
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Affiliation(s)
- Joseph T Lynch
- The Trauma and Orthopaedic Research Unit, Australian National University, The Canberra Hospital, Building 6, Level 1, Garran, ACT, Australia.
| | | | - Catherine R Galvin
- College of Engineering and Computer Science, Australian National University, Acton, ACT, Australia
| | - Paul N Smith
- The Trauma and Orthopaedic Research Unit, Australian National University, The Canberra Hospital, Building 6, Level 1, Garran, ACT, Australia
| | - Diana M Perriman
- The Trauma and Orthopaedic Research Unit, Australian National University, The Canberra Hospital, Building 6, Level 1, Garran, ACT, Australia
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Imani Nejad Z, Khalili K, Hosseini Nasab SH, Schütz P, Damm P, Trepczynski A, Taylor WR, Smith CR. The Capacity of Generic Musculoskeletal Simulations to Predict Knee Joint Loading Using the CAMS-Knee Datasets. Ann Biomed Eng 2020; 48:1430-1440. [PMID: 32002734 PMCID: PMC7089909 DOI: 10.1007/s10439-020-02465-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/23/2020] [Indexed: 11/26/2022]
Abstract
Musculoskeletal models enable non-invasive estimation of knee contact forces (KCFs) during functional movements. However, the redundant nature of the musculoskeletal system and uncertainty in model parameters necessitates that model predictions are critically evaluated. This study compared KCF and muscle activation patterns predicted using a scaled generic model and OpenSim static optimization tool against in vivo measurements from six patients in the CAMS-knee datasets during level walking and squatting. Generally, the total KCFs were under-predicted (RMS: 47.55%BW, R2: 0.92) throughout the gait cycle, but substiantially over-predicted (RMS: 105.7%BW, R2: 0.81) during squatting. To understand the underlying etiology of the errors, muscle activations were compared to electromyography (EMG) signals, and showed good agreement during level walking. For squatting, however, the muscle activations showed large descrepancies especially for the biceps femoris long head. Errors in the predicted KCF and muscle activation patterns were greatest during deep squat. Hence suggesting that the errors mainly originate from muscle represented at the hip and an associated muscle co-contraction at the knee. Furthermore, there were substaintial differences in the ranking of subjects and activities based on peak KCFs in the simulations versus measurements. Thus, future simulation study designs must account for subject-specific uncertainties in musculoskeletal predictions.
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Affiliation(s)
- Zohreh Imani Nejad
- Department of Mechanical Engineering, University of Birjand, Birjand, Iran
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Khalil Khalili
- Department of Mechanical Engineering, University of Birjand, Birjand, Iran
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | | | - Pascal Schütz
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Philipp Damm
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Adam Trepczynski
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - William R Taylor
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
| | - Colin R Smith
- Institute for Biomechanics, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
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10
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Yabumoto H, Nakagawa Y, Mukai S. Surgical Technique and Clinical Outcomes of Osteochondral Autograft Transplantation for Large Osteonecrotic Lesions of the Femoral Condyle With Residual Normal Cartilage: The Eyeglass Technique. Orthop J Sports Med 2019; 7:2325967119872446. [PMID: 31637267 PMCID: PMC6783664 DOI: 10.1177/2325967119872446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Osteochondral autograft transplantation (OAT) is usually performed for a
defect that is <400 mm2 because of the limitations of
autografts. Purpose: To present the surgical technique and clinical outcomes of OAT using the
eyeglass technique for large osteonecrotic lesions of the femoral condyle
(LOFs) (>400 mm2) with residual normal cartilage. Study Design: Cohort study; Level of evidence, 3. Methods: Cases (group 1) included 15 patients (18 knees) who underwent OAT using the
eyeglass technique for LOFs with residual normal cartilage, while controls
(group 2) included 11 patients (11 knees) who underwent OAT using the
standard technique for small osteonecrotic lesions of the femoral condyle
(≤400 mm2). Clinical outcomes were evaluated preoperatively and
at the final follow-up (group 1, 56 months; group 2, 48 months) according to
the International Knee Documentation Committee (IKDC) objective grade, the
IKDC subjective score, and the Japanese Orthopaedic Association (JOA)
score. Results: The mean lesion size was 685 mm2 in group 1 and 230 mm2
in group 2. Patients in group 1 had postoperative scores equivalent to those
in group 2. The postoperative IKDC subjective scores in group 1 (mean, 86.9)
and group 2 (mean, 87.0) showed no significant difference at the final
follow-up (P = .653). For postoperative IKDC objective
grades, 83.3% of group 1 and 81.8% of group 2 were graded as “nearly normal”
or better, and no significant intergroup difference was found for the IKDC
objective grade (P = .989). Also, no significant intergroup
difference was found for the postoperative JOA score (group 1, 93.9; group
2, 81.4; P = .480). Nine second-look arthroscopic
procedures were performed in group 1 compared with 4 in group 2, and all
patients had plugs that were graded as “nearly normal” or better by the
International Cartilage Repair Society classification system. Conclusion: The postoperative results of patients who underwent OAT using the eyeglass
technique for large osteonecrotic lesions (>400 mm2) were
equivalent to the results of patients who underwent OAT using the standard
technique for small osteonecrotic lesions (≤400 mm2).
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Affiliation(s)
- Hiromitsu Yabumoto
- Department of Orthopaedic Surgery, Kansai Denryoku Hospital, Osaka, Japan
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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11
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Tarumi E, Nakagawa Y, Mukai S, Yabumoto H, Nakamura T. The clinical outcomes and the ability to sit straight in the Japanese style following high tibial osteotomy combined with osteochondral autologous transfer for osteonecrosis of the medial femoral condyle. J Orthop Sci 2019; 24:136-141. [PMID: 30245092 DOI: 10.1016/j.jos.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/13/2018] [Accepted: 08/12/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND There have been some reports of high tibial osteotomy combined with osteochondral autograft transfer for osteonecrosis of the medial femoral condyle of the knee. However, few of them have focused on the deep knee flexion needed to sit straight in the Japanese style. PURPOSE To evaluate the clinical outcomes and the knee flexion of HTO combined with OAT for osteonecrosis of the medial femoral condyle of the knee, especially the ability to sit straight in the Japanese style. METHODS Between 1998 and 2012, valgus HTO combined with OAT was performed in 23 patients for stage IV osteonecrosis according to Koshino's radiological classification of the medial femoral condyle. The follow-up period was more than 2 years in all cases. The mean age at the time of the surgery was 65.8 years, and the mean follow-up period was 72.2 months. The function of the knee and the ability to sitting straight in the Japanese style were examined. Twenty-one knees were examined with second-look arthroscopy to assess the recipient and donor sites. RESULTS The JOA scale and IKDC subjective scores were significantly improved. Twelve patients were able to sit straight in the Japanese style after the surgery, compared to 3 patients who were able to do so before surgery. On second-look arthroscopy of 21 knees, the average ICRS score was 10.5 points. No patient needed additional surgery except for removal of the implants. CONCLUSION Valgus HTO combined with OAT is one treatment option for osteonecrosis of the medial femoral condyle with osteoarthritis. In the present study, many of the patients regained good knee function, and 50% of the patients were able to sit straight in the Japanese style after surgery, which is a higher rate than after total knee arthroplasty and unilateral knee arthroplasty.
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Affiliation(s)
- Eri Tarumi
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Japan.
| | - Yasuaki Nakagawa
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Japan
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Japan
| | - Hiromitsu Yabumoto
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Japan
| | - Takashi Nakamura
- Department of Orthopaedic Surgery, National Hospital Organization, Kyoto Medical Center, Japan; Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Japan
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12
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Kobayashi S, Niki Y, Harato K, Udagawa K, Matsumoto M, Nakamura M. The effects of barbed suture on watertightness after knee arthrotomy closure: a cadaveric study. J Orthop Surg Res 2018; 13:323. [PMID: 30572958 PMCID: PMC6302503 DOI: 10.1186/s13018-018-1035-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Wound closure is one of the crucial aspects of total knee arthroplasty (TKA) for patients who perform high-flexion activities of daily living, because the joint capsule is highly stretched and integrity of the arthrotomy closure must be maintained. Watertightness of the knee joint is a different aspect of the repair integrity of arthrotomy closure and is being noticed with increasing usage of the drain clamp method for blood management after TKA. Recently, the barbed knotless suture has been growing in popularity as a strong, secure closure appropriate for high-tension areas, such as the fascia and joint capsule. The purpose of this study was to compare the barbed knotless suture with simple interrupted suture in cadaveric knees. Methods Nine fresh-frozen cadaveric lower extremities were used. After placing a parapatellar incision and setting a closed suction drain, arthrotomies were closed randomly using three suture materials: simple interrupted absorbable suture (No. 0 PDS, group C); or a single running knotless barbed suture Stratafix with 8N (group BS-8N) or 15N (group BS-15N) of tension. After arthrotomy closure, saline was injected in a retrograde manner into the joint through a drain until saline started to leak from the joint. Peak values for intra-articular pressure and infusion volume in each group were recorded and compared. Results Mean infusion volumes were 13.0 ± 7.2 ml, 38.6 ± 10.7 ml, and 5.1 ± 2.5 ml in groups BS-8N, BS-15N, and C, respectively. Mean intra-articular pressures were 0.67 ± 0.47 kPa, 9.44 ± 4.55 kPa, and 0.56 ± 0.44 kPa in groups BS-8N, BS-15N, and C, respectively. Infusion volume and joint internal pressure were significantly higher in group BS-15N than in groups BS-8N (p = 0.008) or C (p = 0.04). Conclusions Barbed suture with 15N appears appropriate for maintaining maximal watertightness after knee joint capsule closure, offering successful drain clamping, higher resistance to early mobilization protocols, and subsequent achievement of early deep knee flexion after TKA. Electronic supplementary material The online version of this article (10.1186/s13018-018-1035-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shu Kobayashi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Kengo Harato
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kazuhiko Udagawa
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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13
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Kaneko T, Kono N, Mochizuki Y, Hada M, Sunakawa T, Ikegami H, Musha Y. The influence of compressive forces across the patellofemoral joint on patient-reported outcome after bi-cruciate stabilized total knee arthroplasty. Bone Joint J 2018; 100-B:1585-1591. [PMID: 30499324 DOI: 10.1302/0301-620x.100b12.bjj-2018-0693.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS Patellofemoral problems are a common complication of total knee arthroplasty. A high compressive force across the patellofemoral joint may affect patient-reported outcome. However, the relationship between patient-reported outcome and the intraoperative patellofemoral contact force has not been investigated. The purpose of this study was to determine whether or not a high intraoperative patellofemoral compressive force affects patient-reported outcome. PATIENTS AND METHODS This prospective study included 42 patients (42 knees) with varus-type osteoarthritis who underwent a bi-cruciate stabilized total knee arthroplasty and in whom the planned alignment was confirmed on 3D CT. Of the 42 patients, 36 were women and six were men. Their mean age was 72.3 years (61 to 87) and their mean body mass index (BMI) was 24.4 kg/m 2 (18.2 to 34.3). After implantation of the femoral and tibial components, the compressive force across the patellofemoral joint was measured at 10°, 30°, 60°, 90°, 120°, and 140° of flexion using a load cell (Kyowa Electronic Instruments Co., Ltd., Tokyo, Japan) manufactured in the same shape as the patellar implant. Multiple regression analyses were conducted to investigate the relationship between intraoperative patellofemoral compressive force and patient-reported outcome two years after implantation. RESULTS No patient had anterior knee pain after total knee arthroplasty. The compressive force across the patellofemoral joint at 140°of flexion was negatively correlated with patient satisfaction (R 2 = 0.458; β = -0.706; p = 0. 041) and Forgotten Joint Score-12 (FJS-12; R 2 = .378; β = -0.636; p = 0. 036). The compressive force across the patellofemoral joint at 60° of flexion was negatively correlated with the patella score (R 2 = 0.417; β = -0.688; p = 0. 046). CONCLUSION Patient satisfaction, FJS-12, and patella score were affected by the patellofemoral compressive force at 60° and 140° of flexion. Reduction of the patellofemoral compressive forces at 60° and 140° of flexion angle during total knee arthroplasty may improve patient-reported outcome, but has no effect on anterior knee pain.
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Affiliation(s)
- T Kaneko
- Department of Orthopedic Surgery (Ohashi), Toho University School of Medicine, Tokyo, Japan
| | - N Kono
- Department of Orthopedic Surgery (Ohashi), Toho University School of Medicine, Tokyo, Japan
| | - Y Mochizuki
- Department of Orthopedic Surgery (Ohashi), Toho University School of Medicine, Tokyo, Japan
| | - M Hada
- Department of Orthopedic Surgery (Ohashi), Toho University School of Medicine, Tokyo, Japan
| | - T Sunakawa
- Department of Orthopedic Surgery (Ohashi), Toho University School of Medicine, Tokyo, Japan
| | - H Ikegami
- Department of Orthopedic Surgery (Ohashi), Toho University School of Medicine, Tokyo, Japan
| | - Y Musha
- Department of Orthopedic Surgery (Ohashi), Toho University School of Medicine, Tokyo, Japan
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14
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Murakami K, Hamai S, Moro-Oka T, Okazaki K, Higaki H, Shimoto T, Ikebe S, Nakashima Y. Variable tibiofemoral articular contact stress in fixed-bearing total knee arthroplasties. Orthop Traumatol Surg Res 2018; 104:177-183. [PMID: 29274859 DOI: 10.1016/j.otsr.2017.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/14/2017] [Accepted: 11/17/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rotational allowance at the tibiofemoral joint would be required during deep flexion. However, the amount of flexion and rotation has not been investigated in modern total knee arthroplasty (TKA) designs. The present study aimed to determine the contact stress in five posterior-stabilized fixed-bearing TKA designs. HYPOTHESIS We hypothesized that the contact area and stresses at the tibiofemoral articular surfaces vary according to the type of implant design and tested condition. MATERIALS AND METHODS The contact area and mean and peak contact stresses at the tibiofemoral articular surfaces were determined when a compressive load of 1200N was applied to a NexGen LPS Flex, Scorpio NRG, Genesis II, PFC Sigma, and Foundation implant. Measurements were performed at 0° and 45° flexion with 0°, 5°, 10°, and 15° rotation, and at 90° and 135° flexion with 0, 5°, 10°, 15°, and 20° rotation. RESULTS The LPS Flex showed that the femoral component could not achieve 20° rotation at 135° flexion. The Scorpio NRG showed less than 20MPa of contact stress at all conditions. The Genesis II showed higher contact stress than 20MPa at 135° flexion with 20° rotation. The PFC Sigma showed that the femoral component could not achieve >10° rotation at any flexion angle. The Foundation showed more than 20MPa of contact stress at 90° flexion with 20° rotation and at 135° flexion with 10°, 15°, and 20° rotation. DISCUSSION Surgeons should be more aware of the variable contact conditions of the tibiofemoral articular surfaces in individual TKA designs. LEVEL OF EVIDENCE Level IV, basic science study.
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Affiliation(s)
- K Murakami
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu university, 1-3-3, Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan
| | - S Hamai
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu university, 1-3-3, Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan.
| | - T Moro-Oka
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu university, 1-3-3, Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan; Moro-oka orthopaedic hospital, 101-3, Katawana Nakagawa-machi, 811-1201 Chikushi-gun, Fukuoka, Japan
| | - K Okazaki
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu university, 1-3-3, Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan
| | - H Higaki
- Department of biorobotics, faculty of engineering, Kyushu Sangyo university, 2-3-1, Matsugadai, 813-8583 Higashi-ku, Fukuoka, Japan
| | - T Shimoto
- Department of information and systems engineering, faculty of information engineering, Fukuoka institute of technology, 3-30-1, Wajiro-higashi, 811-0295 Higashi-ku, Fukuoka, Japan
| | - S Ikebe
- Department of biorobotics, faculty of engineering, Kyushu Sangyo university, 2-3-1, Matsugadai, 813-8583 Higashi-ku, Fukuoka, Japan
| | - Y Nakashima
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu university, 1-3-3, Maidashi, 812-8582 Higashi-ku, Fukuoka, Japan
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15
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Taylor WR, Schütz P, Bergmann G, List R, Postolka B, Hitz M, Dymke J, Damm P, Duda G, Gerber H, Schwachmeyer V, Hosseini Nasab SH, Trepczynski A, Kutzner I. A comprehensive assessment of the musculoskeletal system: The CAMS-Knee data set. J Biomech 2017; 65:32-39. [DOI: 10.1016/j.jbiomech.2017.09.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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16
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Kingston DC, Tennant LM, Chong HC, Acker SM. Peak activation of lower limb musculature during high flexion kneeling and transitional movements. ERGONOMICS 2016; 59:1215-1223. [PMID: 26923936 DOI: 10.1080/00140139.2015.1130861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Few studies have measured lower limb muscle activation during high knee flexion or investigated the effects of occupational safety footwear. Therefore, our understanding of injury and disease mechanisms, such as knee osteoarthritis, is limited for these high-risk postures. Peak activation was assessed in eight bilateral lower limb muscles for twelve male participants, while shod or barefoot. Transitions between standing and kneeling had peak quadriceps and tibialis anterior (TA) activations above 50% MVC. Static kneeling and simulated tasks performed when kneeling had peak TA activity above 15% MVC but below 10% MVC for remaining muscles. In three cases, peak muscle activity was significantly higher (mean 8.9% MVC) when shod. However, net compressive knee joint forces may not be significantly increased when shod. EMG should be used as a modelling input when estimating joint contact forces for these postures, considering the activation levels in the hamstrings and quadriceps muscles during transitions. Practitioner Summary: Kneeling transitional movements are used in activities of daily living and work but are linked to increased knee osteoarthritis risk. We found peak EMG activity of some lower limb muscles to be over 70% MVC during transitions and minimal influence of wearing safety footwear.
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Affiliation(s)
- David C Kingston
- a Department of Kinesiology , University of Waterloo , Waterloo , Canada
| | - Liana M Tennant
- a Department of Kinesiology , University of Waterloo , Waterloo , Canada
| | - Helen C Chong
- a Department of Kinesiology , University of Waterloo , Waterloo , Canada
| | - Stacey M Acker
- a Department of Kinesiology , University of Waterloo , Waterloo , Canada
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17
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Niki Y, Takeda Y, Harato K, Suda Y. Factors affecting the achievement of Japanese-style deep knee flexion after total knee arthroplasty using posterior-stabilized prosthesis with high-flex knee design. J Orthop Sci 2015; 20:1012-8. [PMID: 26275557 DOI: 10.1007/s00776-015-0769-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Achievement of very deep knee flexion after total knee arthroplasty (TKA) can play a critical role in the satisfaction of patients who demand a floor-sitting lifestyle and engage in high-flexion daily activities (e.g., seiza-sitting). Seiza-sitting is characterized by the knees flexed >145º and feet turned sole upwards underneath the buttocks with the tibia internally rotated. The present study investigated factors affecting the achievement of seiza-sitting after TKA using posterior-stabilized total knee prosthesis with high-flex knee design. METHODS Subjects comprised 32 patients who underwent TKA with high-flex knee prosthesis and achieved seiza-sitting (knee flexion >145º) postoperatively. Another 32 patients served as controls who were capable of knee flexion >145º preoperatively, but failed to achieve seiza-sitting postoperatively. Accuracy of femoral and tibial component positions was assessed in terms of deviation from the ideal position using a two-dimensional to three-dimensional matching technique. Accuracies of the component position, posterior condylar offset ratio and intraoperative gap length were compared between the two groups. RESULTS The proportion of patients with >3º internally rotated tibial component was significantly higher in patients who failed at seiza-sitting (41 %) than among patients who achieved it (13 %, p = 0.021). Comparison of intraoperative gap length between patient groups revealed that gap length at 135º flexion was significantly larger in patients who achieved seiza-sitting (4.2 ± 0.4 mm) than in patients who failed at it (2.7 ± 0.4 mm, p = 0.007). Conversely, no significant differences in gap inclination were seen between the groups. CONCLUSIONS From the perspective of surgical factors, accurate implant positioning, particularly rotational alignment of the tibial component, and maintenance of a sufficient joint gap at 135º flexion appear to represent critical factors for achieving >145º of deep knee flexion after TKA.
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Affiliation(s)
- Yasuo Niki
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yuki Takeda
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kengo Harato
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yasunori Suda
- Department of Orthopaedic Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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