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Goto K, Hirota J, Miyamoto Y, Katsuragawa Y. The Accuracy of a Portable Accelerometer-Based Navigation System for Tibial Alignment Can be Reliable during Total Knee Arthroplasty for Obese Patients. J Knee Surg 2024; 37:303-309. [PMID: 37192656 DOI: 10.1055/a-2094-8822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
A portable accelerometer-based navigation system can be useful for achieving the target alignment. Tibial registration is based on the medial and lateral malleoli; however, the identification of landmarks may be difficult in obese (body mass index [BMI] >30 kg/m2) patients whose bones are not easily palpable from the body surface. This study compared tibial component alignment achieved using a portable accelerometer-based navigation system (Knee Align 2 [KA2]) in obese and control groups and aimed to validate the accuracy of bone cutting in obese patients. A total of 210 knees that underwent primary total knee arthroplasty using the KA2 system were included. After 1:3 propensity score matching, there were 32 and 96 knees in the BMI >30 group (group O) and BMI ≤30 group (group C), respectively. The absolute deviations of the tibial implant from the intended alignment were evaluated in the coronal plane (hip-knee-ankle [HKA] angle and medial proximal tibial angle) and sagittal plane (posterior tibial slope [PTS]). The inlier rate of each cohort, which was defined as tibial component alignment within 2 degrees of the intended alignment, was investigated. In the coronal plane, the absolute deviations of the HKA and MPTA from the intended alignment were 2.2 ± 1.8 degrees and 1.8 ± 1.5 degrees in group C and 1.7 ± 1.5 degrees and 1.7 ± 1.0 degrees in group O (p = 1.26, and p = 0.532). In the sagittal plane, the absolute deviations of the tibial implant were 1.6 ± 1.2 degrees in group C and 1.5 ± 1.1 degrees in group O (p = 0.570). The inlier rate was not significantly different between group C and group O (HKA: 64.6 vs. 71.9%, p = 0.521; MPTA: 67.7 vs. 78.1%, p = 0.372; PTS: 82.2 vs. 77.8%, p = 0.667). The accuracy of tibial bone cutting for the obese group was comparable to that of the control group. An accelerometer-based portable navigation system can be useful when attempting to achieve the target tibial alignment in obese patients. LEVEL OF EVIDENCE: Level IV.
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Affiliation(s)
- Kazumi Goto
- Department of Orthopaedic Surgery, Mitsui Memorial Hospital, Chiyoda-ku, Tokyo, Japan
| | - Jinso Hirota
- Department of Orthopaedic Surgery, Mitsui Memorial Hospital, Chiyoda-ku, Tokyo, Japan
| | - Yoshinari Miyamoto
- Department of Orthopaedic Surgery, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yozo Katsuragawa
- Department of Orthopaedic Surgery, Mitsui Memorial Hospital, Chiyoda-ku, Tokyo, Japan
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Ogawa H, Sengoku M, Nakamura Y, Shimokawa T, Ohnishi K, Akiyama H. Increase in the Posterior Tibial Slope Provides Better Joint Awareness and Patient Satisfaction in Cruciate-Retaining Total Knee Arthroplasty. J Knee Surg 2024; 37:316-325. [PMID: 37192658 DOI: 10.1055/a-2094-8967] [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: 05/18/2023]
Abstract
The effect of the posterior tibial slope (PTS) in cruciate-retaining total knee arthroplasty (CR-TKA) on clinical outcomes remains unclear. We aimed to investigate (1) the effect of alteration of the PTS on clinical outcomes, including patient satisfaction and joint awareness, and (2) the relationship between the patient-reported outcomes, the PTS, and compartment loading. Based on the alteration of the PTS after CR-TKA, 39 and 16 patients were stratified into increased and decreased PTS groups, respectively. Clinical evaluation was performed by the Knee Society Score (KSS) 2011 and the Forgotten Joint Score-12 (FJS-12). Compartment loading was intraoperatively assessed. KSS 2011 (symptoms, satisfaction, and total score) was significantly higher (p = 0.018, 0.023, and 0.040, respectively), and FJS ("climbing stairs?") was significantly lower (p = 0.025) in the increased PTS group compared with the decreased PTS group. The decrease in both medial and lateral compartment loading of Δ45°, Δ90°, and ΔFull was significantly greater in the increased PTS group than in the decreased PTS group (p< 0.01 for both comparisons). Medial compartment loading of Δ45°, Δ90°, and ΔFull significantly correlated with KSS 2011 for "symptom" (r = - 0.4042, -0.4164, and -0.4010, respectively; p = 0.0267, 0.0246, and 0.0311, respectively). ΔPTS significantly correlated with medial compartment loading differentials of Δ45°, Δ90°, and ΔFull (r = - 0.3288, -0.3792, and -0.4424, respectively; p = 0.0358, 0.01558, and 0.0043, respectively). Patients with increased PTS showed better symptoms and higher patient satisfaction compared with those with decreased PTS following CR-TKA, possibly due to a greater decrease in compartment loading during knee flexion.Level of evidence:level IV, therapeutic case series.
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Affiliation(s)
- Hiroyasu Ogawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
| | - Masaya Sengoku
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
| | - Yutaka Nakamura
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
| | - Tetsuya Shimokawa
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
| | - Kazuichiro Ohnishi
- Department of Orthopaedic Surgery, Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Song SJ, Bae DK, Hwang SH, Park HS, Park CH. Similar Midterm Outcomes of Total Knee Arthroplasties with Anterior and Posterior Tibial Slopes Performed on Paired Knees at a Minimum Follow-up of 5 Years. J Knee Surg 2024; 37:310-315. [PMID: 37192660 DOI: 10.1055/a-2094-8728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
A small posterior tibial slope (PTS) is generally recommended in posterior stabilized (PS) total knee arthroplasty (TKA). An unwanted anterior tibial slope (ATS), which can affect postoperative results, may be created in PS TKA because of the inaccuracy of surgical instruments and techniques, as well as high interpatient variability. We compared midterm clinical and radiographic results of PS TKAs with ATS and PTS performed on paired knees using the same prosthesis. One-hundred-twenty-four patients who underwent TKAs with ATS and PTS on paired knees using ATTUNE posterior-stabilized prostheses were retrospectively reviewed after a minimum follow-up period of 5 years. The mean follow-up period was 5.4 years. The Knee Society Knee and Function scores, Western Ontario and McMaster Universities Osteoarthritis Index, Feller and Kujalar scores, and range of motion (ROM) were evaluated. The preferred TKA out of ATS and PTS was also investigated. The hip-knee-ankle angle, component positions, tibial slope, posterior femoral offset, Insall-Salvati ratio, and knee sagittal angle were measured by radiography. There were no significant differences in the clinical results, including ROM, between TKAs with ATS and PTS preoperatively and at the last follow-up. Regarding patient preference, 58 patients (46.8%) were satisfied with bilateral knees, 30 (24.2%) preferred knees with ATS, and 36 (29%) preferred knees with PTS. There was no significant difference in the rate of preference between TKAs with ATS and PTS (p = 0.539). Except for the postoperative tibial slope (-1.8 vs. 2.5 degrees, p < 0.001), there were also no significant differences in the radiographic results, including the knee sagittal angle, preoperatively and at the last follow-up. The midterm outcomes were similar between PS TKAs with ATS and PTS performed on paired knees at a minimum of 5 years of follow-up. Nonsevere ATS did not affect midterm outcomes in PS TKA with proper soft tissue balancing and the current prosthesis of improved design. However, a long-term follow-up study is required to confirm the safety of nonsevere ATS in PS TKA. LEVEL OF EVIDENCE:: III.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Republic of Korea
| | - Sung Hyun Hwang
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Hong Sik Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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Brown NM, Lingampalli N, Hellman MD. Intraoperative Challenges of the Kinematic Knee. Orthop Clin North Am 2024; 55:27-32. [PMID: 37980101 DOI: 10.1016/j.ocl.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Total knee arthroplasty (TKA) is a widely accepted surgical procedure for managing end-stage knee osteoarthritis. Among the various TKA techniques, kinematic alignment has gained increasing popularity as it can potentially restore a more natural joint function. However, despite its theoretical advantages, kinematic total knee replacement presents several operative challenges that necessitate a thorough understanding and analysis of patient-specific anatomy during surgical planning and execution. This review article aims to critically evaluate the operative challenges associated with kinematic TKA and explore potential strategies to optimize surgical outcomes. The challenges encompass multiple aspects including patient selection, preoperative planning, bone cuts, soft tissue balancing, and component positioning.
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Affiliation(s)
- Nicholas M Brown
- Loyola University Medical Center, 2160 South 1st Avenue #3328, Maywood, IL 60153, USA.
| | - Nithya Lingampalli
- Loyola University Medical Center, 2160 South 1st Avenue #3328, Maywood, IL 60153, USA
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Akçaalan S, Akkaya M, Dogan M, Valdivielso AA, Zeiton MA, Mohammad HR, Sangaletti R, Benazzo F, Kara S, Gehrke T, Citak M. Do age, gender, and region affect tibial slope? A multi-center study. Arch Orthop Trauma Surg 2023; 143:6983-6991. [PMID: 37438581 DOI: 10.1007/s00402-023-04976-x] [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: 12/19/2022] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Tibial slope is a parameter that is important to recognize in knee kinematics and knee surgery. A very wide range of values governing posterior tibial slope exist in the literature. This study is based on the hypothesis that age, gender and region may have an effect on the tibial slope. MATERIALS AND METHODS A total of 1800 lateral knee radiographies from five different countries [Turkey, Germany, Italy, Spain, and the United Kingdom (UK)] were utilized to measure the native posterior tibial slope. Participants were categorized in deciles with each decade of age after 40 years determined as a separate age group. Accordingly, four different age categories were formed in total, namely, the 40- to 49-, 50- to 59-, 60-69, and 70- to 79-year-old groups. Patients with severe knee osteoarthritis, those with a history of arthroscopic and open surgery around the knee, and those with severe morbid obesity and those outside the specified age group were excluded from the study. The angle between the line tangential to the medial tibial plateau and the proximal anatomical axis of the tibia was measured. RESULTS The tibial slope values of both males and females in the Turkish population were found to be higher than those in other populations. It was observed that tibial slope values increased with age in females in all populations, except for those in the Spanish and UK populations. In the male population, it was found that tibial slope values increased with age in all populations except in the Spanish population. CONCLUSIONS Region, age, and gender affect tibial slope in different populations in various ways. Our study shows that the region an individual lives in and living conditions affect the tibial slope.
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Affiliation(s)
- Serhat Akçaalan
- Orthopedics and Traumatology Clinics, Kirikkale Yuksek Ihtısas Hospital, Bağlarbaşı, Ahmet Ay Caddesi, 71300, Merkez/Kırıkkale, Turkey.
| | - Mustafa Akkaya
- Orthopedics and Traumatology Department, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Metin Dogan
- Orthopedics and Traumatology Department, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Ainhoa Alvarez Valdivielso
- Orthopaedic Surgery and Traumatology Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Moez Asaid Zeiton
- Orthopedics and Traumatology Department, Royal Bolton Hospital, Minerva Rd, Farnworth, Bolton, United Kingdom
| | - Hasan Raza Mohammad
- Orthopedics and Traumatology Department, Royal Bolton Hospital, Minerva Rd, Farnworth, Bolton, United Kingdom
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
| | - Francesco Benazzo
- Sezione di Chirurgia Protesica ad Indirizzo Robotico - Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124, Brescia, Italy
- IUSS, Istituto di Studi Superiori, Pavia, Italy
| | - Seher Kara
- Helios ENDO-Klinik, Holstenstr, Hamburg, Germany
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Akti S, Akti S, Zeybek H, Celebi NO, Karaguven D, Cankaya D. Anterior metaphyseal angle; much less individual variation in determining the posterior slope of the tibia. J Orthop Sci 2023; 28:1046-1051. [PMID: 35864026 DOI: 10.1016/j.jos.2022.06.017] [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: 02/21/2022] [Revised: 04/19/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The question of how to specify the posterior tilt of the tibia during arthroplasty operations remains unclear. The most current opinion is that a design whereby incisions are made in parallel with the individual pre-arthritic posterior tilt will yield better post-operational results. However, the wide range of inter-individual variations of posterior tilt of the tibia and the difficult task of identifying the shaft axis of the tibia through standard lateral radiographs are the main obstacles to this particular method. Therefore, there is a need for another reference line that can be measured with plain radiography and yields less inter-individual variation. The hypothesis of this study was that the angle formed between the anterior metaphyseal line of the proximal tibia and the tibial plateau would prove to be less variable across individuals. METHODS Long-shot radiographs of non-rotating lateral tibias of 85 patients aged between 18 and 38 years were analysed. The angle forming between the anterior metaphyseal line of the proximal tibia and the slope of the tibial plateau, and the posterior slope angle was measured by 2 separate observers using the classical method. RESULTS From the measurements of the posterior slope angle taken with the classical method, 38% (33/85) of the patients were within the ±2-degree range of the mean, and the anterior metaphyseal angle was within ±2 degrees of the mean in 75% (64/85) of the total patients. 44.23% variation (CoV) in posterior slop degrees, 2.73% (CoV) variation in the anterior metaphyseal angle measured by the same researchers. The difference between the percentages of variation was also found to be statistically significant. (z = 15.36, p = 0.000). CONCLUSION The anterior metaphyseal angle can be utilized to predict the individual posterior slope. Nevertheless, further large-scale, multicentre studies are needed to establish a mean value for the population.
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Affiliation(s)
- Sefa Akti
- Department of Orthopaedics and Traumatology, Cumhuriyet University, Sivas, Turkey.
| | - Serdar Akti
- Department of Radiology, Erbaa State Hospital, Tokat, Turkey
| | - Hakan Zeybek
- Department of Orthopaedics and Traumatology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Nilgun Ozgul Celebi
- Department of Statistics, Hacettepe University Faculty of Science, Ankara, Turkey
| | - Dogac Karaguven
- Department of Orthopaedics and Traumatology, Ufuk University, Ankara, Turkey
| | - Deniz Cankaya
- Department of Orthopaedics and Traumatology, Gulhane Teaching and Research Hospital, Ankara, Turkey
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Nishitani K, Kuriyama S, Nakamura S, Song YD, Morita Y, Ito H, Matsuda S. Excessive flexed position of the femoral component causes abnormal kinematics and joint contact/ ligament forces in total knee arthroplasty. Sci Rep 2023; 13:6356. [PMID: 37076503 PMCID: PMC10115888 DOI: 10.1038/s41598-023-33183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/08/2023] [Indexed: 04/21/2023] Open
Abstract
Poor clinical outcomes are reported in excessive flexion of the femoral component in total knee arthroplasty (TKA), but their mechanisms have not yet been elucidated. This study aimed to investigate the biomechanical effect of flexion of the femoral component. Cruciate-substituting (CS) and posterior-stabilised (PS) TKA were reproduced in a computer simulation. The femoral component was then flexed from 0° to 10° with anterior reference, keeping the implant size and the extension gap. Knee kinematics, joint contact, and ligament forces were evaluated in deep-knee-bend activity. When the femoral component was flexed 10° in CS TKA, paradoxical anterior translation of the medial compartment was observed at mid-flexion. The PS implant was best stabilised with a 4° flexion model in mid-flexion range. The medial compartment contact force and the medial collateral ligament (MCL) force increased with the flexion of the implant. There were no remarkable changes in the patellofemoral contact force or quadriceps in either implant. In conclusions, excessive flexion of the femoral component yielded abnormal kinematics and contact/ligament forces. Avoiding excessive flexion and maintaining mild flexion of the femoral component would provide better kinematics and biomechanical effects in CS and PS TKA.
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Affiliation(s)
- Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Young Dong Song
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yugo Morita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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Scott DF, Hellie AA. Mid-Flexion, Anteroposterior Stability of Total Knee Replacement Implanted with Kinematic Alignment: A Randomized, Quantitative Radiographic Laxity Study with Posterior-Stabilized and Medial-Stabilized Implants. J Bone Joint Surg Am 2023; 105:9-19. [PMID: 36574642 DOI: 10.2106/jbjs.22.00549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
UPDATE This article was updated on January 4, 2023, because of a previous error, which was discovered after the preliminary version of the article was posted online. On page 16, in Figure 5, the x-axis that had read "P<0.0086" now reads "KSS Pain (p=0.02)," and the value for the MS group that had read "48.9" now reads "48.8."This article was updated on January 6, 2022, because of a previous error. On page 13, in the section entitled "Results," the sentence that had read "However, when only the subset of female subjects was considered, the MS group demonstrated significantly less anteroposterior laxity in 90° of flexion than the MS group (2.3 versus 5.4 mm; p = 0.008)." now reads "However, when only the subset of female subjects was considered, the MS group demonstrated significantly less anteroposterior laxity in 90° of flexion than the PS group (2.3 versus 5.4 mm; p = 0.008)." BACKGROUND Stability in mid-flexion is important for satisfactory clinical outcomes following total knee arthroplasty (TKA). The purpose of the present study was to compare the anteroposterior stability of knees that had been treated with a posterior-stabilized (PS) device or a medial-stabilized (MS) device. We hypothesized that mid-flexion laxity would be greater in the PS group and that clinical outcome scores would be better for the group with lower laxity. METHODS Sixty-three patients who had been randomly selected from a larger randomized, prospective, blinded clinical trial underwent primary TKA with either a PS implant (n = 30) or an MS implant (n = 33). Range of motion, the Knee Society Score (KSS), and the Forgotten Joint Score (FJS) were collected, and anteroposterior laxity with the knee in 45° and 90° of flexion was evaluated with stress radiographs. RESULTS In 45° of flexion, the MS group demonstrated significantly less total anteroposterior displacement than the PS group (mean, 3.6 versus 16.5 mm; p ≤ 0.0001). In 90° of flexion, the total anteroposterior displacement was not significantly different for the 2 groups when both male and female patients were included (mean, 3.9 versus 5.9; p = 0.07). However, when only the subset of female subjects was considered, the MS group demonstrated significantly less anteroposterior laxity in 90° of flexion than the PS group (2.3 versus 5.4 mm; p = 0.008). The groups did not differ significantly in terms of preoperative age, body mass index, sex distribution, FJS, KSS, or range of motion, and they also did not differ in terms of postoperative FJS or range of motion. However, all 33 patients in the MS group returned to sports as indicated in question 12 of the FJS, compared with 19 subjects in the PS group (p = 0.0001). The postoperative KSS Pain, Pain/Motion, and Function scores were all significantly higher in the MS group than the PS; specifically, the mean KSS Pain score was 48.8 in the MS group, compared with 44.8 in the PS group (p = 0.02); the mean KSS Pain/Motion score was 98.4 in the MS group, compared with 89.5 in the PS group (p < 0.0001); and the mean KSS Function score was 95.5 in the MS group, compared with 85.7 in the PS group (p = 0.003). CONCLUSIONS Mid-flexion laxity was greater in patients with PS implants than in those with MS implants, and laxity in 90° was greater in the subset of female patients in the PS group. The decreased laxity observed in the MS group correlated with higher KSS Pain, Pain/Motion, and Function scores as well as with a higher rate of return to sports activities. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- David F Scott
- Spokane Joint Replacement Center, Inc., Spokane, Washington.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Amy A Hellie
- Spokane Joint Replacement Center, Inc., Spokane, Washington
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Lee OS, Lee J, Lee MC, Han HS. Effect of Posterior Tibial Slope Change on Postoperative Range of Motion and Clinical Outcomes after Posterior Cruciate-Substituting Total Knee Arthroplasty. J Knee Surg 2023; 36:87-94. [PMID: 33992035 DOI: 10.1055/s-0041-1729967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The posterior tibial slope (PTS) is usually adjusted by less than 5 degrees, without considering its individual difference, during posterior cruciate-substituting (PS) total knee arthroplasty (TKA). The effect of these individual changes of PTS would be important because clinical results depending on postoperative PTS were reported conflictingly. We investigated the effect of the change in PTS on the postoperative range of motion (ROM) and clinical scores after PS TKA. We retrospectively reviewed 164 knees from 107 patients who underwent PS TKA with a 2-year follow-up. We analyzed the preoperative and postoperative PTS, ROM, visual analog scale pain scale, Western Ontario and McMaster University Index (WOMAC), Hospital for Special Surgery Knee Score, Knee Society Score, and Forgotten Joint Score (FJS). The association of the absolute change in PTS with ROM and clinical scores was analyzed using correlation analysis and multiple regression analysis. As a result, the mean PTS and mean ROM changed from 9.6 ± 3.4 and 120.1 ± 15.4 degrees preoperatively to 2.0 ± 1.3 and 128.4 ± 9.3 degrees postoperatively, and the mean PTS change was 7.6 ± 3.5 degrees. The PTS change had no statistically significant association with the postoperative ROM and clinical scoring systems, although it did have a weak positive correlation with WOMAC function, No 10 (difficulty in rising from sitting) (correlation coefficient = 0.342, p = 0.041), and moderate positive correlation with the FJS, No. 6 (awareness when climbing stairs) (correlation coefficient = 0.470, p = 0.001). The authors concluded that the amount of change in PTS did not affect the postoperative ROM and clinical scores, although proximal tibial resection with a constant target of PTS resulted in individually different changes in the PTS after PS TKA.
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Affiliation(s)
- O-Sung Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Uijeongbu-si, Korea (the Republic of)
| | - Jangyun Lee
- Department of Orthopedic Surgery, National Medical Center, Seoul, Korea (the Republic of)
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea (the Republic of)
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Panciera A, Digennaro V, Bogucki BDB, Barile F, Manzetti M, Ferri R, Cecchin D, Faldini C. The role of posterior condylar offset ratio on clinical and functional outcome of posterior stabilized total knee arthroplasty: a retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03459-w. [PMID: 36536107 DOI: 10.1007/s00590-022-03459-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Postoperative Range of Motion (ROM) is an important measurement of the success of a Total Knee Arthroplasty (TKA). Much enthusiasm has been recently directed toward the posterior femoral condylar offset (PFCO), with some authors reporting increasing postoperative knee flexion when increasing PFCO. The aim of this study is to retrospectively determine the effect of the PFCO on the clinical and functional outcome of a cohort of patients who underwent a Posterior Stabilized (PS) TKA. METHODS Clinical and radiological data of all patients who underwent TKA with PS implant for primary osteoarthritis were retrospectively reviewed. Knee Society Score (KSS), knee ROM, PFCO ratio (PFCOR), and tibial slope (TS) were measured pre and postoperatively. RESULTS One hundred and twenty-one patients (141 knees) met the inclusion criteria. The mean knee flexion increased from 98 ± 20.2° (range 30-130) to 123 ± 12.1° (range 70-140) and the mean KSS increased from 74.0 ± 3.3 (range 27-130) to 203.9 ± 8.1 (range 26-249). Postoperative PFCOR and TS were 0.492 ± 0.005 (range 0.40-0.57) and 2.36 ± 0.56° (range - 10.9-12.15°), respectively. Neither maximal flexion angle nor KSS showed a significant correlation with postoperative PFCOR (Pearsons'r = - 0.057, p = 0.5 for flexion angle and Pearsons'r = - 0.073, p = 0.5 for KSS) or with postoperative TS (Pearsons'r = 0.042, p = 0.62 for flexion angle and Pearsons'r = 0.002, p = 0.98 for KSS). CONCLUSION Posterior femoral condylar offset remains an important parameter and, especially when using anterior femoral referencing TKA, care must be taken to prevent excessive resection of the posterior femoral condyles.
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Affiliation(s)
- Alessandro Panciera
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Vitantonio Digennaro
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | | | - Francesca Barile
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Marco Manzetti
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Riccardo Ferri
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Davide Cecchin
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
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11
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Ishii Y, Noguchi H, Sato J, Takahashi I, Ishii H, Ishii R, Ishii K, Toyabe SI. Comparison of the Tibial Posterior Slope Angle Between the Tibial Mechanical Axis and Various Diaphyseal Tibial Axes After Total Knee Arthroplasty. Arthroplast Today 2022; 17:137-141. [PMID: 36158461 PMCID: PMC9493290 DOI: 10.1016/j.artd.2022.06.015] [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: 03/05/2022] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 11/04/2022] Open
Abstract
Background The posterior tibial slope angle (PTS) is crucial for sagittal alignment after total knee arthroplasty (TKA). This study aimed to determine which PTS based on the lateral view of standard knee radiographs (LSKRs; 36 × 43 cm) reflects the PTS based on a full-length lateral tibial radiograph (FLTR). Methods A total of 290 patients (355 knees) who underwent primary TKA were retrospectively recruited. Cross-sectional views from the 3-dimensional digital model of the tibial prosthesis and bone complex in the sagittal plane were used as FLTRs and LSKRs. Considering the region 21.5 cm proximal to the site of FLTR as the spot for LSKR to determine the 5 tibial diaphyseal axes, the axis that simulates the PTS as determined by the tibial mechanical axis between the center of the tibial component and the ankle plafond in LSKR was determined and compared. Results PTS (α5) defined by the line connecting the midpoints of tibial width between the region 10-cm distal to the knee joint and the distal end of the tibia based on LSKR revealed the least mean difference (0.13° ± 1.00°) and the strongest correlation (P < .001, r = 0.948) with PTS based on FLTR (α0). The number of knees in α5, indicating a difference of <2° from α0, was 333 of 355 (93.8%). The equivalence test results indicated that α0 and α5 were statistically equivalent within a difference of 2° (P < .001). Conclusions PTS (α5) can be used as a clinically reliable substitution of the true PTS on an FLTR for evaluating sagittal alignment after TKA.
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12
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Excessive Sagittal Slope of the Tibia Component during Kinematic Alignment-Safety and Functionality at a Minimum 2-Year Follow-Up. J Pers Med 2022; 12:jpm12091407. [PMID: 36143192 PMCID: PMC9506154 DOI: 10.3390/jpm12091407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to assess the safety and functional outcomes of excessive sagittal alignment in the unrestricted kinematic alignment technique for total knee arthroplasty (TKA). A retrospective, single-center study was conducted between 2018 and 2020, including patients undergoing primary TKA with a minimum 2-year follow-up. EOS imaging conducted before and after surgery was reviewed for overall alignment, and a number of measurements were taken, including sagittal tibial slope and other tibia and femur component positioning. Patients were interviewed and asked to fill out several questionnaires including a visual analog scale, the Oxford Knee Score, and the Knee Injury and Osteoarthritis Outcome Score. Overall, 225 patients (66.7%) had a sagittal tibial slope angle above 5° (excessive) and 112 (33.3%) patients had an angle under 5° (moderate). A significant improvement in pain and function scores was observed in both groups following the surgery (p < 0.001). There were no significant differences between the moderate and excessive groups in the average VAS, OKS or the various subtypes of the KOOS score. However, there was a slight but significant difference in the number of patients achieving MCID in KOOS symptoms. There were no cases of early failure or loosening. Unrestricted KA and the excessive sagittal alignment of the tibial component seem to be reliable and safe in terms of restoring daily function and alleviating pain after a minimum of 2 years following the surgery.
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13
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Scott DF, Gray CG. Outcomes are Better With a Medial-Stabilized vs a Posterior-Stabilized Total Knee Implanted With Kinematic Alignment. J Arthroplasty 2022; 37:S852-S858. [PMID: 35189286 DOI: 10.1016/j.arth.2022.02.059] [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: 11/22/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is no consensus whether a posterior-stabilized (PS) total knee device is superior to a more congruent, cruciate-substituting, medial-stabilized device (MS). This study compared the clinical outcomes of these devices. The primary hypothesis was that the clinical outcomes would be better in the MS group implanted with kinematic alignment. METHODS This prospective, randomized, single-center Level 1 study compared the outcomes of 99 patients who received a PS device and 101 patients who received an MS device implanted with kinematic alignment. Institutional Review Board approval and informed consent were obtained. Clinical and radiographic assessments were performed preoperatively, 6 weeks, 6 months, and annually. RESULTS All subjects reached the minimum follow-up of 2 years. There were no statistically significant differences in demographic characteristics, preoperative scores, or alignment (preoperative or postoperative). Tourniquet time was 7.24% longer for the PS group (40.28 min vs 37.56 min, P < .0086). There were significant differences between groups for the 1-year and 2-year Knee Society scores, Forgotten Joint Score, and ROM; in every case favoring the MS group. The FJS was 68.3 in the MS group at 2 years and 58.3 in the PS group (P = .02). The maximum flexion at 2 years was 132° in the MS group and 124° in the PS group (P < .0001). CONCLUSION The clinical outcomes of the MS group at 1 and 2 years were better. At the minimum 2-year follow-up, the results demonstrate the superiority of the medial-stabilized device in terms of multiple clinical outcomes. LEVEL OF EVIDENCE I.
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Affiliation(s)
- David F Scott
- Spokane Joint Replacement Center Inc., Spokane, Washington; Washington State University, Elson S. Floyd College of Medicine, Spokane, Washington
| | - Celeste G Gray
- Spokane Joint Replacement Center Inc., Spokane, Washington
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14
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Cherian NJ, Ohnoutka C, Peissig EJ, Hsing TM, Aggarwal A, Keeney JA. Cemented Patellar Implant Malposition: A Non-Issue for the Painful Total Knee Arthroplasty. J Arthroplasty 2022; 37:S859-S863. [PMID: 35151808 DOI: 10.1016/j.arth.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Non-optimal patellofemoral relationships may influence treatment decisions during revision total knee arthroplasty (TKA). We performed this study to determine whether patellar implant malposition or patellar tilt is associated with inferior patient-reported outcome scores or patient satisfaction after primary TKA. METHODS We identified 396 TKA patients (439 knees) from an institutional registry who had undergone patellar resurfacing, with preoperative and 6-week postoperative radiographs available, and patient-reported outcome measures (PROMs) completed at least 1 year after surgery (mean 505 days). Preoperative patient demographic characteristics, patient-reported expectations, National Institutes of Health - Patient Reported Outcomes Measurements Instrument Systems global health, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and University of California Los Angeles activity scores were compared between 60 TKAs performed with non-optimal patellofemoral relationships (36 patellar implant malposition, 24 patellar tilt) and 379 TKAs performed with optimal patellar implant placement. RESULTS There were no differences between the 2 cohorts regarding demographic features, preoperative radiographic disease severity, expectations, and PROMs; or postoperative tibiofemoral component alignment, PROMs, and patient-reported satisfaction (P = .48). Knee Injury and Osteoarthritis Outcome Score for Joint Replacement improved similarly (P = .62) for patients with optimal resurfacing (48.5-77.6 points) and non-optimal resurfacing (47.7-76.6 points). A similar proportion of optimal and suboptimal resurfaced patients reported being satisfied with their TKA (92.7% vs 88.1%, P = .29). CONCLUSION Although suboptimal patellofemoral relationships may prompt treatment considerations during revision TKA, the data obtained from this study do not suggest that patellar implant malposition or patellar tilt independently contribute to postoperative pain, functional limitation, or dissatisfaction. LEVEL OF EVIDENCE This is a level III, retrospective cohort study.
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Affiliation(s)
- Nathan J Cherian
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Cole Ohnoutka
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Evan J Peissig
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Thomas M Hsing
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Ajay Aggarwal
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - James A Keeney
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
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15
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Mizu-Uchi H, Ma Y, Ishibashi S, Colwell CW, Nakashima Y, D'Lima DD. Tibial sagittal and rotational alignment reduce patellofemoral stresses in posterior stabilized total knee arthroplasty. Sci Rep 2022; 12:12319. [PMID: 35854017 PMCID: PMC9296446 DOI: 10.1038/s41598-022-15759-6] [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: 11/21/2021] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Patellofemoral joint complications remain an important issue in total knee arthroplasty. We compared the patellofemoral contact status between cruciate-retaining and posterior-stabilized designs with varying degrees of tibial sagittal and rotational alignment using a computer simulation to ensure proper alignments in total knee arthroplasty. Knee kinematics, patellofemoral contact force and quadriceps force were computed using a musculoskeletal modeling program (LifeMOD/KneeSIM 2010; LifeModeler, Inc., San Clemente, California) during a weight-bearing deep knee bend. Two different posterior tibial slope (PTS)s (3° and 7°) and five different tibial tray rotational alignments (neutral, internal 5° and 10°, and external 5° and 10°) were simulated. Patellofemoral contact area and stresses were next computed using finite element analysis. The patellofemoral contact force for the posterior-stabilized design was substantially lower than the cruciate-retaining design after post-cam contact because of increasing femoral roll-back. Neutral rotational alignment of the tibial component resulted in smaller differences in patellofemoral contact stresses between cruciate-retaining and posterior-stabilized designs for PTSs of 3° or 7°. However, the patellar contact stresses in the cruciate-retaining design were greater than those in posterior-stabilized design at 120° of knee flexion with PTS of 3° combined with internal rotation of the tibial component. Our study provides biomechanical evidence implicating lower PTSs combined with internal malrotation of the tibial component and the resultant increase in patellofemoral stresses as a potential source of anterior knee pain in cruciate-retaining design.
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Affiliation(s)
- Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuan Ma
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shojiro Ishibashi
- Department of Orthopaedic Surgery, Saiseikai Fukuoka General Hospital, 1-3-46, Tenjin, Chuo-ku, Fukuoka, 810-0001, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Clifford W Colwell
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA, 92037, USA
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 10666 North Torrey Pines Road, MS126, La Jolla, CA, 92037, USA.
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16
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Chen Y, Ding J, Dai S, Yang J, Wang M, Tian T, Deng X, Li B, Cheng G, Liu J. Radiographic measurement of the posterior tibial slope in normal Chinese adults: a retrospective cohort study. BMC Musculoskelet Disord 2022; 23:386. [PMID: 35473639 PMCID: PMC9040249 DOI: 10.1186/s12891-022-05319-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/11/2022] [Indexed: 01/16/2023] Open
Abstract
Background Measurement of the posterior tibial slope (PTS) angle has important applications in total knee replacement surgery, high tibial osteotomy, and anterior cruciate ligament reconstruction. This study aimed to determine the mean PTS of knee joints in healthy Chinese adults, and provide data to guide knee surgery in China. Methods A retrospective analysis of 1257 (n = 1233, 50.4% male) plain X-ray films of participants aged 25–59 years was performed. The picture archiving and communication system was used for PTS measurement. The PTS was defined as the angle between the vertical line of the tangent of the anterior tibial cortex of the proximal tibia, and the tangent line of the tibial cortex. Two imaging physicians conducted the PTS measurements independently, and both the inter- and intraclass correlation coefficients (ICCs) were calculated. Results The mean PTS value was 7.68 ± 3.84° (range: 0–21°). The left PTS was significantly smaller in males than in females (7.22 ± 3.89 vs 8.05 ± 3.60; P = 0.005). Additionally, the PTS in participants aged 25–29 years was significantly larger than that in the other age groups (Left side: 8.64 ± 3.73 vs 6.92 ± 3.42, 7.42 ± 3.75, 7.53 ± 3.98; P < 0.001 and Right side: 8.68 ± 3.84 vs 7.48 ± 4.21, 7.13 ± 3.64, 7.66 ± 3.80; P = 0.004). There were no significant differences in PTS between the left and right sides. Two-way analysis of variance suggested that the differences in PTS between age groups were not affected by sex. The interobserver ICC was 0.91 (95% confidence interval [CI]: 0.85–0.94), and the intraobserver ICC was 0.90 (95% CI: 0.82–0.94). Conclusions This study demonstrated that there were significant differences in PTS based on sex and age, highlighting the need to provide individualized treatment for knee surgery. It provided valuable information regarding the normal PTS values in Chinese adults and presented regionalised data to guide knee surgery.
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Affiliation(s)
- Yong Chen
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Wenzhoulu, Gongshu District, Hangzhou City, 310000, Zhejiang Province, China
| | - Jianping Ding
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Siyu Dai
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Jiao Yang
- Department of Radiology, the Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Mengke Wang
- The Second People's Hospital of Chun'an County, Hangzhou, China
| | - Tian Tian
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Xiaolong Deng
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Boyi Li
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Guohua Cheng
- Hangzhou Jianpei Technology Co., Ltd, Hangzhou, China
| | - Jie Liu
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Wenzhoulu, Gongshu District, Hangzhou City, 310000, Zhejiang Province, China.
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Tomite T, Saito H, Kijima H, Ishikawa N, Hatakeyama Y, Tazawa H, Miyakoshi N. Causes and Clinical Outcomes of Patellar Post Impingement. Arthroplast Today 2022; 14:48-52. [PMID: 35242956 PMCID: PMC8857593 DOI: 10.1016/j.artd.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/25/2021] [Accepted: 12/19/2021] [Indexed: 10/27/2022] Open
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18
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Adıyeke L, Kafadar AB, Erdoğan Ö, Gündüz ÇD. The effect of tibial slope angle on clinical and functional results after mobile bearing total knee arthroplasty. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221075828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Levent Adıyeke
- Department of Orthopedics and Traumatology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Adnan Behçet Kafadar
- Department of Orthopedics and Traumatology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Özgür Erdoğan
- Department of Orthopedics and Traumatology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Çağdaş Deniz Gündüz
- Department of Orthopedics and Traumatology, Ministry of Health Birecik State Hospital, Sanliurfa, Turkey
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Takemura S, Ikawa T, Ohyama Y, Kim M, Takaoka K, Minoda Y, Kadoya Y. The posterior tibial slope does not influence the flexion angle in posterior-stabilized mobile-bearing total knee arthroplasty. ARTHROPLASTY 2021; 3:28. [PMID: 35236482 PMCID: PMC8796609 DOI: 10.1186/s42836-021-00085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
Background It remains uncertain whether an increase in the tibial slope leads to better flexion in posterior-stabilized (PS) total knee prostheses. Purpose To compare the intra-operative flexion angle between standard and an additional 10° posterior slope inserts. Patients and methods Between December 2014 and February 2015, 22 patients (25 knees) who underwent PS mobile-bearing primary total knee arthroplasty (TKA) were included. Flexion angles were measured using either standard or specially-made inserts. Differences in flexion angles between the two situations were analyzed to determine the relationship between changes in flexion angle and pre-operative flexion angle or body mass index (BMI), and between intra- and post-operative flexion angle. Results The difference between the average flexion angle of standard inserts and specially-made inserts was not statistically significant. Although the correlations between changes in flexion angle due to insert difference and flexion angle, pre-operative flexion angle or BMI were not significant, there was a positive correlation between intra-operative and post-operative flexion at 2 years. Conclusion The results showed an additional posterior tibial slope by 10° did not affect the intra-operative flexion angle. Surgeons performing PS mobile-bearing TKA do not need to excessively slope the tibial bone cutting to improve the post-operative flexion angle. Level of evidence I, Experimental study. Supplementary Information The online version contains supplementary material available at 10.1186/s42836-021-00085-5.
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Affiliation(s)
- Susumu Takemura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Tessyu Ikawa
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital Osaka, 2-10-39, Shibata, Kita-ku, Osaka, 530-0012, Japan
| | - Yohei Ohyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Mitsunari Kim
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
| | - Kunio Takaoka
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshinori Kadoya
- Department of Orthopaedic Surgery, Hanwa Joint Reconstruction Center, Hanwa Daini Senboku Hospital, 3176, Fukai Kitamachi, Naka-ku, Sakai, 599-8271, Japan
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Khasian M, Meccia BA, LaCour MT, Komistek RD. Effects of Posterior Tibial Slope on a Posterior Cruciate Retaining Total Knee Arthroplasty Kinematics and Kinetics. J Arthroplasty 2021; 36:2379-2385. [PMID: 33376035 DOI: 10.1016/j.arth.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/01/2020] [Accepted: 12/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It has been hypothesized that increasing posterior tibial slope can influence condylar rollback and play a role in increasing knee flexion. However, the effects of tibial slope on knee kinematics are not well studied. The objective of this study is to assess the effects of tibial slope on femorotibial kinematics and kinetics for a posterior cruciate retaining total knee arthroplasty design. METHODS A validated forward solution model of the knee was implemented to predict the femorotibial biomechanics of a posterior cruciate retaining total knee arthroplasty with varied posterior slopes of 0°-8° at 2° intervals. All analyses were conducted on a weight-bearing deep knee bend activity. RESULTS Increasing the tibial slope shifted the femoral component posteriorly at full extension but decreased the overall femoral rollback throughout flexion. With no tibial slope, the lateral condyle contacted the polyethylene 6 mm posterior of the midline, but as the slope increased to 8°, the femur shifted an extra 5 mm, to 11 mm posterior of the tibial midline. Similar shifts were observed for the medial condyle, ranging from 7 mm posterior to 13 mm posterior, respectively. Increasing posterior slope decreased the posterior cruciate ligament tension and femorotibial contact force. CONCLUSION The results of this study revealed that, although increasing the tibial slope shifted the femur posteriorly at full extension and maximum flexion, it reduced the amount of femoral rollback. Despite the lack of rollback, a more posterior location of condyles suggests lower chances of bearing impingement of the posterior femur and may explain why increasing slope may lead to higher knee flexion.
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Affiliation(s)
- Milad Khasian
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
| | - Bradley A Meccia
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
| | - Michael T LaCour
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
| | - Richard D Komistek
- Center for Musculoskeletal Research, Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, Tennessee
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21
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Lu Y, Yuan X, Qiao F, Hao Y. Effects of different prosthetic instrumentations on tibial bone resection in total knee arthroplasty. Sci Rep 2021; 11:7297. [PMID: 33790376 PMCID: PMC8012597 DOI: 10.1038/s41598-021-86787-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/16/2021] [Indexed: 01/13/2023] Open
Abstract
Our aim was to assess the accuracy of the obtained posterior tibial slope (PTS) with a fixed angle cutting block. 247 TKAs in 213 patients were reviewed. We included 104 Legion Prosthesis, 76 U2 Knee Prosthesis, 46 NexGen LPS-Flex Prosthesis, and 21 Vanguard Knee System products. Preoperative and postoperative PTS were measured via expanded lateral tibia radiographs. For postoperative PTS, the Legion group had significantly smaller slopes than the U2 Knee group and Vanguard group. However, there was no significant difference between the Legion and NexGen groups, and no significant difference among the NexGen, U2 Knee, and Vanguard groups. Multiple linear regression showed that the different tibial lengths and preoperative PTS had statistically significant effects on postoperative PTS. However, there were weak correlations between the tibial length and PTS, and between preoperative and postoperative PTS. For TKA, although the PTS is not completely consistent with the angle of the cutting block, using conventional tibial bone resection technology with different tibial cutting instrumentations provided by various manufacturers in TKA can obtain safe PTS.
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Affiliation(s)
- Yufeng Lu
- Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, People's Republic of China
| | - Xuechao Yuan
- Shaanxi University of Chinese Medicine, Xianyang, 712046, Shaanxi, People's Republic of China
| | - Feng Qiao
- Department of Integrated Traditional Chinese Medicine (TCM) and Western Medicine Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, People's Republic of China
| | - Yangquan Hao
- Osteonecrosis and Joint Reconstruction Ward, Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054, Shaanxi, People's Republic of China.
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Meier M, Janssen D, Koeck FX, Thienpont E, Beckmann J, Best R. Variations in medial and lateral slope and medial proximal tibial angle. Knee Surg Sports Traumatol Arthrosc 2021; 29:939-946. [PMID: 32390118 DOI: 10.1007/s00167-020-06052-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The primary objective of this study was to quantify the variations of the medial posterior tibial slope (MPTS) and the lateral posterior tibial slope (LPTS), as well as of the medial proximal tibial angle (MPTA), and to determine the fraction of patients for which standard techniques including different alignment techniques would result in alteration of the patient's individual posterior tibial slope (PTS) and MPTA. Furthermore, it was of interest if a positive correlation between PTS and MPTA or between medial and lateral slope exists. METHODS A retrospective study was performed on CT-scans of 234 consecutively selected European patients undergoing individual total knee replacement. All measurements were done on three-dimensional CAD models, which were generated on the basis of individual CT-scans, including the hip, knee, and ankle center. Measurements included the medial and lateral PTS and the MPTA. PTS was measured as the angle between the patient's articular surface and a plane perpendicular to the mechanical axis of the tibia in the sagittal plane. MPTA was defined as the angle between the tibial mechanical axis and the proximal articular surface of the tibia in the coronal plane. RESULTS Analysis revealed a wide variation of the MPTS, LPTS, and MPTA among the patients. MPTS and LPTS varied significantly both interindividually and intraindividually. The range of PTS was up to 20° for MPTS (from - 4.3° to 16.8°) and for LPTS (from - 2.9 to 17.2°). The mean intraindividual difference between MPTS and LPTS in the same knee was 2.6° (SD 2.0) with a maximum of 9.5°. MPTA ranged from 79.8 to 92.1° with a mean of 86.6° (SD ± 2.4). Statistical analysis revealed a weak positive correlation between MPTA and MPTS. CONCLUSION The study demonstrates a huge interindividual variability in PTS and MPTA as well as significant intraindividual differences in MPTS and LPTS. Therefore, the question arises, whether the use of standard techniques, including fixed PTSs and MPTAs, is sufficient to address every single patient's individual anatomy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Malin Meier
- Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany
| | - Dino Janssen
- Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany
| | | | | | - Johannes Beckmann
- Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany.
| | - Raymond Best
- Sportklinik Stuttgart, Taubenheimstraße 8, 70372, Stuttgart, Germany
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Kim HJ, Kim JW, Shin JY, Kim J, Lee HJ, Park KH, Kyung HS. A sagittal reference line using the preoperative radiograph in total knee arthroplasty. J Orthop Surg (Hong Kong) 2021; 28:2309499020924143. [PMID: 32468963 DOI: 10.1177/2309499020924143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We evaluated the accuracy of a sagittal alignment of tibial component in total knee arthroplasty (TKA) with the sagittal reference line using the preoperative radiograph. METHODS We evaluated 151 patients who underwent primary TKA with posterior cruciate substituting type implant. For 75 patients, the sagittal reference line using preoperative radiograph (group A) was used, while for 76 patients the sagittal reference using intraoperative fibular shaft line (group B) was used. The parallel line (line S) to the anatomical axis of the tibia in the lateral plain radiograph was used as the sagittal reference. The distance from line S to proximal tibia cutting area and to skin surface 20 cm distal to the cutting area was measured in preoperative radiographs. Next, the distance to the extramedullary guide rod was applied intraoperatively, reflecting the results. The intraoperative fibular shaft line was determined using the connecting line between the tip of fibular head and the lateral malleolus. The postoperative tibial component slope angle and the difference to the target slope angle were compared. RESULTS The difference to the target angle was 1.8 ± 1.3° in group A, whereas the difference was 2.5 ± 1.4° in group B (p = 0.04). The patients with difference within 3° to the target angle were 78.7% in group A and 61.8% in group B (p = 0.024). CONCLUSION The sagittal reference line using the preoperative lateral radiograph was helpful as a reference guide for the tibial slope in TKA.
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Affiliation(s)
- Hee-June Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jeong-Woo Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Junekyu Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Hyun-Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Kyeong-Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Hee-Soo Kyung
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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24
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Hada M, Mizu-Uchi H, Okazaki K, Murakami K, Kaneko T, Higaki H, Nakashima Y. Posterior tibial slope and anterior post-cam contact can change knee kinematics in extension in bi-cruciate stabilized total knee arthroplasty. Bone Joint Res 2020; 9:761-767. [PMID: 33135422 PMCID: PMC7649504 DOI: 10.1302/2046-3758.911.bjr-2020-0076.r2] [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: 11/16/2022] Open
Abstract
Aims This study aims to investigate the effects of posterior tibial slope (PTS) on knee kinematics involved in the post-cam mechanism in bi-cruciate stabilized (BCS) total knee arthroplasty (TKA) using computer simulation. Methods In total, 11 different PTS (0° to 10°) values were simulated to evaluate the effect of PTS on anterior post-cam contact conditions and knee kinematics in BCS TKA during weight-bearing stair climbing (from 86° to 6° of knee flexion). Knee kinematics were expressed as the lowest points of the medial and lateral femoral condyles on the surface of the tibial insert, and the anteroposterior translation of the femoral component relative to the tibial insert. Results Anterior post-cam contact in BCS TKA was observed with the knee near full extension if PTS was 6° or more. BCS TKA showed a bicondylar roll forward movement from 86° to mid-flexion, and two different patterns from mid-flexion to knee extension: screw home movement without anterior post-cam contact and bicondylar roll forward movement after anterior post-cam contact. Knee kinematics in the simulation showed similar trends to the clinical in vivo data and were almost within the range of inter-specimen variability. Conclusion Postoperative knee kinematics in BCS TKA differed according to PTS and anterior post-cam contact; in particular, anterior post-cam contact changed knee kinematics, which may affect the patient’s perception of the knee during activities. Cite this article: Bone Joint Res 2020;9(11):761–767.
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Affiliation(s)
- Masaru Hada
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koji Murakami
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Takao Kaneko
- Department of Orthopaedic Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, Fukuoka, Japan
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Wang Y, Yan S, Zeng J, Zhang K. The biomechanical effect of different posterior tibial slopes on the tibiofemoral joint after posterior-stabilized total knee arthroplasty. J Orthop Surg Res 2020; 15:320. [PMID: 32787891 PMCID: PMC7425532 DOI: 10.1186/s13018-020-01851-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/30/2020] [Indexed: 12/21/2022] Open
Abstract
Background Different posterior tibial slopes (PTS) after posterior-stabilized total knee arthroplasty (PS-TKA) may lead to different biomechanical characteristics of knee joint. This cadaveric study was designed to investigate the tibiofemoral kinematics and contact pressures after PS-TKA with different PTS. Methods Nine human cadaveric knee specimens were used for PS-TKA with the PTS of 3°, 6°, and 9°. The tibiofemoral kinematics and contact pressures were measured during knee flexion angle changing from 0 to 120° (with an increment of 10°) with an axial load of 1000 N at each angle. Results The root mean square (RMS) of the tibiofemoral contact area and the mean and peak contact pressures during knee flexion were 586.2 mm2, 1.85 MPa, and 5.39 MPa before TKA and changed to 130.2 mm2, 7.56 MPa, and 17.98 MPa after TKA, respectively. Larger contact area and smaller mean and peak contact pressures were found in the joints with the larger PTS after TKA. The RMS differences of femoral rotation before and after TKA were more than 9.9°. The posterior translation of the lateral condyle with larger PTS was more than that with smaller PTS, while overall, the RMS differences before and after TKA were more than 11.4 mm. Conclusion After TKA, the tibiofemoral contact area is reduced, and the contact pressure is increased greatly. Approximately 80% of the femoral rotation is lost, and only about 60% of the femoral translation of lateral condyle is recovered. TKA with larger PTS results in more posterior femoral translation, larger contact area, and smaller contact pressure, indicating that with caution, it may be beneficial to properly increase PTS for PS-TKA.
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Affiliation(s)
- Yingpeng Wang
- School of Biomedical Engineering, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Songhua Yan
- School of Biomedical Engineering, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China
| | - Jizhou Zeng
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, Tongzhou District, Beijing, 110149, China.
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, No.10 Xitoutiao, You An Men Wai, Beijing, 100069, China. .,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, 100069, China.
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26
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Tabary M, Esfahani A, Nouraie M, Babaei MR, Khoshdel AR, Araghi F, Shahrezaee M. Relation of the chondromalatia patellae to proximal tibial anatomical parameters, assessed with MRI. Radiol Oncol 2020; 54:159-167. [PMID: 32324164 PMCID: PMC7276644 DOI: 10.2478/raon-2020-0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/18/2020] [Indexed: 02/08/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is a non-invasive highly sensitive tool for diagnosing chondromalacia patellae in the early stages. Many studies have evaluated patellar and trochlear morphology with different radiologic indices. We aimed to assess the discriminative power of tibial, patellar, and femoral indices in MRI for chondromalacia patellae. Patients and methods 100 cases of chondromalacia, as well as 100 age-matched controls among the patients who underwent knee MRI between February 2017 and March 2019, were included. The standard protocol of knee MRI was applied and the diagnosis of chondromalacia was made on MRI findings. Chondromalacia subjects were also classified as grade 1 to 4 according to the Modified Outerbridge's MRI grading system. We measured 25 MRI parameters in the knee and adjacent structures to determine the relation between chondromalacia patellae and anatomical MRI parameters. Results Tibial slope, trochlear depth, lateral trochlear inclination, and lateral patellar tilt angle had significant correlation with chondromalacia. Any increase in lateral trochlear inclination and lateral patellar tilt angle could increase the probability of the disease (Odds ratio [OR] 1.15, 1.13; 95% CI: 1.03-1.30; 1.02-1.26, respectively), while any increase in medial tibial slope and trochlear depth could decrease the probability of chondromalacia (OR 0.85, 0.06; 95% CI: 0.73-0.98, 0.02-0.17, respectively). We also designed a model for the severity of disease by using the patellar height index (relative odds ratio: 75.9). Conclusions The result of this study showed the novelty role of tibial anatomy in developing chondromalacia and its mechanism. We also concluded that patellar height might be an important factor in defining disease severity.
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Affiliation(s)
- Mohammadreza Tabary
- Department of Science and Research Branch, AJA University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mohammad Reza Babaei
- Department of Interventional Radiology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Khoshdel
- Modern Epidemiology Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Farnaz Araghi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Shahrezaee
- Department of Science and Research Branch, AJA University of Medical Sciences, Tehran, Iran
- Department of Orthopedics, AJA University of Medical Sciences, Tehran, Iran
- Mostafa Shahrezaee, M.D., Professor of Orthopedics, Department of Science and Research Branch, AJA University of Medical Sciences, Etemadzadeh St., Tehran, Iran.
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High variability of proximal tibial asymmetry and slope: a CT data analysis of 15,807 osteoarthritic knees before TKA. Knee Surg Sports Traumatol Arthrosc 2020; 28:1105-1112. [PMID: 31570962 DOI: 10.1007/s00167-019-05728-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE As the correct rotational and sagittal alignment of the tibial tray are of key importance for optimal total knee arthroplasty (TKA) function, the objective of this study was to determine these individual variations in the proximal tibial geometry in terms of posterior tibial slope (PTS) and tibial surface asymmetry by analysing a large dataset of computer tomography (CT) information. METHODS A retrospective two-part review was performed on 15,807 datasets that were generated during the design phase for a customized TKA implant. First, 15807 CAD (computer-aided-design) models derived from CT data were used to conduct the analysis on the variation of the PTS. Second, the axial cut of each proximal tibia in a consecutively selected subset of 2202 datasets was used to measure the tibial asymmetry. RESULTS The majority (65.5%) of tibiae had a posterior slope between 5° and 10°, while 26.5% of knees had a slope > 10°. The asymmetry measured as offset between the lateral and medial posterior boundaries was highly variable, with overall an increasing proportion of patients with high asymmetry with increasing tibial ML width. Only 14% of tibiae exhibited symmetric (< 2 mm offset) lateral and medial plateaus, and 22% had an offset > 5 mm. CONCLUSION This study from an extraordinary large data base reveals that tibial posterior slope and asymmetry of the tibial profile vary largely between patients receiving TKA with increasing tibial asymmetry with ML width. CT scans might help to preoperatively better select the best fitting TKA, otherwise surgeons intraoperatively will often have to deal with compromises regarding fitting, sizing and rotational issues. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Shu L, Li S, Sugita N. Systematic review of computational modelling for biomechanics analysis of total knee replacement. BIOSURFACE AND BIOTRIBOLOGY 2020. [DOI: 10.1049/bsbt.2019.0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Liming Shu
- Department of Mechanical EngineeringSchool of EngineeringThe University of Tokyo7‐3‐1 Hongo, Bunkyo‐kuTokyo113‐8656Japan
| | - Shihao Li
- Department of Mechanical EngineeringSchool of EngineeringThe University of Tokyo7‐3‐1 Hongo, Bunkyo‐kuTokyo113‐8656Japan
| | - Naohiko Sugita
- Department of Mechanical EngineeringSchool of EngineeringThe University of Tokyo7‐3‐1 Hongo, Bunkyo‐kuTokyo113‐8656Japan
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Zhu Y, Xu W, Luo G, Wang H, Yang J, Lu W. Random Forest enhancement using improved Artificial Fish Swarm for the medial knee contact force prediction. Artif Intell Med 2020; 103:101811. [PMID: 32143807 DOI: 10.1016/j.artmed.2020.101811] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/06/2020] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
Abstract
Knee contact force (KCF) is an important factor to evaluate the knee joint function for the patients with knee joint impairment. However, the KCF measurement based on the instrumented prosthetic implants or inverse dynamics analysis is limited due to the invasive, expensive price and time consumption. In this work, we propose a KCF prediction method by integrating the Artificial Fish Swarm and the Random Forest algorithm. First, we train a Random Forest to learn the nonlinear relation between gait parameters (input) and contact pressures (output) based on a dataset of three patients instrumented with knee replacement. Then, we use the improved artificial fish group algorithm to optimize the main parameters of the Random Forest based KCF prediction model. The extensive experiments verify that our method can predict the medial knee contact force both before and after the intervention of gait patterns, and the performance outperforms the classical multi-body dynamics analysis and artificial neural network model.
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Affiliation(s)
- Yean Zhu
- East China Jiaotong University, Nanchang, China.
| | - Weiyi Xu
- East China Jiaotong University, Nanchang, China.
| | - Guoliang Luo
- East China Jiaotong University, Nanchang, China.
| | - Haolun Wang
- East China Jiaotong University, Nanchang, China.
| | | | - Wei Lu
- Jiangxi Provincial People's Hospital, Nanchang, China.
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30
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Effect of surgical parameters on the biomechanical behaviour of bicondylar total knee endoprostheses - A robot-assisted test method based on a musculoskeletal model. Sci Rep 2019; 9:14504. [PMID: 31601894 PMCID: PMC6787084 DOI: 10.1038/s41598-019-50399-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 09/11/2019] [Indexed: 01/16/2023] Open
Abstract
The complicated interplay of total knee replacement (TKR) positioning and patient-specific soft tissue conditions still causes a considerable number of unsatisfactory outcomes. Therefore, we deployed a robot-assisted test method, in which a six-axis robot moved and loaded a bicondylar cruciate-retaining (CR)-TKR in a virtual lower extremity emulated by a musculoskeletal multibody model. This enabled us to systematically analyse the impact of the posterior cruciate ligament (PCL), tibial slope, and tibial component rotation on TKR function while considering the physical implant components and physiological-like conditions during dynamic motions. The PCL resection yielded a decrease of femoral rollback by 4.5 mm and a reduction of tibiofemoral contact force by 50 N. A reduced tibial slope led to an increase of tibiofemoral contact force by about 170 N and a decrease of femoral rollback up to 1.7 mm. Although a higher tibial slope reduced the contact force, excessive tibial slopes should be avoided to prevent joint instability. Contrary to an external rotation of the tibial component, an internal rotation clearly increased the contact force and lateral femoral rollback. Our data contribute to improved understanding the biomechanics of TKRs and show the capabilities of the robot-assisted test method based on a musculoskeletal multibody model as a preoperative planning tool.
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Higuchi T, Koseki H, Yonekura A, Chiba K, Nakazoe Y, Sunagawa S, Noguchi C, Osaki M. Comparison of radiological features of high tibial osteotomy and tibial condylar valgus osteotomy. BMC Musculoskelet Disord 2019; 20:409. [PMID: 31484580 PMCID: PMC6727502 DOI: 10.1186/s12891-019-2764-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022] Open
Abstract
Background The purpose of this study was to compare radiological features between high tibial osteotomy (HTO) and tibial condylar valgus osteotomy (TCVO), in order to define the radiological indication criteria for TCVO. Methods Thirty-two cases involving 35 knees that had undergone HTO and the same number that had undergone TCVO for knee osteoarthritis were retrospectively evaluated. Characteristics of both groups did not differ significantly. Lower limb alignment, bone morphology, joint congruity, and joint instability were measured in standing full-length leg and knee radiographs obtained before and after surgery. Results Radiological features in the TCVO group included greater frequencies of advanced knee OA grade, varus lower limb malalignment, depression of the medial tibial plateau, and varus-valgus joint instability compared to the HTO group before surgery. However, tibial morphology, alignment of the lower limb, and joint instability improved to comparable levels after surgery in both groups. Conclusions TCVO appears preferable in cases with advanced knee OA, destroyed or inclined medial tibial plateau, widened and subluxated lateral joint, and high varus-valgus joint instability.
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Affiliation(s)
- Takashi Higuchi
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Hironobu Koseki
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan. .,Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yusuke Nakazoe
- Department of Orthopedic Surgery, Wajinkai Hospital, Nagasaki, Japan
| | - Shinya Sunagawa
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Chieko Noguchi
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Sekiguchi K, Nakamura S, Kuriyama S, Nishitani K, Ito H, Tanaka Y, Watanabe M, Matsuda S. Effect of tibial component alignment on knee kinematics and ligament tension in medial unicompartmental knee arthroplasty. Bone Joint Res 2019; 8:126-135. [PMID: 30997038 PMCID: PMC6444020 DOI: 10.1302/2046-3758.83.bjr-2018-0208.r2] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Unicompartmental knee arthroplasty (UKA) is one surgical option for treating symptomatic medial osteoarthritis. Clinical studies have shown the functional benefits of UKA; however, the optimal alignment of the tibial component is still debated. The purpose of this study was to evaluate the effects of tibial coronal and sagittal plane alignment in UKA on knee kinematics and cruciate ligament tension, using a musculoskeletal computer simulation. Methods The tibial component was first aligned perpendicular to the mechanical axis of the tibia, with a 7° posterior slope (basic model). Subsequently, coronal and sagittal plane alignments were changed in a simulation programme. Kinematics and cruciate ligament tensions were simulated during weight-bearing deep knee bend and gait motions. Translation was defined as the distance between the most medial and the most lateral femoral positions throughout the cycle. Results The femur was positioned more medially relative to the tibia, with increasing varus alignment of the tibial component. Medial/lateral (ML) translation was smallest in the 2° varus model. A greater posterior slope posteriorized the medial condyle and increased anterior cruciate ligament (ACL) tension. ML translation was increased in the > 7° posterior slope model and the 0° model. Conclusion The current study suggests that the preferred tibial component alignment is between neutral and 2° varus in the coronal plane, and between 3° and 7° posterior slope in the sagittal plane. Varus > 4° or valgus alignment and excessive posterior slope caused excessive ML translation, which could be related to feelings of instability and could potentially have negative effects on clinical outcomes and implant durability. Cite this article: K. Sekiguchi, S. Nakamura, S. Kuriyama, K. Nishitani, H. Ito, Y. Tanaka, M. Watanabe, S. Matsuda. Bone Joint Res 2019;8:126–135. DOI: 10.1302/2046-3758.83.BJR-2018-0208.R2.
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Affiliation(s)
- K Sekiguchi
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan; Medical Staff, Yawata Central Hospital, Yawata, Japan
| | - S Nakamura
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - S Kuriyama
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - K Nishitani
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - H Ito
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Y Tanaka
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - M Watanabe
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - S Matsuda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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Tomite T, Saito H, Kijima H, Saito K, Tazawa H, Ishikawa N, Miyakoshi N, Shimada Y. The usefulness of planning using a preoperative lateral leg image to determine accurate posterior tibial slope in total knee arthroplasty. J Orthop 2019; 16:25-30. [PMID: 30765930 DOI: 10.1016/j.jor.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022] Open
Abstract
Objective Sagittal alignment of the tibia following total knee arthroplasty (TKA) can affect various factors, such as durability, range of motion, stability, and even kinematics. The aim of the present study was to investigate whether taking plain preoperative lateral leg X-ray images to plan the posterior tibial slope can give an insert placement with more accurate sagittal alignment. Methods A total of 100 patients who underwent total TKA with posterior-stabilized prostheses. were divided into a group of 50 cases in which the posterior tibial slope was determined intra-operatively with only the fibular axis as the landmark, and a group of 50 cases in which determination of the posterior tibial slope was planned preoperatively with reference to preoperative lateral leg images. For the posterior slope, tibial cutting was performed with the posterior slope built into the bone cutting guide of the insert as the target. The angle of the fibular axis and the posterior slope of the tibial insert were measured on the postoperative lateral leg X-ray image, and the difference from the target angle was examined in the two groups. Results In the group in which only the fibular axis was used for reference, the mean deviation from the target was 3.96°, while in the group in which planning was carried out preoperatively using lateral leg X-ray images, the mean deviation was 1.59° (P < 0.05). Conclusion Drawing up a preoperative plan using lateral leg X-ray images gives a useful landmark at low cost for accurate determination of TKA posterior tibial slope.
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Affiliation(s)
- Takenori Tomite
- Department of Orthopedic Surgery, Akita Red Cross Hospital, Kamikitate Sarutaazanaeshirosawa 222-1, Akita City, Akita, 018-1495, Japan.,Akita Sports, Arthroscopy, and Knee Group (ASAKG), Hondou 1-1-1, Akita City, Akita, 010-8543, Japan
| | - Hidetomo Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondou 1-1-1, Akita City, Akita, 010-8543, Japan.,Akita Sports, Arthroscopy, and Knee Group (ASAKG), Hondou 1-1-1, Akita City, Akita, 010-8543, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondou 1-1-1, Akita City, Akita, 010-8543, Japan.,Akita Sports, Arthroscopy, and Knee Group (ASAKG), Hondou 1-1-1, Akita City, Akita, 010-8543, Japan
| | - Kimio Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondou 1-1-1, Akita City, Akita, 010-8543, Japan.,Akita Sports, Arthroscopy, and Knee Group (ASAKG), Hondou 1-1-1, Akita City, Akita, 010-8543, Japan
| | - Hiroshi Tazawa
- Department of Orthopedic Surgery, Akita Red Cross Hospital, Kamikitate Sarutaazanaeshirosawa 222-1, Akita City, Akita, 018-1495, Japan
| | - Noriyuki Ishikawa
- Department of Orthopedic Surgery, Akita Red Cross Hospital, Kamikitate Sarutaazanaeshirosawa 222-1, Akita City, Akita, 018-1495, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondou 1-1-1, Akita City, Akita, 010-8543, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondou 1-1-1, Akita City, Akita, 010-8543, Japan.,Akita Sports, Arthroscopy, and Knee Group (ASAKG), Hondou 1-1-1, Akita City, Akita, 010-8543, Japan
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Kang KT, Kwon SK, Kwon OR, Lee JS, Koh YG. Comparison of the biomechanical effect of posterior condylar offset and kinematics between posterior cruciate-retaining and posterior-stabilized total knee arthroplasty. Knee 2019; 26:250-257. [PMID: 30577956 DOI: 10.1016/j.knee.2018.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 07/26/2018] [Accepted: 11/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effect of the changes in the femoral posterior condylar offset (PCO) on anterior-posterior (AP) translation and internal-external (IE) rotation in cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) remains unknown. The purpose of this study was to compare the kinematics in CR and PS TKA with respect to the difference in prosthetic design and PCO change through a computational simulation. METHODS We developed three-dimensional finite element models with the different PCOs of ±1, ±2 and ±3 mm in the posterior direction using CR and PS TKA. We performed the simulation with different PCOs under a deep knee bend condition and evaluated the kinematics for the AP and IE in CR and PS TKA. RESULTS The more tibiofemoral (TF) translation in the posterior direction was found as PCO translated in posterior direction for both CR and PS TKA compared to the neutral position. However, the change of the AP translation with respect to the PCO change in CR TKA was greater than PS TKA. The more TF external rotation was found as PCO translated in the anterior direction for both CR and PS TKA compared to the neutral position. However, unlike the TF translation, the TF rotation was not influenced by the PCO change in both CR and PS TKA. CONCLUSION The PCO magnitude was influenced by a postoperative change in the kinematics in CR TKA although a relatively smaller effect was observed in PS TKA. Hence, surgeons should be aware of the PCO change, especially for CR TKA.
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Affiliation(s)
- Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul, Republic of Korea
| | - Sae Kwang Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
| | - Oh-Ryong Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
| | - Jun-Sang Lee
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seocho-gu, Seoul, Republic of Korea.
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Effects of posterior condylar offset and posterior tibial slope on mobile-bearing total knee arthroplasty using computational simulation. Knee 2018; 25:903-914. [PMID: 29980426 DOI: 10.1016/j.knee.2018.06.011] [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: 11/10/2017] [Revised: 05/10/2018] [Accepted: 06/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postoperative changes of the femoral posterior condylar offset (PCO) and posterior tibial slope (PTS) affect the biomechanics of the knee joint after fixed-bearing total knee arthroplasty (TKA). However, the biomechanics of mobile-bearing is not well known. Therefore, the aim of this study was to investigate whether alterations to the PCO and PTS affect the biomechanics for mobile-bearing TKA. METHODS We used a computational model for a knee joint that was validated using in vivo experiment data to evaluate the effects of the PCO and PTS on the tibiofemoral (TF) joint kinematics, patellofemoral (PF) contact stress, collateral ligament force and quadriceps force, for mobile-bearing TKA. The computational model was developed using ±1-, ±2- and ±3-mm PCO models in the posterior direction and -3°, 0°, +3°, and +6° PTS models based on each of the PCO models. RESULTS The maximum PF contact stress, collateral ligament force and quadriceps force decreased as the PTS increased. In addition, the maximum PF contact stress and quadriceps force decreased, and the collateral ligament force increased as PCO translated in the posterior direction. This trend is consistent with that observed in any PCO and PTS. CONCLUSIONS Our findings show the various effects of postoperative alterations in the PCO and PTS on the biomechanical results of mobile-bearing TKA. Based on the computational simulation, we suggest that orthopaedic surgeons intraoperatively conserve the patient's own anatomical PCO and PTS in mobile-bearing TKA.
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Kang KT, Kwon SK, Son J, Kwon OR, Lee JS, Koh YG. The increase in posterior tibial slope provides a positive biomechanical effect in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:3188-3195. [PMID: 29623377 DOI: 10.1007/s00167-018-4925-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aims to clarify the influence of the posterior tibial slope (PTS) on knee joint biomechanics after posterior-stabilized (PS) total knee arthroplasty (TKA) using a computer simulation. METHODS A validated TKA computational model was used to evaluate and quantify the effects of an increased PTS. In order to conduct a squat simulation, models with a - 3° to 15° PTS using increments of 3° were developed. Forces on the quadriceps and collateral ligament, a tibial posterior translation, contact point on a polyethylene (PE) insert, and contact stress on the patellofemoral (PF) joint and post in a PE insert were compared. RESULTS The maximum force on the quadriceps and the PF contact stress decreased with increases in the PTS. The kinematics on the tibiofemoral (TF) joint translated in an increasingly posterior manner, and the medial and lateral contact points on a PE insert were located in posterior regions with increases in the PTS. Additionally, increases in the PTS decreased the force on the collateral ligament and increased the contact stress on the post in a PE insert. A higher force on the quadriceps is required when the PTS decreases with an equivalent flexion angle. CONCLUSIONS A surgeon should be prudent in terms of determining the PTS because an excessive increase in the PTS may lead to the progressive loosening of the TF joint due to a reduction in collateral ligament tension and failure of the post in a PE insert. Thus, we support a more individualized approach of optimal PTS determination given the findings of the study.
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Affiliation(s)
- Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sae Kwang Kwon
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Juhyun Son
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Oh-Ryong Kwon
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Jun-Sang Lee
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea
| | - Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, Republic of Korea.
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Comparison of Kinematics in Cruciate Retaining and Posterior Stabilized for Fixed and Rotating Platform Mobile-Bearing Total Knee Arthroplasty with respect to Different Posterior Tibial Slope. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5139074. [PMID: 29992149 PMCID: PMC6016153 DOI: 10.1155/2018/5139074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 12/23/2022]
Abstract
Reconstructed posterior tibial slope (PTS) plays a significant role in kinematics restoration after total knee arthroplasty (TKA). However, the effect of increased and decreased PTS on prosthetic type and design has not yet been investigated. We used a finite element model, validated using in vitro data, to evaluate the effect of PTS on knee kinematics in cruciate-retaining (CR) and posterior-stabilized (PS) fixed TKA and rotating platform mobile-bearing TKA. Anterior-posterior tibial translation and internal-external tibial rotation were investigated for PTS ranging from -3° to 15°, with increments of 1°, for three different designs of TKA. Tibial posterior translation and external rotation increased as the PTS increased in both CR and PS TKAs. In addition, there was no remarkable difference in external rotation between CR and PS TKAs. However, for the mobile-bearing TKA, PTS had less effect on the kinematics. Based on our computational simulation, PTS is the critical factor that influences kinematics in TKA, especially in the CR TKA. Therefore, the surgeon should be careful in choosing the PTS in CR TKAs.
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Hada M, Mizu-Uchi H, Okazaki K, Kaneko T, Murakami K, Ma Y, Hamai S, Nakashima Y. Bi-cruciate stabilized total knee arthroplasty can reduce the risk of knee instability associated with posterior tibial slope. Knee Surg Sports Traumatol Arthrosc 2018; 26:1709-1716. [PMID: 28940016 DOI: 10.1007/s00167-017-4718-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the relationship between posterior tibial slope and knee kinematics in bi-cruciate stabilized (BCS) total knee arthroplasty (TKA), which has not been previously reported. METHODS This computer simulation study evaluated Journey 2 BCS components (Smith & Nephew, Inc., Memphis, TN, USA) implanted in a female patient to simulate weight-bearing stair climbing. Knee kinematics, patellofemoral contact forces, and quadriceps forces during stair climbing (from 86° to 6° of flexion) were computed in the simulation. Six different posterior tibial slope angles (0°-10°) were simulated to evaluate the effect of posterior tibial slope on knee kinematics and forces. RESULTS At 65° of knee flexion, no anterior sliding of the tibial component occurred if the posterior tibial slope was less than 10°. Anterior contact between the anterior aspect of the tibial post- and the femoral component was observed if the posterior tibial slope was 6° or more. An increase of 10° in posterior tibial slope (relative to 0°) led to a 4.8% decrease in maximum patellofemoral contact force and a 1.2% decrease in maximum quadriceps force. CONCLUSION BCS TKA has a wide acceptable range of posterior tibial slope for avoiding knee instability if the posterior tibial slope is less than 10°. Surgeons should prioritize avoiding adverse effects over trying to achieve positive effects such as decreasing patellofemoral contact force and quadriceps force by increasing posterior tibial slope. Our study helps surgeons determine the optimal posterior tibial slope during surgery with BCS TKA; posterior tibial slope should not exceed 10° in routine clinical practice.
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Affiliation(s)
- Masaru Hada
- Department of Orthopaedic Surgery, Toho University School of Medicine, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.,Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan.
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takao Kaneko
- Department of Orthopaedic Surgery, Toho University School of Medicine, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan
| | - Koji Murakami
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Yuan Ma
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan
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In vivo kinematics of gait in posterior-stabilized and bicruciate-stabilized total knee arthroplasties using image-matching techniques. INTERNATIONAL ORTHOPAEDICS 2018; 42:2573-2581. [PMID: 29623458 DOI: 10.1007/s00264-018-3921-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE This study aimed to evaluate the effects of two types of total knee arthroplasty (TKA) designs: posterior-stabilized (PS) and bicruciate-stabilized (BCS) on in vivo kinematics during gait. METHODS Continuous X-ray images of the gait were taken using a flat panel detector for 23 PS and BCS TKAs. We analyzed the tibiofemoral implant flexion angle, anteroposterior (AP) translation, axial rotation, and anterior/posterior cam-post contact using image-matching techniques. RESULTS Double knee actions were demonstrated for the PS and BCS design (35 and 61%, respectively, p = 0.08). The tibiofemoral AP positions were significantly more posterior at peak extension (- 1.7 ± 2.2 and 1.0 ± 2.5 mm, respectively, p < 0.01) and anterior at peak flexion (1.3 ± 2.3 and - 0.8 ± 2.8 mm, respectively, p = 0.01) for the PS design than for the BCS design, with a significant difference in AP translation (3.0 ± 3.9 mm anterior and 1.7 ± 2.8 mm posterior, respectively, p < 0.01). Anterior/posterior tibial post contacts were found in 83/4% and 74/30% for the PS and BCS designs, respectively, with a significant difference in posterior contact (p = 0.72/0.04, respectively). CONCLUSION The knee flexion pattern, tibiofemoral AP translation, axial rotation, and cam-post contact during gait varied, depending on the type of implant, the PS and BCS designs.
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Kang KT, Koh YG, Son J, Kwon OR, Lee JS, Kwon SK. Influence of Increased Posterior Tibial Slope in Total Knee Arthroplasty on Knee Joint Biomechanics: A Computational Simulation Study. J Arthroplasty 2018; 33:572-579. [PMID: 29017801 DOI: 10.1016/j.arth.2017.09.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/28/2017] [Accepted: 09/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The reconstructed posterior tibial slope (PTS) plays a significant role in restoring knee kinematics in cruciate-retaining-total knee arthroplasty (TKA). A few studies have reported the effect of the PTS on biomechanics. METHODS This study investigates the effect of the PTS on tibiofemoral (TF) kinematics, patellofemoral (PF) contact stress, and forces at the quadriceps, posterior cruciate ligament (PCL) and collateral ligament after cruciate-retaining-TKA using computer simulations. The simulation for the validated TKA finite element model was performed under deep knee bend condition. All analyses were repeated from -3° to 15° PTS in increments of 3°. RESULTS The kinematics on the TF joint translated increasingly posteriorly when the PTS increased. Medial and lateral contact points translated in posterior direction in extension and flexion as PTS increased. The maximum contact stress on the PF joint and quadriceps, and collateral ligament force decreased when the PTS increased. An implantation of the tibial plate with increased PTS reduced the PCL load. Physiologic insert movement led to an increasingly posterior position of the femur and reduced quadriceps force especially for knee flexion angles above high flexion (120°) when compared to TKA with a decreased slope of the tibial base plate. CONCLUSION An increase in the PTS increased medial and lateral movements without paradoxical motion. However, an excessive PTS indicated progressive loosening of the TF joint gap due to a reduction in collateral ligament tension during flexion.
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Affiliation(s)
- Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Juhyun Son
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Oh-Ryong Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Jun-Sang Lee
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Sae-Kwang Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
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Kang KT, Koh YG, Son J, Kwon OR, Lee JS, Kwon SK. A computational simulation study to determine the biomechanical influence of posterior condylar offset and tibial slope in cruciate retaining total knee arthroplasty. Bone Joint Res 2018; 7:69-78. [PMID: 29330345 PMCID: PMC5805829 DOI: 10.1302/2046-3758.71.bjr-2017-0143.r1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Posterior condylar offset (PCO) and posterior tibial slope (PTS) are critical factors in total knee arthroplasty (TKA). A computational simulation was performed to evaluate the biomechanical effect of PCO and PTS on cruciate retaining TKA. Methods We generated a subject-specific computational model followed by the development of ± 1 mm, ± 2 mm and ± 3 mm PCO models in the posterior direction, and -3°, 0°, 3° and 6° PTS models with each of the PCO models. Using a validated finite element (FE) model, we investigated the influence of the changes in PCO and PTS on the contact stress in the patellar button and the forces on the posterior cruciate ligament (PCL), patellar tendon and quadriceps muscles under the deep knee-bend loading conditions. Results Contact stress on the patellar button increased and decreased as PCO translated to the anterior and posterior directions, respectively. In addition, contact stress on the patellar button decreased as PTS increased. These trends were consistent in the FE models with altered PCO. Higher quadriceps muscle and patellar tendon force are required as PCO translated in the anterior direction with an equivalent flexion angle. However, as PTS increased, quadriceps muscle and patellar tendon force reduced in each PCO condition. The forces exerted on the PCL increased as PCO translated to the posterior direction and decreased as PTS increased. Conclusion The change in PCO alternatively provided positive and negative biomechanical effects, but it led to a reduction in a negative biomechanical effect as PTS increased. Cite this article: K-T. Kang, Y-G. Koh, J. Son, O-R. Kwon, J-S. Lee, S. K. Kwon. A computational simulation study to determine the biomechanical influence of posterior condylar offset and tibial slope in cruciate retaining total knee arthroplasty. Bone Joint Res 2018;7:69–78. DOI: 10.1302/2046-3758.71.BJR-2017-0143.R1.
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Affiliation(s)
- K-T Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Y-G Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
| | - J Son
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - O-R Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
| | - J-S Lee
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
| | - S K Kwon
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, South Korea
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Biomechanical Effects of Posterior Condylar Offset and Posterior Tibial Slope on Quadriceps Force and Joint Contact Forces in Posterior-Stabilized Total Knee Arthroplasty. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4908639. [PMID: 29349074 PMCID: PMC5733759 DOI: 10.1155/2017/4908639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/14/2017] [Accepted: 10/25/2017] [Indexed: 11/24/2022]
Abstract
This study aimed to determine the biomechanical effect of the posterior condylar offset (PCO) and posterior tibial slope (PTS) in posterior-stabilized (PS) fixed-bearing total knee arthroplasty (TKA). We developed ±1, ±2, and ±3 mm PCO models in the posterior direction and −3°, 0°, 3°, and 6° PTS models using a previously validated FE model. The influence of changes in the PCO and PTS on the biomechanical effects under deep-knee-bend loading was investigated. The contact stress on the PE insert increased by 14% and decreased by 7% on average as the PCO increased and decreased, respectively, compared to the neutral position. In addition, the contact stress on post in PE insert increased by 18% on average as PTS increased from −3° to 6°. However, the contact stress on the patellar button decreased by 11% on average as PTS increased from −3° to 6° in all different PCO cases. The quadriceps force decreased by 14% as PTS increased from −3° to 6° in all PCO models. The same trend was found in patellar tendon force. Changes in PCO had adverse biomechanical effects whereas PTS increase had positive biomechanical effects. However, excessive PTS should be avoided to prevent knee instability and subsequent failure.
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Wautier D, Thienpont E. Changes in anteroposterior stability and proprioception after different types of knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:1792-1800. [PMID: 26869036 DOI: 10.1007/s00167-016-4038-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/26/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE To compare different types of knee arthroplasty, in selected patients with a knee score above 80 points, for their post-operative changes in anteroposterior (AP) laxity and proprioception. METHODS Four groups of each ten patients were tested for AP translation after different types of arthroplasty with a KT-1000 device at 30°, 60° and 90° of flexion. Proprioception of the joint was evaluated by joint position sense with three different tests. Clinical outcome of stability and proprioceptive testing was analysed by comparing the results of three (KSS, KOOS and FJS-12) patient-reported outcome measurement scores (PROMS) for each of the different implant types. RESULTS Anteroposterior laxity was observed at 30° and 90° of flexion for the two PS TKA designs included in this study, but not for the UKA or the medial pivot design. All knee designs, except UKA, had an increased laxity at 60° of flexion. Proprioceptive testing was inconclusive. PROMS were not able to identify differences in clinical outcome among different knee designs in these selected patients, despite observed differences in AP laxity. CONCLUSION Increased AP laxity is a result of the surgical procedure in knee arthroplasty. UKA is the only design mimicking native laxity of the knee. A medial pivot design can obtain the same result as UKA at 30° and 90° of flexion, but not at the importantly cited 60° of flexion as tested under non-load-bearing conditions. The clinical relevance of this study is that despite of an important range of AP translations among the different knee designs, good-to-excellent patient-reported outcome was observed within the findings of this study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Delphine Wautier
- Department of Orthopedic Surgery, University Hospital Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Emmanuel Thienpont
- Department of Orthopedic Surgery, University Hospital Saint Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
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Superior-inferior position of patellar component affects patellofemoral kinematics and contact forces in computer simulation. Clin Biomech (Bristol, Avon) 2017; 45:19-24. [PMID: 28437676 DOI: 10.1016/j.clinbiomech.2017.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/08/2017] [Accepted: 04/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior knee pain has been reported as a major postoperative complication after total knee arthroplasty, which may lead to patient dissatisfaction. Rotational alignment and the medial-lateral position correlate with patellar maltracking, which can cause knee pain postoperatively. However, the superior-inferior position of the patellar component has not been investigated. The purpose of the current study was to investigate the effects of the patellar superior-inferior position on patellofemoral kinematics and kinetics. METHODS Superior, central, and inferior models with a dome patellar component were constructed. In the superior and inferior models, the position of the patellar component translated superiorly and inferiorly, respectively, by 3mm, relative to the center model. Kinematics of the patellar component, quadriceps force, and patellofemoral contact force were calculated using a computer simulation during a squatting activity in a weight-bearing deep knee bend. FINDINGS In the inferior model, the flexion angle, relative to the tibial component, was the greatest among all models. The inferior model showed an 18.0%, 36.5%, and 22.7% increase in the maximum quadriceps force, the maximum medial patellofemoral force, and the maximum lateral patellofemoral force, respectively, compared with the superior model. INTERPRETATION Superior-inferior positions affected patellofemoral kinematic and kinetics. Surgeons should avoid the inferior position of the patellar component, because the inferior positioned model showed greater quadriceps and patellofemoral force, resulting in a potential risk for anterior knee pain and component loosening.
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An Anatomic Investigation Into the Relationship Between Posterior Condylar Offset and Posterior Tibial Slope of One Thousand One Hundred Thirty-Eight Cadaveric Knees. J Arthroplasty 2017; 32:1659-1664.e1. [PMID: 28065623 DOI: 10.1016/j.arth.2016.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/20/2016] [Accepted: 12/12/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Posterior condylar offset (PCO) and posterior tibial slope (PTS) have critical consequences in total knee arthroplasty, especially with regards to sagittal plane balancing. However, there has only been limited investigation into the functional consequences of each, and there have only been anecdotal observations regarding any associations between PCO and PTS. METHODS In a large osteological study of 1138 knees, standardized measurements of PCO and PTS were taken using previously described techniques on specimens of different age, race, and gender. Multiple linear regression was performed to determine the independent predictors of medial and lateral PTS. RESULTS Mean standardized medial PCO was greater than lateral PCO (1.22 ± 0.16 vs 1.15 ± 0.19 mm, P < .001) and medial PTS was greater than lateral PTS (7.3 ± 3.8° vs 5.7 ± 3.7°, P < .001). Decreasing PCO, female gender, and African-American race were associated with both increased medial and lateral PTS. Neither age nor femoral length correlated with medial or lateral PTS. CONCLUSION These data are the first to quantify that an inverse correlation between PCO and PTS exists. This relationship represents an important area for future biomechanical and clinical studies.
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Nakamura S, Tian Y, Tanaka Y, Kuriyama S, Ito H, Furu M, Matsuda S. The effects of kinematically aligned total knee arthroplasty on stress at the medial tibia: A case study for varus knee. Bone Joint Res 2017; 6:43-51. [PMID: 28077396 PMCID: PMC5301901 DOI: 10.1302/2046-3758.61.bjr-2016-0090.r1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 11/21/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Little biomechanical information is available about kinematically aligned (KA) total knee arthroplasty (TKA). The purpose of this study was to simulate the kinematics and kinetics after KA TKA and mechanically aligned (MA) TKA with four different limb alignments. MATERIALS AND METHODS Bone models were constructed from one volunteer (normal) and three patients with three different knee deformities (slight, moderate and severe varus). A dynamic musculoskeletal modelling system was used to analyse the kinematics and the tibiofemoral contact force. The contact stress on the tibial insert, and the stress to the resection surface and medial tibial cortex were examined by using finite element analysis. RESULTS In all bone models, posterior translation on the lateral side and external rotation in the KA TKA models were greater than in the MA TKA models. The tibiofemoral force at the medial side was increased in the moderate and severe varus models with KA TKA. In the severe varus model with KA TKA, the contact stress on the tibial insert and the stress to the resection surface and to the medial tibial cortex were increased by 41.5%, 32.2% and 53.7%, respectively, compared with MA TKA, and the bone strain at the medial side was highest among all models. CONCLUSION Near normal kinematics was observed in KA TKA. However, KA TKA increased the contact force, stress and bone strain at the medial side for moderate and severe varus knee models. The application of KA TKA for severe varus knees may be inadequate.Cite this article: S. Nakamura, Y. Tian, Y. Tanaka, S. Kuriyama, H. Ito, M. Furu, S. Matsuda. The effects of kinematically aligned total knee arthroplasty on stress at the medial tibia: A case study for varus knee. Bone Joint Res 2017;6:43-51. DOI: 10.1302/2046-3758.61.BJR-2016-0090.R1.
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Affiliation(s)
- S Nakamura
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Y Tian
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Y Tanaka
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - S Kuriyama
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - H Ito
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - M Furu
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - S Matsuda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoinkawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
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Tanaka Y, Nakamura S, Kuriyama S, Ito H, Furu M, Komistek RD, Matsuda S. How exactly can computer simulation predict the kinematics and contact status after TKA? Examination in individualized models. Clin Biomech (Bristol, Avon) 2016; 39:65-70. [PMID: 27690304 DOI: 10.1016/j.clinbiomech.2016.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 09/14/2016] [Accepted: 09/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is unknown whether a computer simulation with simple models can estimate individual in vivo knee kinematics, although some complex models have predicted the knee kinematics. The purposes of this study are first, to validate the accuracy of the computer simulation with our developed model during a squatting activity in a weight-bearing deep knee bend and then, to analyze the contact area and the contact stress of the tri-condylar implants for individual patients. METHODS We compared the anteroposterior (AP) contact positions of medial and lateral condyles calculated by the computer simulation program with the positions measured from the fluoroscopic analysis for three implanted knees. Then the contact area and the stress including the third condyle were calculated individually using finite element (FE) analysis. FINDINGS The motion patterns were similar in the simulation program and the fluoroscopic surveillance. Our developed model could nearly estimate the individual in vivo knee kinematics. The mean and maximum differences of the AP contact positions were 1.0mm and 2.5mm, respectively. At 120° of knee flexion, the contact area at the third condyle was wider than the both condyles. The mean maximum contact stress at the third condyle was lower than the both condyles at 90° and 120° of knee flexion. INTERPRETATION Individual bone models are required to estimate in vivo knee kinematics in our simple model. The tri-condylar implant seems to be safe for deep flexion activities due to the wide contact area and low contact stress.
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Affiliation(s)
- Yoshihisa Tanaka
- 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
| | - Hiromu Ito
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Moritoshi Furu
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Richard D Komistek
- Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN, USA
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Kyoto University, Graduate School of Medicine, Kyoto, Japan
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