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van Houten AH, Heesterbeek PJC, Hannink G, Labey L, Wymenga AB. Limited effect of anatomical insert geometry on in vitro laxity in balanced anatomic posterior cruciate ligament retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:1273-1281. [PMID: 33860338 DOI: 10.1007/s00167-021-06564-1] [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: 01/10/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The present study assessed the effect of insert articular surface geometry (anatomical versus conventional insert design) on anteroposterior (AP) translation and varus-valgus (VV) laxity in balanced posterior cruciate ligament (PCL) retaining total knee arthroplasty (TKA). Secondly, we evaluated if the AP translation and VV laxity in the reconstructed knee resembled the stability of the native knee. METHODS Nine fresh-frozen full-leg cadaver specimens were used in this study. After testing the native knee, anatomical components of a PCL-retaining implant were implanted. The knee joints were subjected to anteriorly and posteriorly directed forces (at 20° and 90° flexion) and varus-valgus stresses (at 20°, 45° and 90° flexion) in both non-weightbearing and weightbearing situations in a knee kinematics simulator. Measurements were performed in the native knee, TKA with anatomical insert geometry (3° built-in varus, medial concave, lateral convex), and TKA with symmetrical insert geometry. RESULTS In weightbearing conditions, anterior translations ranged between 2.6 and 3.9 mm at 20° flexion and were < 1 mm at 90° flexion. Posterior translation at 20° flexion was 2.7 mm for the native knee versus 4.0 mm (p = 0.047) and 7.0 mm (p = 0.02) for the symmetrical insert and the anatomical insert, respectively. Posterior translation at 90° flexion was < 1.1 mm and not significantly different between the native knee and insert types. In non-weightbearing conditions, the anterior translation at 20° flexion was 5.9 mm for the symmetrical and 4.6 mm for the anatomical insert (n.s.), compared with 3.0 mm for the native knee (p = 0.02). The anterior translation at 90° flexion was significantly higher for the reconstructed knees (anatomical insert 7.0 mm; symmetrical insert 9.2 mm), compared with 1.6 mm for the native knee (both p = 0.02). Varus-valgus laxity at different flexion angles was independent of insert geometry. A valgus force in weightbearing conditions led to significantly more medial laxity (1°-3° opening) in the native knee at 45° and 90° flexion compared with the reconstructed knee for all flexion angles. CONCLUSIONS Insert geometry seems to have a limited effect with respect to AP translation and VV laxity, in the well-balanced PCL-retaining TKA with an anatomical femoral component. Secondly, AP translation and VV laxity in the reconstructed knee approximated the laxity of the native knee.
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Affiliation(s)
- Albert H van Houten
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands.
- OCON Centre for Orthopaedic Surgery, Hengelo, The Netherlands.
| | - Petra J C Heesterbeek
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luc Labey
- Department of Mechanical Engineering, KU Leuven, Geel, Belgium
| | - Ate B Wymenga
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands
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Perkins MR, Arnholt CM, MacDonald DW, Kurtz SM, Mihalko WM. Retrieval Analysis of Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty and Correlations to Laxity and Wear. J Arthroplasty 2020; 35:2249-2253. [PMID: 32279944 DOI: 10.1016/j.arth.2020.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/06/2020] [Accepted: 03/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) with posterior-stabilized (PS) or posterior cruciate-retaining (CR) implants has high success rates and survivorship. However, it is uncertain how laxity and constraint are associated with long-term polyethylene wear under physiological conditions. METHODS To answer this question, we measured the laxity patterns of 47 harvested cadaver specimens with primary TKAs in a custom knee-testing machine at full extension and at 30°, 60°, and 90° of flexion. The wear patterns of the tibial inserts were assessed using a semiquantitative method which is a modified approach of that proposed by Hood et al in 1983. RESULTS Statistical analysis found that the PS TKA cohort had a statistically significant increase in varus laxity at 60° and 90° of flexion, as well as total coronal laxity at 60° of flexion when compared to the CR cohort. Furthermore, analysis demonstrated a significant correlation between increased PS coronal laxity and increased tibial wear, a trend that was not seen in the CR specimens. CONCLUSION Our findings suggest that greater laxity in flexion after primary TKA may increase the wear realized over time and that PS TKAs may be more susceptible due to the loss of support the PCL affords to the flexion space. Whether a CR or PS TKA is used, surgeons need to avoid the pitfalls that may create greater flexion laxity during the procedure to optimize long-term polyethylene wear.
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Affiliation(s)
- Meredith R Perkins
- Department of Biomedical Engineering and Orthopedic Surgery, University of Tennessee Health Science Center, Memphis, TN
| | - Christina M Arnholt
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA
| | - Daniel W MacDonald
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA
| | - Steven M Kurtz
- Implant Research Center, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA
| | - William M Mihalko
- Campbell Clinic Orthopaedics, Germantown, TN; Department of Biomedical Engineering and Orthopedic Surgery, University of Tennessee Health Science Center, Memphis, TN
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Te Molder MEM, Wymenga AB, Heesterbeek PJC. Mid-flexion laxity in the asymptomatic native knee is predominantly present on the lateral side. Knee Surg Sports Traumatol Arthrosc 2019; 27:3614-3625. [PMID: 30903221 DOI: 10.1007/s00167-019-05474-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE During total knee arthroplasty (TKA), an orthopaedic surgeon is focused on soft-tissue balance in extension (0°) and in flexion (90°). Patients with instability problems of the knee often report a feeling of instability during daily life activities, at around 30° knee flexion. There are no reference values available for knee laxity of healthy subjects in mid-flexion (30°) and flexion (90°) for comparison with the TKA population. Therefore, the aim was to quantify varus and valgus knee laxity in extension, mid-flexion and flexion in the asymptomatic native knee. METHODS In 40 healthy volunteers matched for age, gender and BMI with the TKA-population, varus and valgus knee laxity in extension (0°), mid-flexion (30°) and flexion (90°) was measured on low-dose radiographs. For each subject, one randomly selected knee was stressed in extension, mid-flexion and flexion (with 15 Nm) using a stress device. RESULTS Varus laxity in mid-flexion was higher than in extension and flexion (p < 0.01). Valgus laxity tended to be highest in mid-flexion laxity; however, no differences in knee laxity between flexion angles were seen (n.s.). Varus knee laxity in extension was higher in females than in males (p < 0.05). CONCLUSIONS Mid-flexion laxity in the native knee is more prominent on the lateral side of the knee, while the medial side is more stable and constrained. Varus knee laxity in extension was shown to be higher in females than in males. LEVEL OF EVIDENCE Prognostic Level II.
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Affiliation(s)
- Malou E M Te Molder
- Sint Maartenskliniek Research, Sint Maartenskliniek, P.O. box 9011, 6500 GM, Nijmegen, The Netherlands.
| | - Ate B Wymenga
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Petra J C Heesterbeek
- Sint Maartenskliniek Research, Sint Maartenskliniek, P.O. box 9011, 6500 GM, Nijmegen, The Netherlands
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Kayani B, Konan S, Horriat S, Ibrahim MS, Haddad FS. Posterior cruciate ligament resection in total knee arthroplasty: the effect on flexion-extension gaps, mediolateral laxity, and fixed flexion deformity. Bone Joint J 2019; 101-B:1230-1237. [PMID: 31564152 DOI: 10.1302/0301-620x.101b10.bjj-2018-1428.r2] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to assess the effect of posterior cruciate ligament (PCL) resection on flexion-extension gaps, mediolateral soft-tissue laxity, fixed flexion deformity (FFD), and limb alignment during posterior-stabilized (PS) total knee arthroplasty (TKA). PATIENTS AND METHODS This prospective study included 110 patients with symptomatic osteoarthritis of the knee undergoing primary robot-assisted PS TKA. All operations were performed by a single surgeon using a standard medial parapatellar approach. Optical motion capture technology with fixed femoral and tibial registration pins was used to assess gaps before and after PCL resection in extension and 90° knee flexion. Measurements were made after excision of the anterior cruciate ligament and prior to bone resection. There were 54 men (49.1%) and 56 women (50.9%) with a mean age of 68 years (sd 6.2) at the time of surgery. The mean preoperative hip-knee-ankle deformity was 4.1° varus (sd 3.4). RESULTS PCL resection increased the mean flexion gap significantly more than the extension gap in the medial (2.4 mm (sd 1.5) vs 1.3 mm (sd 1.0); p < 0.001) and lateral (3.3 mm (sd 1.6) vs 1.2 mm (sd 0.9); p < 0.01) compartments. The mean gap differences after PCL resection created significant mediolateral laxity in flexion (gap difference: 1.1 mm (sd 2.5); p < 0.001) but not in extension (gap difference: 0.1 mm (sd 2.1); p = 0.51). PCL resection significantly improved the mean FFD (6.3° (sd 4.4) preoperatively vs 3.1° (sd 1.5) postoperatively; p < 0.001). There was a strong positive correlation between the preoperative FFD and change in FFD following PCL resection (Pearson's correlation coefficient = 0.81; p < 0.001). PCL resection did not significantly affect limb alignment (mean change in alignment: 0.2° valgus (sd 1.2); p = 0.60). CONCLUSION PCL resection creates flexion-extension mismatch by increasing the flexion gap more than the extension gap. The increase in the lateral flexion gap is greater than the increase in the medial flexion gap, which creates mediolateral laxity in flexion. Improvements in FFD following PCL resection are dependent on the degree of deformity before PCL resection. Cite this article: Bone Joint J 2019;101-B:1230-1237.
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Affiliation(s)
- Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Sujith Konan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Saman Horriat
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Mazin S Ibrahim
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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Hino K, Kutsuna T, Watamori K, Ishimaru Y, Kiyomatsu H, Shiraishi Y, Miura H. Bi-cruciate substituting total knee arthroplasty provides varus-valgus stability throughout the midflexion range. Knee 2018; 25:897-902. [PMID: 29937117 DOI: 10.1016/j.knee.2018.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/09/2018] [Accepted: 06/05/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Proper soft tissue balance is crucial for a successful clinical outcome after total knee arthroplasty (TKA). Bi-cruciate substituting (BCS)-TKA has been developed to more closely approximate normal knee characteristics. The purpose of the present study was to evaluate midflexion laxity before and after BCS-TKA using a navigation system, and assess the correlation between intraoperative laxity and the maximum flexion angle after surgery. METHODS Fifty-one knees in 46 patients with osteoarthritis replaced with BCS prosthesis were assessed. Manual mild passive internal-external rotational and varus-valgus stress was applied to the knees, and the maximum total laxity was measured automatically by a navigation system before and after TKA. The correlations with the range of motion (ROM) were evaluated using Spearman's correlation coefficients (ρ). RESULTS Internal-external stress assessment revealed no statistically significant difference at each flexion angle before and after BCS-TKA. In contrast, the varus-valgus stress assessment revealed that BCS-TKA had significantly decreased varus-valgus laxity from preoperative levels at 20-120° flexion angles. Furthermore, the maximum flexion angle at six months after surgery significantly correlated with the intraoperative laxity at deep flexion range. CONCLUSION BCS-TKA stabilized varus-valgus laxity to better than preoperative levels at midflexion range.
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Affiliation(s)
- Kazunori Hino
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tatsuhiko Kutsuna
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kunihiko Watamori
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yasumitsu Ishimaru
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiroshi Kiyomatsu
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yoshitaka Shiraishi
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan.
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Serna-Berna R, Lizaur-Utrilla A, Vizcaya-Moreno MF, Miralles Muñoz FA, Gonzalez-Navarro B, Lopez-Prats FA. Cruciate-Retaining vs Posterior-Stabilized Primary Total Arthroplasty. Clinical Outcome Comparison With a Minimum Follow-Up of 10 Years. J Arthroplasty 2018; 33:2491-2495. [PMID: 29691173 DOI: 10.1016/j.arth.2018.02.094] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Controversy continues regarding whether the posterior cruciate ligament should be retained or removed during total knee arthroplasty (TKA) procedure. The objective was to compare the clinical outcomes with a minimum follow-up of 10 years between patients who received contemporary cruciate-retaining or posterior-stabilized primary TKA. METHODS Case-control study of 268 patients who underwent cruciate-retaining TKA vs 211 to posterior-stabilized design, with the same arthroplasty system, and a minimum follow-up of 10 years. Clinical assessment was performed by Knee Society scores, Western Ontario and MacMasters Universities and Short-Form 12 questionnaires, range of motion, and patient satisfaction. RESULTS Successful outcomes were found for both designs. No significant differences in functional scores, range of motion, patient-related scores, or patient satisfaction. Between the 5-year and last postoperative follow-up, there were a significant decrease of all clinical scores in both groups. In addition, complication rate and implant survival were similar between groups. CONCLUSION The superiority of one design over the other was not found. Both designs can be used expecting long-term successful outcomes and high survival. The choice of the design depended on the status of the posterior cruciate ligament and surgeon preference.
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Affiliation(s)
- Ricardo Serna-Berna
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Alicante, Spain; Traumatology and Orthopaedia, Miguel Hernandez University, Alicante, Spain
| | - Maria F Vizcaya-Moreno
- Clinical Research Group, Faculty of Health Sciences, University of Alicante, Alicante, Spain
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Wood AR, Rabbani TA, Sheffer B, Wagner RA, Sanchez HB. Protecting the PCL During Total Knee Arthroplasty Using a Bone Island Technique. J Arthroplasty 2018; 33:102-106. [PMID: 28927647 DOI: 10.1016/j.arth.2017.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/23/2017] [Accepted: 08/09/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prior studies have shown that the posterior cruciate ligament (PCL) may be partially resected during cruciate retaining (CR) total knee arthroplasty (TKA) using highly experienced hands and standard surgical technique; therefore, proper surgical technique is aimed at preservation and balance of the PCL during CR TKA. The central objective of this study is to evaluate the effectiveness of a simple surgical technique to prevent PCL damage during performance of a CR TKA. METHODS Sixty embalmed cadaver specimens were randomized into 2 groups, experimental and control. The control group consisted of standard tibial resection without the use of an osteotome. The experimental group utilized an osteotome in addition to standard technique to preserve a bone island anterior to the tibial attachment of the PCL. RESULTS In the control group, PCL damage was noted in 73% (22/30) of specimens. In the experimental group, where an osteotome was used, PCL damage was found in 23% (7/30) of specimens. The use of an osteotome was found to have an absolute risk reduction of 50% when compared to the control group which did not use an osteotome to protect the PCL. CONCLUSION In the setting of minimal surgical experience, the use of an osteotome to preserve the PCL during CR TKA by forming a bone island was found to be an effective means of protecting the PCL over standard technique. In addition, standard technique with the use of a Y-shaped PCL retractor was found to provide questionable protection to the PCL.
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Affiliation(s)
- Addison R Wood
- Department of Structural Anatomy and Rehabilitative Science, University of North Texas Health Science Center, Fort Worth, Texas; Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, Texas
| | - Tebyan A Rabbani
- Department of Structural Anatomy and Rehabilitative Science, University of North Texas Health Science Center, Fort Worth, Texas
| | - Benjamin Sheffer
- Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, Texas
| | - Russell A Wagner
- Department of Structural Anatomy and Rehabilitative Science, University of North Texas Health Science Center, Fort Worth, Texas; Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, Texas
| | - Hugo B Sanchez
- Department of Structural Anatomy and Rehabilitative Science, University of North Texas Health Science Center, Fort Worth, Texas; Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, Texas
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Hino K, Kutsuna T, Oonishi Y, Watamori K, Kiyomatsu H, Iseki Y, Watanabe S, Ishimaru Y, Miura H. Assessment of the midflexion rotational laxity in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:3495-3500. [PMID: 27246993 DOI: 10.1007/s00167-016-4175-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/17/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate changes in midflexion rotational laxity before and after posterior-stabilized (PS)-total knee arthroplasty (TKA). METHODS Twenty-nine knees that underwent PS-TKA were evaluated. Manual mild passive rotational stress was applied to the knees, and the internal-external rotational angle was measured automatically by a navigation system at 30°, 45°, 60°, and 90° of knee flexion. RESULTS The post-operative internal rotational laxity was statistically significantly increased compared to the preoperative level at 30°, 45°, 60°, and 90° of flexion. The post-operative external rotational laxity was statistically significantly decreased compared to the preoperative level at 45° and 60° of flexion. The post-operative internal-external rotational laxity was statistically significantly increased compared to the preoperative level only at 30° of flexion. The preoperative and post-operative rotational laxity showed a significant correlation at 30°, 45°, 60°, and 90° of flexion. CONCLUSION Internal-external rotational laxity increases at the initial flexion range due to resection of both the anterior or posterior cruciate ligaments and retention of the collateral ligaments in PS-TKA. Preoperative and post-operative rotational laxity indicated a significant correlation at the midflexion range. This study showed that a large preoperative rotational laxity increased the risk of a large post-operative laxity, especially at the initial flexion range in PS-TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kazunori Hino
- Department of Orthopaedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 790-0295, Japan.
| | - Tatsuhiko Kutsuna
- Department of Orthopaedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 790-0295, Japan
| | - Yoshio Oonishi
- Department of Orthopaedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 790-0295, Japan
| | - Kunihiko Watamori
- Department of Orthopaedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 790-0295, Japan
| | - Hiroshi Kiyomatsu
- Department of Orthopaedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 790-0295, Japan
| | - Yasutake Iseki
- Department of Orthopaedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 790-0295, Japan
| | - Seiji Watanabe
- Department of Orthopaedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 790-0295, Japan
| | - Yasumitsu Ishimaru
- Department of Orthopaedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 790-0295, Japan
| | - Hiromasa Miura
- Department of Orthopaedic Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 790-0295, Japan
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Notarnicola A, Maccagnano G, Fiore A, Spinarelli A, Montenegro L, Paoloni M, Pastore F, Tafuri S, Moretti B. Baropodometry on patients after total knee arthroplasty. Musculoskelet Surg 2017; 102:129-137. [PMID: 28971359 DOI: 10.1007/s12306-017-0505-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/25/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE It is well known that total knee replacement surgery decreases pain and improves function, but the effect on postural assessment needs to be studied better with the use of new technological devices. Total knee arthroplasty (TKA) improves motor coordination and stability of the knee. On the other hand, changing joint functionality can modify the balance. The aim of this trial is to record and analyze the static and dynamic baropodometric data of patients in the first few months following joint replacement. For the physiatrist, this tool can be useful to check if the rehabilitation treatment protocols and times are correct. METHODS We designed a prospective observation longitudinal study to assess postural stability following TKA. Between December 2014 and May 2015, sixty consecutive patients were recruited through local orthopedic physician offices and hospitals. The patients scheduled to undergo TKA were recruited and were monitored before surgery (T0) and at 1 (T1), 3 (T2) and 6 months (T3) after knee surgery. The correction of varus/valgus deviation at X-ray and the Knee Society Score were performed to verify the functional recovery. We used static and dynamic baropodometric analysis to evaluate postural assessment. RESULTS After surgery, there was a significant improvement in physiological alignment of knee axes (p < 0.0001) and of Knee and Function Scores (excellent, mean values 80.5 and 80.7, respectively, p < 0.0001). The static analysis showed that the center of gravity and the pressure on the foot of the operated limb were corrected toward the physiological center (p < 0.0001) and the body weight displaced to the forefeet and to the hindfeet reduced bilaterally (p < 0.0001). The type of footprint did not change. The dynamic analysis confirmed the significant normalization of the pressure on the foot of the operated limb at all follow-ups (p < 0.0001). The percentage of load was reduced on the operated limb (p = 0.0096) and speed of step, cadence and semi-step length increased (p < 0.0001). CONCLUSION These data show the progressive recovery of stability after TKA from the immediate postoperative to the subsequent months. The clinical and functional improvement correlated with a load redistribution between the two limbs. The baropodometry could be an excellent noninvasive method for monitoring effects of rehabilitation treatment.
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Affiliation(s)
- A Notarnicola
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy. .,Course of Motor and Sports Sciences, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Lungomare Starita 1, 70123, Bari, Italy.
| | - G Maccagnano
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - A Fiore
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - A Spinarelli
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - L Montenegro
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - M Paoloni
- Physical Medicine and Rehabilitation, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - F Pastore
- Orthopedics Section, Regional General Hospital Francesco Miulli, SP 127 Acquaviva-Santeramo Km 4.100, Acquaviva delle Fonti, Bari, Italy
| | - S Tafuri
- Department of Biomedical Sciences and Human Oncology, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - B Moretti
- Orthopedics Section, Department of Medical Sciences of Basis, Neurosciences and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, General Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Athwal KK, El Daou H, Lord B, Davies AJ, Manning W, Rodriguez Y Baena F, Deehan DJ, Amis AA. Lateral soft-tissue structures contribute to cruciate-retaining total knee arthroplasty stability. J Orthop Res 2017; 35:1902-1909. [PMID: 27859544 DOI: 10.1002/jor.23477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 11/03/2016] [Indexed: 02/04/2023]
Abstract
Little information is available to surgeons regarding how the lateral structures prevent instability in the replaced knee. The aim of this study was to quantify the lateral soft-tissue contributions to stability following cruciate-retaining total knee arthroplasty (CR TKA). Nine cadaveric knees were tested in a robotic system at full extension, 30°, 60°, and 90° flexion angles. In both native and CR implanted states, ±90 N anterior-posterior force, ±8 Nm varus-valgus, and ±5 Nm internal-external torque were applied. The anterolateral structures (ALS, including the iliotibial band), the lateral collateral ligament (LCL), the popliteus tendon complex (Pop T), and the posterior cruciate ligament (PCL) were transected and their relative contributions to stabilizing the applied loads were quantified. The LCL was found to be the primary restraint to varus laxity (an average 56% across all flexion angles), and was significant in internal-external rotational stability (28% and 26%, respectively) and anterior drawer (16%). The ALS restrained 25% of internal rotation, while the PCL was significant in posterior drawer only at 60° and 90° flexion. The Pop T was not found to be significant in any tests. Therefore, the LCL was confirmed as the major lateral structure in CR TKA stability throughout the arc of flexion and deficiency could present a complex rotational laxity that cannot be overcome by the other passive lateral structures or the PCL. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1902-1909, 2017.
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Affiliation(s)
- Kiron K Athwal
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom
| | - Hadi El Daou
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom
| | - Breck Lord
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom
| | - Andrew J Davies
- Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
| | - William Manning
- Department of Orthopaedic Surgery, Newcastle Freeman University Hospital, Newcastle, upon Tyne, United Kingdom
| | | | - David J Deehan
- Department of Orthopaedic Surgery, Newcastle Freeman University Hospital, Newcastle, upon Tyne, United Kingdom
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom.,Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, Charing Cross Hospital, London W6 8RF, United Kingdom
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An in vitro analysis of medial structures and a medial soft tissue reconstruction in a constrained condylar total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:2646-2655. [PMID: 27026029 PMCID: PMC5522503 DOI: 10.1007/s00167-016-4087-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 03/14/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to quantify the medial soft tissue contributions to stability following constrained condylar (CC) total knee arthroplasty (TKA) and determine whether a medial reconstruction could restore stability to a soft tissue-deficient, CC-TKA knee. METHODS Eight cadaveric knees were mounted in a robotic system and tested at 0°, 30°, 60°, and 90° of flexion with ±50 N anterior-posterior force, ±8 Nm varus-valgus, and ±5 Nm internal-external torque. The deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) were transected and their relative contributions to stabilising the applied loads were quantified. After complete medial soft tissue transection, a reconstruction using a semitendinosus tendon graft was performed, and the effect on kinematic behaviour under equivocal conditions was measured. RESULTS In the CC-TKA knee, the sMCL was the major medial restraint in anterior drawer, internal-external, and valgus rotation. No significant differences were found between the rotational laxities of the reconstructed knee to the pre-deficient state for the arc of motion examined. The relative contribution of the reconstruction was higher in valgus rotation at 60° than the sMCL; otherwise, the contribution of the reconstruction was similar to that of the sMCL. CONCLUSION There is contention whether a CC-TKA can function with medial deficiency or more constraint is required. This work has shown that a CC-TKA may not provide enough stability with an absent sMCL. However, in such cases, combining the CC-TKA with a medial soft tissue reconstruction may be considered as an alternative to a hinged implant.
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Non-Sagittal Knee Joint Kinematics and Kinetics during Gait on Level and Sloped Grounds with Unicompartmental and Total Knee Arthroplasty Patients. PLoS One 2016; 11:e0168566. [PMID: 28002437 PMCID: PMC5176302 DOI: 10.1371/journal.pone.0168566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/04/2016] [Indexed: 11/19/2022] Open
Abstract
After knee arthroplasty (KA) surgery, patients experience abnormal kinematics and kinetics during numerous activities of daily living. Biomechanical investigations have focused primarily on level walking, whereas walking on sloped surfaces, which is stated to affect knee kinematics and kinetics considerably, has been neglected to this day. This study aimed to analyze over-ground walking on level and sloped surfaces with a special focus on transverse and frontal plane knee kinematics and kinetics in patients with KA. A three-dimensional (3D) motion analysis was performed by means of optoelectronic stereophogrammetry 1.8 ± 0.4 years following total knee arthroplasty (TKA) and unicompartmental arthroplasty surgery (UKA). AnyBody™ Modeling System was used to conduct inverse dynamics. The TKA group negotiated the decline walking task with reduced peak knee internal rotation angles compared with a healthy control group (CG). First-peak knee adduction moments were diminished by 27% (TKA group) and 22% (UKA group) compared with the CG during decline walking. No significant differences were detected between the TKA and UKA groups, regardless of the locomotion task. Decline walking exposed apparently more abnormal knee frontal and transverse plane adjustments in KA patients than level walking compared with the CG. Hence, walking on sloped surfaces should be included in further motion analysis studies investigating KA patients in order to detect potential deficits that might be not obvious during level walking.
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Athwal KK, Daou HE, Kittl C, Davies AJ, Deehan DJ, Amis AA. The superficial medial collateral ligament is the primary medial restraint to knee laxity after cruciate-retaining or posterior-stabilised total knee arthroplasty: effects of implant type and partial release. Knee Surg Sports Traumatol Arthrosc 2016; 24:2646-55. [PMID: 26519188 DOI: 10.1007/s00167-015-3796-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/15/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to quantify the contributions of medial soft tissues to stability following cruciate-retaining (CR) or posterior-stabilised (PS) total knee arthroplasty (TKA). METHODS Using a robotic system, eight cadaveric knees were subjected to ±90-N anterior-posterior force, ±5-Nm internal-external and ±8-Nm varus-valgus torques at various flexion angles. The knees were tested intact and then with CR and PS implants, and successive cuts of the deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) quantified the percentage contributions of each structure to restraining the applied loads. RESULTS In implanted knees, the sMCL restrained valgus rotation (62 % across flexion angles), anterior-posterior drawer (24 and 10 %, respectively) and internal-external rotation (22 and 37 %). Changing from CR TKA to PS TKA increased the load on the sMCL when resisting valgus loads. The dMCL restrained 11 % of external and 13 % of valgus rotations, and the PMC was significant at low flexion angles. CONCLUSIONS This work has shown that medial release in the varus knee should be minimised, as it may inadvertently result in a combined laxity pattern. There is increasing interest in preserving constitutional varus in TKA, and this work argues for preservation of the sMCL to afford the surgeon consistent restraint and maintain a balanced knee for the patient.
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Affiliation(s)
- Kiron K Athwal
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Hadi El Daou
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | - Christoph Kittl
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK
| | | | - David J Deehan
- Department of Orthopaedic Surgery, Newcastle Freeman University Hospital, Newcastle upon Tyne, UK
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, Exhibition Road, London, SW7 2AZ, UK. .,Musculoskeletal Surgery Group, Department of Surgery and Cancer, Imperial College London School of Medicine, Charing Cross Hospital, London, W6 8RF, UK.
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Götz J, Beckmann J, Sperrer I, Baier C, Dullien S, Grifka J, Koeck F. Retrospective comparative study shows no significant difference in postural stability between cruciate-retaining (CR) and cruciate-substituting (PS) total knee implant systems. INTERNATIONAL ORTHOPAEDICS 2015; 40:1441-6. [PMID: 26686495 DOI: 10.1007/s00264-015-3067-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/01/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE Modified postural stability after retaining the posterior cruciate ligament (PCL) in total knee arthroplasty is still discussed controversially. The objective of this study was to evaluate whether a PCL-retaining implant design should be preferred over a PCL-substituting implant design regarding postural stability in one-leg stance and clinical outcome. METHODS Forty patients underwent total knee arthroplasty, 20 of them with a cruciate-retaining (CR) and 20 of them with a cruciate-substituting (PS) implant system. Postural stability was analysed 6 months postoperatively in one-leg stance using the Biodex Balance System. In addition, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Knee Society Score were completed. RESULTS This study shows that there is no significant difference in postural stability between CR and PS) implant systems with PS implants showing better results in WOMAC score. CONCLUSIONS In case it is necessary to use a PS implant, no negative influence on postural stability is to be expected compared to a CR implant.
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Affiliation(s)
- Juergen Götz
- Asklepios-Klinikum Bad Abbach, Orthopädische Klinik für die Universität Regensburg, Bad Abbach, Germany.
- Asklepios Klinikum Bad Abbach, Medical Centre University of Regensburg, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany.
| | | | - Ingo Sperrer
- Asklepios-Klinikum Bad Abbach, Orthopädische Klinik für die Universität Regensburg, Bad Abbach, Germany
| | - Clemens Baier
- Asklepios-Klinikum Bad Abbach, Orthopädische Klinik für die Universität Regensburg, Bad Abbach, Germany
| | - Silvia Dullien
- Asklepios-Klinikum Bad Abbach, Orthopädische Klinik für die Universität Regensburg, Bad Abbach, Germany
| | - Joachim Grifka
- Asklepios-Klinikum Bad Abbach, Orthopädische Klinik für die Universität Regensburg, Bad Abbach, Germany
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