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Song YD, Nakamura S, Kuriyama S, Nishitani K, Morita Y, Yamawaki Y, Maeda T, Sakai S, Matsuda S. Comparison of knee kinematics and ligament forces in single and multi-radius cruciate-retaining total knee arthroplasty: A computer simulation study. Knee 2023; 45:92-99. [PMID: 37925809 DOI: 10.1016/j.knee.2023.09.007] [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: 04/11/2023] [Revised: 07/19/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The single-radius design in total knee arthroplasty has been designed to develop a more fixed flexion-extension axis without mid-flexion instability compared with the multi-radius design. It remains unclear whether differences between the multi-radius and single-radius designs can affect kinematics and collateral ligament forces. This study aimed to simulate knee kinematics and kinetics between single-radius and multi-radius models using a musculoskeletal computer model. METHODS The single-radius and multi-radius femoral components were virtually implanted in a computer simulation using the same tibial insert. The effects of implant design on kinematics and medial collateral ligament forces during squatting and gait activities were analyzed. RESULTS During squatting, the multi-radius model exhibited paradoxical anterior translation on both the medial and lateral flexion facet center where peak anterior translation was 2.4 mm for medial flexion facet center and 2.2 mm for the lateral flexion facet center, while the peak anterior translation of the single-radius model was less than 1 mm at early flexion. A rapid decrease in medial collateral ligament tension was observed in the early flexion phase in the multi-radius model, which occurred simultaneously with paradoxical anterior translation, whereas the relatively constant medial collateral ligament tension was observed in the single-radius model. During gait activity, the single-radius model exhibited a more posterior position than the multi-radius model. CONCLUSION These suggest that abrupt changes in the medial collateral ligament force influence anterior sliding of the femur, and that the single-radius design is a reasonable choice for prevention of mid-flexion instability.
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Affiliation(s)
- Young Dong Song
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan.
| | - Shinichi Kuriyama
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Yugo Morita
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yamawaki
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Maeda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Sayako Sakai
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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Campi S, Papalia R, Esposito C, Candela V, Gambineri A, Longo UG. The Correlation between Objective Ligament Laxity and the Clinical Outcome of Mechanically Aligned TKA. J Clin Med 2023; 12:6007. [PMID: 37762946 PMCID: PMC10532354 DOI: 10.3390/jcm12186007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Instability is one of the causes of failure in total knee arthroplasty (TKA). The aim of this study was to analyze the correlation between objective ligament laxity and the clinical outcome of mechanically aligned TKA. Fifty-one knees in 47 patients were evaluated at a minimum follow-up of 6 months. The correlation between the angular displacement and functional scores (Knee Society Score and Knee Injury and Osteoarthritis Score) was analyzed. A negative correlation (p-value < 0.05) was observed between medial laxity ≥5° at 0, 30, 60, and 90° of flexion and the outcome measures. Lateral laxity did not correlate with the clinical outcome. At 30° of knee flexion, a total varus and valgus laxity ≥10° was related to poorer outcomes. The same amount of angular displacement did not influence the outcome in the other flexion angles. There was no difference in single-radius vs multi-radius implants in terms of medial and lateral laxity and clinical outcome. A valgus displacement ≥5° measured at 0, 30, 60, and 90 degrees of flexion correlated with an inferior clinical outcome. In contrast, the same amount of displacement measured on the lateral compartment did not influence the clinical outcome after TKA.
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Affiliation(s)
- Stefano Campi
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (S.C.); (R.P.); (V.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| | - Rocco Papalia
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (S.C.); (R.P.); (V.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| | - Carlo Esposito
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| | - Vincenzo Candela
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (S.C.); (R.P.); (V.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| | - Andrea Gambineri
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
| | - Umile Giuseppe Longo
- Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy; (S.C.); (R.P.); (V.C.)
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (C.E.); (A.G.)
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Mehta N, Burnett RA, Kahlenberg CA, Miller R, Chalmers B, Cross MB. Mid-Flexion Instability After Total Knee Arthroplasty: Diagnosis, Implant Design, and Outcomes. Orthopedics 2023; 46:e13-e19. [PMID: 35876775 DOI: 10.3928/01477447-20220719-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mid-flexion instability (MFI) in total knee arthroplasty refers to a distinct clinical entity where the knee is stable at full extension and 90° of flexion, but unstable somewhere between these 2 points. The presentation of MFI is often vague, and studies defining objective clinical or intraoperative measurements are limited. In this review, we aim to properly define the condition, describe diagnostic criteria and risk factors contributing to MFI, review current implant design, and present outcomes of revision surgery performed for MFI. [Orthopedics. 2023;46(1):e13-e19.].
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Cheng CK. CORR Insights®: Does Kinematic Alignment Increase Polyethylene Wear Compared With Mechanically Aligned Components? A Wear Simulation Study. Clin Orthop Relat Res 2022; 480:1801-1803. [PMID: 35901445 PMCID: PMC9384931 DOI: 10.1097/corr.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/10/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Cheng-Kung Cheng
- Chair Professor, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Director, Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
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Fang C, Luan Y, Wang Z, Shao L, Qu T, Cheng CK. Moderate External Rotation of Tibial Component Generates More Natural Kinematics Than Internal Rotation After Total Knee Arthroplasty. Front Bioeng Biotechnol 2022; 10:910311. [PMID: 35910010 PMCID: PMC9327137 DOI: 10.3389/fbioe.2022.910311] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
This study aimed to investigate the influence of tibial malrotation on knee kinematics after total knee arthroplasty (TKA). A symmetric fixed-bearing posterior-stabilized prosthesis was implanted in the validated knee model with different rotational alignments of the tibial component (neutral, 3° external rotation, 5° external rotation, 3° internal rotation, and 5° internal rotation). Computational kinematic simulations were used to evaluate the postoperative kinematics of the knee joint including anteroposterior translation femoral condyles and axial rotation of tibial component during 0°–135° knee flexion. The results revealed that the neutral position of the tibial component was not the closest kinematics to the intact knee, the model with 5° external rotation of the tibial component showed the closest lateral condyle translation and tibial axial rotation, and moderate external rotation could improve the kinematics after TKA.
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Affiliation(s)
- Chaohua Fang
- Department of Joint Surgery, Ningbo No. 6 Hospital, Ningbo, China
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
| | - Yichao Luan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Zhiwei Wang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Beijing, China
| | - Long Shao
- Department of Joint Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Tiebing Qu
- Department of Orthopaedics, Beijing Boai Hospital, Beijing, China
- The Center of Diagnosis and Treatment for Joint Disease, China Rehabilitation Research Center, Beijing, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine, Ministry of Education, Shanghai, China
- *Correspondence: Cheng-Kung Cheng,
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Li W, Liang J, Zeng F, Lin B, Liu C, Huang S, Liu Q. Anatomic characteristics of the knee influence the risk of suffering an isolated meniscal injury and the risk factors differ between women and men. Knee Surg Sports Traumatol Arthrosc 2021; 29:3751-3762. [PMID: 33388828 DOI: 10.1007/s00167-020-06396-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyse the relationship between multiple anatomic characteristics of the knee (tibia and femur) and isolated meniscal injury in women and men. METHODS Forty-seven patients with isolated medial meniscal injuries, 62 patients with isolated lateral meniscal injuries, and 70 control subjects were included. Medial posterior tibial slope (MTS), lateral posterior tibial slope (LTS), medial tibial plateau depth (MTD), coronal tibial slope (CTS), femoral notch width (NW), femoral condylar width (FCW), intercondylar notch depth (ND), femoral notch width index (NWI), intercondylar notch shape index (NSI), and cruciate ligaments tensity (CLT) were measured from magnetic resonance images. Anatomic characteristics differing between groups were compared, and risk factors for isolated meniscal injury were identified by multivariate forward stepwise logistic regression for men and women separately. RESULTS Risk factors for an isolated medial meniscal injury were a steeper MTS and a lowered MTD in men, and a steeper MTS and an increased NWI in women. Risk factors for isolated lateral meniscal injury were a steeper LTS and an increased NW in men, and a steeper LTS and a lowered ND in women. Risk factors for both medial and lateral meniscal injuries were a higher CTS, an increased NWI, and a looser CLT in men, and a higher CTS, an increased NSI, and a looser CLT in women. CONCLUSION The anatomic characteristics of the tibial plateau, femur, and cruciate ligaments influence the risk of suffering isolated meniscal injury, and the risk factors differ between men and women. This study provides a reference for developing identification criteria for those at risk of isolated meniscal injury. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Wenhua Li
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Jie Liang
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Fei Zeng
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Bomiao Lin
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Chenglong Liu
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China.
| | - Shijia Huang
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
| | - Qiaolan Liu
- Department of trauma orthopedics, Zhujiang Hospital, Southern Medical University, No.253 Gongye Avenue, Guangzhou, 510280, Guangdong Province, China
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Increasing the height of the anterior lip on a tibial insert in a posterior stabilized knee prosthesis has little effect on the wear rate. Med Eng Phys 2021; 91:48-53. [PMID: 34074465 DOI: 10.1016/j.medengphy.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/22/2021] [Accepted: 03/24/2021] [Indexed: 11/24/2022]
Abstract
A high anterior lip on a total knee prosthesis is an effective way of reducing anterior translation, but the effect on joint wear is unclear. Using finite element analysis (FEA), this study quantitatively compared wear rates and anterior contact stresses in three posterior stabilized knee prostheses with different heights for the anterior lip during six daily activities (walking, stair ascent, stair descent, sit-to-stand, pivot turn and crossover turn). The wear rate and location of maximum wear depth were similar for the three lip heights tested, but the knee with the highest anterior lip also showed slight anterior wear scaring due to articular contact stress during swing phase, which was highly dependent on the shape of the contact interface. This study illustrates that tibial inserts with a high anterior lip maintain a wear rate similar to moderate and low lip posterior stabilized designs.
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Vajapey SP, Pettit RJ, Li M, Chen AF, Spitzer AI, Glassman AH. Risk Factors for Mid-Flexion Instability After Total Knee Arthroplasty: A Systematic Review. J Arthroplasty 2020; 35:3046-3054. [PMID: 32532482 DOI: 10.1016/j.arth.2020.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mid-flexion instability after total knee arthroplasty (TKA) is a clinical entity that is not well studied and one that has been associated with patient dissatisfaction and inferior outcomes. We sought to provide a comprehensive review of risk factors associated with mid-flexion instability. METHODS A comprehensive literature search of PUBMED, EMBASE, Google Scholar, and Cochrane Library was performed using keywords "mid flexion," "instability," and "knee arthroplasty" in all possible combinations. All studies published from 2010 to 2020 in English were considered for inclusion. Research design, question studied, and outcomes were recorded for each study. Quantitative and qualitative analysis was performed. RESULTS Eighteen articles meeting inclusion criteria were identified and reviewed. There were 5 computational studies, 5 cadaveric studies, and 8 clinical studies. There were 14 different risk factors investigated in relation to mid-flexion instability after TKA: 6 implant-related, 6 technique-related, and 2 patient-related factors. Of these risk factors, 5 had contradictory results published to date, resulting in an inconclusive association with mid-flexion instability. The results of this review suggest that the effects of joint line elevation and radius-of-curvature of the femoral component on mid-flexion instability are inconclusive while articular surface conformity and preoperative joint laxity may play a bigger role than previously thought. CONCLUSION Mid-flexion instability after TKA is a clinical entity distinct from other established forms of instability. There are patient-related, implant-related, and technique-related factors associated with mid-flexion instability. The majority of the evidence on this topic is derived from computational and cadaveric studies, underscoring the need for further clinical studies.
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Affiliation(s)
- Sravya P Vajapey
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Robert J Pettit
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mengnai Li
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Andrew I Spitzer
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Andrew H Glassman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
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Challenges of pre-clinical testing in orthopedic implant development. Med Eng Phys 2019; 72:49-54. [DOI: 10.1016/j.medengphy.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/24/2019] [Indexed: 01/23/2023]
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