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Zheng N, Dai H, Zou D, Wang Q, Tsai TY. Safe bearing region for avoiding meniscal bearing impingement and overhang in mobile-bearing unicompartmental knee arthroplasty. J Orthop Res 2024; 42:1200-1209. [PMID: 38084771 DOI: 10.1002/jor.25767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024]
Abstract
The purposes of this study were to propose a quantitative method of bearing overhang to minimize the effect of bearing spinning on mobile-bearing unicompartmental knee arthroplasty (MB UKA), suggest and apply safe bearing regions in daily activities. The overhang distance and area were calculated for neutral and spinning positions. The safe bearing regions were based on the relationship between bearing overhang and linear wear rate. Eleven patients were included in an in-vivo experiment under dual fluoroscopic imaging following medial MB UKA. The bearing position was tracked by minimal joint space width, and the bearing overhang was calculated accordingly. Due to an equal contribution of 1 mm increase in medial overhang and 30 mm2 overhang areato wear rate, the maximum effect of potential bearing spinning on medial overhang distance was approximately three times as large as the overhang area. The safe bearing distance and area regions were rectangles and arches with different scales for different size combinations of bearing, femoral and tibial components. The maximum bearing overhang area during lunge (R = 0.76, p = 0.006) and open-chain exercise (R = 0.68, p = 0.02) significantly correlated with the overhang area in standing. The overhang area can be an appropriate parameter for evaluating dislocation degree less affected by potential bearing spinning than the overhang distance in clinical practice. The corresponding safe overhang area regions were proposed for surgical planning and postoperative dislocation degree evaluation. The bearing overhang area in static standing posture can be a valuable reference to estimate the dynamic overhang area and dislocation degree during motion.
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Affiliation(s)
- Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiyong Dai
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Suda Y, Hiranaka T, Kamenaga T, Fujishiro T, Okamoto K, Matsumoto T. Mobile bearing orbit on the tibial component in Oxford unicompartmental knee arthroplasty. Knee 2023; 42:136-142. [PMID: 37001330 DOI: 10.1016/j.knee.2023.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 03/08/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To evaluate the bearing orbit of the tibial component during extension-flexion motion in Oxford unicompartmental knee arthroplasty. MATERIALS AND METHODS A total of 32 knees in 25 patients with medial osteoarthritis who underwent Oxford unicompartmental knee arthroplasty were evaluated. The distance between the vertical wall of the tibial component and the bearing (wall-bearing distance) and that between the anterior edge of the tibial component and the bearing (sagittal bearing position) were measured at 0°, 30°, 60°, 90° and 120° knee flexion with neutral tibial rotation (extension-flexion motion), and internal and external tibial rotation with 90° knee flexion (tibial rotation motion). A custom-made rounded trial bearing and caliper were used for this measurement. We calculated the wall-bearing distance, change in extension-flexion motion and tibial rotation motion. Wall-bearing distances and change in wall-bearing distance were compared using ANOVA or t-test. RESULTS The wall-bearing distance was smallest at 60° and increased 1.0 ± 1.1 mm in knee extension and 1.1 ± 1.5 mm in knee flexion. The bearing moved posteriorly with knee flexion, and the sagittal bearing position increased by 8.1 ± 3.4 mm during extension-flexion motion. Consequently, the bearing moved in a rough C-shaped orbit of the tibial component. CONCLUSIONS The mobile bearing moves in a rough C-shape and is mostly close to the vertical wall of the tibial component at 60°. The wall-bearing distance can change during extension-flexion motion and might be influenced by tibial component rotation. To avoid bearing separation from or contact with the vertical wall that may cause bearing dislocation, the wall-bearing distance should be evaluated before keel slot preparation.
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Affiliation(s)
- Yoshihito Suda
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan.
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan; Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
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Sun X, Lu F, Guo W, Cheng L, Wang W, Zhang Q. Trajectory of bearing movement during Oxford mobile-bearing unicompartmental knee arthroplasty using a kinematic alignment technique. Chin Med J (Engl) 2023; 136:613-615. [PMID: 36806284 PMCID: PMC10106227 DOI: 10.1097/cm9.0000000000002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- Xiaowei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Feifan Lu
- Department of Orthopedic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Wanshou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Liming Cheng
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Weiguo Wang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qidong Zhang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
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Wen P, Zhang Q, Sun X, Zhang B, Ma T, Zhang Y. Exploring the relationship between bearing extrusion and postoperative persistent pain in Oxford unicompartmental knee arthroplasty: A trajectory measurement study. Front Bioeng Biotechnol 2022; 10:965009. [PMID: 36246383 PMCID: PMC9557290 DOI: 10.3389/fbioe.2022.965009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of the study is to explore the relationship between the extrusion of the meniscus bearing and postoperative persistent pain of Oxford unicompartmental knee arthroplasty. Methods: Patients undertaking Oxford UKA from January 2019 to June 2020 were retrospectively analyzed. Intraoperatively, the displacement and movement trajectory of the meniscus bearing was recorded by the specially designed gridding mold of the tibial component. The k-means clustering analysis was applied based on the incidence of postoperative persistent knee pain and the bearing extrusion distance. The intraoperative meniscus bearing movement trajectories were analyzed between the two groups and the patients’ clinical outcomes and radiographic assessments. Results: The k-means clustering analysis indicated that the extrusion of the bearing of 5 mm was the grouping standard. There were 27 patients with 30 knees in the extrusion group and 58 patients with 68 knees in the non-extrusion group. The proportion of optimal bearing movement trajectories in the extrusion group was significantly lower than that in the non-extrusion group (p < 0.05). Postoperative persistent knee pain occurred in six cases (6.1%), with four and two cases in the extrusion and non-extrusion groups, respectively. The incidence of postoperative persistent knee pain in the extrusion group was higher than that of the non-extrusion group (p < 0.05). Radiographic assessment showed that the continuity of the femoral and tibial components in the extrusion group was greater than that in the non-extrusion group (p < 0.05). However, there were no differences in pre- and postoperative HKAA, the varus/valgus degree of both femoral and tibial components, and the flexion/extension angles of the femoral component, and the tibial slope also showed no statistical difference (p > 0.05). Conclusion: For Oxford mobile-bearing UKA, the extrusion of meniscus bearing over 5 mm may increase the incidence of postoperative persistent knee pain, while the improvement of the bearing movement trajectory can effectively reduce this complication.
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Affiliation(s)
- Pengfei Wen
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaowei Sun
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Binfei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Tao Ma
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yumin Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yumin Zhang,
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Hiranaka T, Suda Y, Kamenaga T, Fujishiro T, Koide M, Saitoh A, Tanaka A, Arimoto A, Okamoto K. Bearing Separation From the Lateral Wall of the Tibial Component Is a Risk of Anterior Dislocation of the Mobile Bearing in Oxford Unicompartmental Knee Arthroplasty. J Arthroplasty 2022; 37:942-947. [PMID: 35074447 DOI: 10.1016/j.arth.2022.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Bearing dislocation is a serious complication after Oxford unicompartmental knee arthroplasty. Bearing separation from the lateral wall can cause it to spin (90° horizontal rotation) and eventually dislocate because there is just a 2 mm difference in height in both the lateral and medial sides from the bottom of the bearing, compared with the anterior (5 mm) and posterior (3 mm) sides. The details of this problem have not been previously examined. METHODS Twenty-one dislocations in 12 patients were retrospectively analyzed. Bearing separation was defined as the bearing position being sufficiently distant from the lateral wall of the tibial component to allow spinning. We analyzed the incidence of separation, the direction and the recurrence of the dislocations, and their causes and treatments. RESULTS Five of the 12 patients had separation. Of the total of 21 dislocations, 11 occurred in cases of separation (52%). Seven of 11 anterior dislocations were found to have separation, whereas nine of 13 posterior dislocations occurred without separation (P = .0237). Three of 5 patients with separation had recurrence of dislocation, and eventually 2 underwent revision to fixed-bearing unicompartmental knee arthroplasty. CONCLUSION Bearing separation from the lateral wall of the tibial component can cause bearing dislocation, especially in an anterior direction. To prevent separation, the wall-bearing distance should be evaluated before the keel slot preparation, with manipulation as necessary. Conversely, posterior dislocation was predominant in our nonseparation cases.
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Affiliation(s)
- Takafumi Hiranaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Yoshihito Suda
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo Prefecture, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Motoki Koide
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Akira Saitoh
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Atsuki Tanaka
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Akihiko Arimoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
| | - Koji Okamoto
- Department of Orthopaedic Surgery and Joint Surgery Centre, Takatsuki General Hospital, Osaka, Japan
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Kawaguchi K, Inui H, Taketomi S, Yamagami R, Kono K, Sameshima S, Kage T, Tanaka S. Effects of a 1-mm difference in bearing thickness on intraoperative bearing movement and kinematics in Oxford unicompartmental knee arthroplasty. BMC Musculoskelet Disord 2022; 23:341. [PMID: 35397577 PMCID: PMC8994313 DOI: 10.1186/s12891-022-05203-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background The choice of mobile bearing (MB) thickness is essential for obtaining successful results after mobile-bearing Oxford unicompartmental knee arthroplasty (UKA). This study aimed to investigate the effects of a 1-mm difference in bearing thickness on intraoperative MB movement and intraoperative knee kinematics in Oxford UKAs. Methods We prospectively investigated the effects of a 1-mm difference in bearing thickness on intraoperative MB movement and knee kinematics in 25 patients who underwent Oxford UKAs when surgeons didn’t know which bearing thickness to choose with 1-mm difference. A trial tibial component that was scaled every 2 mm was used to measure the intraoperative MB movement, and the tibial internal rotation relative to the femur and the knee varus angle was simultaneously evaluated using the navigation system as the knee kinematics. We separately evaluated sets of two MB thicknesses with 1-mm differences, and we compared the intraoperative parameters at maximum extension; 30º, 45º, 60º, and 90º flexion; and maximum flexion between the thicker MB (thick group) and the thinner MB (thin group). Results The MB in the thin group was located significantly posteriorly at 90º flexion compared with that in the thick group; however, there were no differences at the other flexion angles. There was significantly less tibial internal rotation in the thin group at 90º flexion than that in the thick group; however, there were no differences at the other flexion angles. The knee varus angles in the thick group were significantly smaller than those in the thin group by approximately one degree at all angles other than at 30º and 45º flexion. Conclusion The thicker MB could bring the less posterior MB movement and the more tibial internal rotation at 90º flexion, additionally the valgus correction angle in the thicker MB should be paid attention. These results could help surgeons to decide the thickness of MBs when they wonder the thickness of MB.
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Kono K, Inui H, Tomita T, D'Lima DD, Yamazaki T, Konda S, Taketomi S, Yamagami R, Kawaguchi K, Sameshima S, Kage T, Tanaka S. Cruciate ligament force of knees following mobile-bearing unicompartmental knee arthroplasty is larger than the preoperative value. Sci Rep 2021; 11:18233. [PMID: 34521921 PMCID: PMC8440682 DOI: 10.1038/s41598-021-97655-z] [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: 04/10/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022] Open
Abstract
We analyzed the implantation effects on cruciate ligament force in unicompartmental knee arthroplasty (UKA) and determined whether kinematics is associated with the cruciate ligament force. We examined 16 patients (17 knees) undergoing medial UKA. Under fluoroscopy, each participant performed a deep knee bend before and after UKA. A two-dimensional/three-dimensional registration technique was employed to measure tibiofemoral kinematics. Forces in the anteromedial and posterolateral bundles of both the anterior cruciate ligament (aACL and pACL) and the anterolateral and posteromedial bundles of the posterior cruciate ligament (aPCL and pPCL) during knee flexion were analyzed pre- and post-UKA. Correlations between changes in kinematics and ligament forces post-UKA were also analyzed. Preoperatively, the aACL forces were highly correlated with anteroposterior (AP) translation of the lateral condyles (Correlation coefficient [r] = 0.59). The pPCL forces were highly correlated with the varus–valgus angulation (r = − 0.57). However, postoperatively, the PCL forces in both bundles were highly correlated with the AP translation of the medial femoral condyle (aPCL: r = 0.62, pPCL: r = 0.60). The ACL and PCL forces of the knees post-UKA were larger than those of the knees pre-UKA. Kinematic changes were significantly correlated with the cruciate ligament force changes.
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Affiliation(s)
- Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Darryl D D'Lima
- Department of Molecular Medicine Arthritis Research, The Scripps Research Institute, La Jolla, CA, 92037, USA.,Shiley Center for Orthopaedic Research & Education at Scripps Clinic, La Jolla, CA, 92121, USA
| | - Takaharu Yamazaki
- Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, 1690 Fusaiji, Fukaya, Saitama, 369-0293, Japan
| | - Shoji Konda
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Kawaguchi K, Inui H, Taketomi S, Yamagami R, Kono K, Sameshima S, Kage T, Tanaka S. Intraoperative rotational kinematics and its influence on postoperative clinical outcomes differ according to age in Unicompartmental knee Arthroplasty. BMC Musculoskelet Disord 2021; 22:505. [PMID: 34074280 PMCID: PMC8167984 DOI: 10.1186/s12891-021-04371-w] [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: 02/25/2021] [Accepted: 05/13/2021] [Indexed: 01/23/2023] Open
Abstract
Background Although Oxford unicompartmental knee arthroplasty (UKA) is used in patients of wide age ranges, there is no clear information regarding the age differences in terms of intraoperative femorotibial rotational kinematics and its influence on clinical outcomes. Therefore, this study was conducted to examine the age differences in terms of intraoperative rotational kinematics and postoperative clinical outcomes and to analyze their relationship with classification according to the age group. Methods We investigated 111 knees of patients who underwent Oxford UKA using a navigation system and divided them into two groups: elderly (aged ≥75 years; 48 knees) and nonelderly (aged < 75 years; 63 knees). Intraoperative tibial internal rotational angles relative to the femur during passive knee flexion were measured using a navigation system, and clinical outcomes were evaluated using knee range of motion, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Knee Society Functional Score at 2 years postoperatively. The relationships between intraoperative tibiofemoral rotational angles and clinical outcomes were also evaluated in the two groups. Results The intraoperative tibial internal rotational angle relative to the femur during knee flexion was significantly larger in the nonelderly group (13.5°) than in the elderly group (9.0°). The intraoperative tibial internal rotational angle showed a positive correlation with the pain subscale of KOOS only in the nonelderly group. Conclusion Intraoperative rotational kinematics and its influence on clinical outcomes were different between elderly and nonelderly patients, and the tibial internal rotational angle could be a more important factor for successful UKA in nonelderly patients.
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Affiliation(s)
- Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Kawaguchi K, Inui H, Taketomi S, Yamagami R, Takagi K, Kage T, Sameshima S, Tanaka S. Rotational kinematics differ between mild and severe valgus knees in total knee arthroplasty. Knee 2021; 28:81-88. [PMID: 33310669 DOI: 10.1016/j.knee.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/29/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no consensus regarding femorotibial rotational kinematics in total knee arthroplasty (TKA) for valgus knee deformity. Additionally, whether the degree of valgus deformity influences intraoperative rotational kinematics and postoperative clinical scores remains unclear. The objectives of this study were to investigate whether the valgus angle is associated with intraoperative rotational kinematics in TKA for valgus knee deformity and to examine the relationship between rotational kinematics and postoperative clinical results. MATERIALS AND METHODS A total of 24 knees with valgus deformity for TKA were included in this study and were divided into two groups depending on the femorotibial angle (FTA); there were 11 knees in the severe valgus group (FTA < 160°) and 13 knees in the mild valgus group (FTA ≥ 160°). Intraoperative femorotibial rotational kinematics from knee extension to flexion were evaluated using an image-free navigation system and postoperative clinical results (range of motion and subjective outcomes) were evaluated 1 year postoperatively. All parameters were compared between the two groups. RESULT Mild valgus knee showed tibial internal rotation during knee flexion before implantation, whereas severe valgus knee showed tibial external rotation during knee flexion before implantation. The postoperative flexion angle was positively correlated with the tibial internal rotation angle after implantation in the mild valgus group only. CONCLUSION Intraoperative rotational kinematics before implantation differed between mild and severe valgus knee deformity in TKA. Intraoperative tibial rotation influenced the postoperative knee flexion angle in mild, but not severe, valgus knee deformity. Ideal postoperative rotational kinematics may be different between the two groups and the difference may be taken into consideration in implant selections and surgical techniques.
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Affiliation(s)
- Kohei Kawaguchi
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Hiroshi Inui
- Department of Orthopaedics, Tokyo University Hospital, Japan.
| | - Shuji Taketomi
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Ryota Yamagami
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Kentaro Takagi
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Tomofumi Kage
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Shin Sameshima
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Sakae Tanaka
- Department of Orthopaedics, Tokyo University Hospital, Japan
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Tapasvi S, Shekhar A, Patil S, Pandit H. Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty: an experimental cadaveric study. Bone Joint Res 2020; 9:272-278. [PMID: 32728426 PMCID: PMC7376280 DOI: 10.1302/2046-3758.96.bjr-2019-0258.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims The mobile bearing Oxford unicompartmental knee arthroplasty (OUKA) is recommended to be performed with the leg in the hanging leg (HL) position, and the thigh placed in a stirrup. This comparative cadaveric study assesses implant positioning and intraoperative kinematics of OUKA implanted either in the HL position or in the supine leg (SL) position. Methods A total of 16 fresh-frozen knees in eight human cadavers, without macroscopic anatomical defects, were selected. The knees from each cadaver were randomized to have the OUKA implanted in the HL or SL position. Results Tibial base plate rotation was significantly more variable in the SL group with 75% of tibiae mal-rotated. Multivariate analysis of navigation data found no difference based on all kinematic parameters across the range of motion (ROM). However, area under the curve analysis showed that knees placed in the HL position had much smaller differences between the pre- and post-surgery conditions for kinematics mean values across the entire ROM. Conclusion The sagittal tibia cut, not dependent on standard instrumentation, determines the tibial component rotation. The HL position improves accuracy of this step compared to the SL position, probably due to better visuospatial orientation of the hip and knee to the surgeon. The HL position is better for replicating native kinematics of the knee as shown by the area under the curve analysis. In the supine knee position, care must be taken during the sagittal tibia cut, while checking flexion balance and when sizing the tibial component.
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Affiliation(s)
| | | | - Shantanu Patil
- Translational Medicine & Research, SRM Medical College and Hospitals, SRM University, Kattankulathur, India
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Shiwaku K, Teramoto A, Nuka S, Matsumura T, Watanabe K, Yamashita T. Varus kinematics at knee flexion affect clinical outcomes of unicompartmental knee arthroplasty: Intraoperative navigation-based kinematics evaluation. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2020; 20:6-11. [PMID: 32042597 PMCID: PMC6997613 DOI: 10.1016/j.asmart.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/11/2020] [Accepted: 01/16/2020] [Indexed: 11/17/2022]
Abstract
Background The aim of the study was to investigate the effects of navigation-based varus or axial rotational alignment through knee flexion on patient reported outcomes or the maximum flexion angle of unicompartmental knee arthroplasty (UKA). Methods Data were retrospectively collected from 46 knees that underwent UKA for medial unicompartmental knee osteoarthritis. An image-free knee navigation system was used in all cases, and intraoperative varus and axial rotational alignment at every knee flexion angle were recorded before and after implantation. All patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at final follow-up. By varus or valgus at 0° knee flexion, the knees were subdivided into two groups (varus at 0° group, varus above the median value; neutral at 0° group, varus equal to or below the median value). By varus or valgus at 90° knee flexion, patients were similarly subdivided into two groups (varus at 90° group; neutral at 90° group). The maximum knee flexion angle was measured 3 months after surgery. Results There were no differences in the KOOS between the neutral at 0° group and the varus at 0° group. However, the KOOS activity score (79 ± 17 vs 69 ± 16, p = 0.02) and the KOOS total score (72 ± 17 vs 65 ± 15, p = 0.03) of the neutral at 90° group were better than those of the varus at 90° group. The alignment and the maximum knee flexion angle 3 months after surgery were not correlated. Conclusion Varus at 0° knee flexion and axial rotational alignment did not affect the clinical outcomes of UKA. Patient reported outcomes was better for the neutral knees with less varus at 90° knee flexion than for varus knees.
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Affiliation(s)
- Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, 060-8543, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, 060-8543, Sapporo, Japan
| | - Satoshi Nuka
- Department of Orthopaedic Surgery, Hakodate Goryoukaku Hospital, 38-3 Goryoukaku, Hakodate, 040-8611, Japan
| | - Takashi Matsumura
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, 060-8543, Sapporo, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Hokkaido, South 1 West 16, Chuo-ku, 060-8543, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, 060-8543, Sapporo, Japan
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