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Hamilton LD, Shelburne KB, Rullkoetter PJ, Barnes CL, Mannen EM. Kinematic Performance of Medial Pivot Total Knee Arthroplasty. J Arthroplasty 2024; 39:1595-1601.e7. [PMID: 38061399 PMCID: PMC11096005 DOI: 10.1016/j.arth.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) implants have continued to evolve to accommodate new understandings of knee mechanics. The medial-pivot implant is a newer design, which is intended to limit anterior-posterior translation in the medial compartment while allowing lateral compartment translation. However, evidence for a generalized medial-pivot characteristic across all activities is limited. The purpose of the study was to quantify and compare in vivo knee joint kinematics using high-speed stereo radiography during activities of daily living in patients who have undergone a TKA with a cruciate sacrificing medial-pivot implant to age-matched and sex-matched native controls. METHODS Fifteen participants (7 patients, 4 women, mean age 70 years and 8 nonsymptomatic controls, 4 women, mean age 64 years) performed 6 functional tasks in high-speed stereo radiography: deep-knee lunge, chair rise, step down, gait, gait with 90° turn, and seated knee extension. Translational differences between groups (surgical versus control) were assessed for the medial and lateral condyle, while pivot location was normalized to subject-specific tibial plateau geometry. RESULTS The surgical cohort displayed a more constrained medial condyle that provided greater stability of the medial compartment and did not result in the paradoxical anterior translation at mid-flexion angles during weight-bearing activities, but was associated with less condylar translation than native knees. Additionally, the transverse tibial pivot location occurs most commonly in the middle third of the tibial plateau and secondarily on the medial third. CONCLUSIONS Some variability in pivot location occurs between activities and is more in nonsymptomatic, native knee controls.
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Affiliation(s)
- Landon D Hamilton
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
| | - Kevin B Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
| | - Paul J Rullkoetter
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Erin M Mannen
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Mechanical and Biomedical Engineering, Boise State University, Boise, Idaho
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Patel SK, Buller LT, Deckard ER, Meneghini RM. Survivorship and Patient Outcomes of Conforming Bearings in Modern Primary Total Knee Arthroplasty: Mean 3.5 Year Follow-Up. J Arthroplasty 2024:S0883-5403(24)00435-2. [PMID: 38734325 DOI: 10.1016/j.arth.2024.04.084] [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: 11/07/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The use of conforming and congruent bearings in total knee arthroplasty (TKA) have rapidly increased due to the benefits of increased stability and the potential for replicating normal knee kinematics. However, limited data exist for these newly available bearings. This study evaluated revision-free survivorship and patient-reported outcome measures (PROMs) of a large granular database of primary TKAs using a single conforming bearing design. METHODS A total of 1,306 consecutive primary TKAs performed using a single conforming bearing design (85% cemented and 15% cementless) were retrospectively reviewed. Kaplan-Meier survivorship estimates were calculated based on the latest clinical follow-up. The PROMs and minimal clinically important differences were evaluated. A total of 93% of cases achieved minimum 1-year clinical follow-up (mean 3.5 years; range, 1 to 7), with a subset of 261 cases that achieved minimum 5-year follow-up (mean 5.8 years; range, 5 to 7). RESULTS All-cause and aseptic Kaplan-Meier survivorship estimates were 97.6 (95% CI [confidence interval], 97 to 99) and 98.1% (95% CI, 97 to 99) at 7.0 years. Revision-free survivorship did not differ by cemented or cementless fixation (98 versus 97%, P = .163). All PROM scores significantly improved from preoperative baseline (P < .001), and ≥ 86% of patients achieved minimal clinically important differences for Knee Society pain and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement total scores. A total of 89% of cases reported their knees to 'sometimes or always' feel normal. For cases with minimum 5-year PROMs, 93% were 'very satisfied' or 'satisfied.' CONCLUSIONS Conforming-bearing TKA demonstrated excellent survivorship up to 7.0 years. In addition, PROMs were comparable to other designs reported in the literature. While mid-term (mean 3.5-year) results are promising, long-term data are warranted on survivorship due to potential polyethylene wear in conforming bearings with more surface area in contact with articulating surfaces. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sohum K Patel
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Leonard T Buller
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana Joint Replacement Institute, Indianapolis, Indiana
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Van Oevelen A, Peiffer M, Chevalier A, Victor J, Steenackers G, Audenaert E, Duquesne K. The relation between meniscal dynamics and tibiofemoral kinematics. Sci Rep 2024; 14:8829. [PMID: 38632378 PMCID: PMC11024146 DOI: 10.1038/s41598-024-59265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Over the past 30 years, research on meniscal kinematics has been limited by challenges such as low-resolution imaging and capturing continuous motion from static data. This study aimed to develop a computational knee model that overcomes these limitations and enables the continuous assessment of meniscal dynamics. A high-resolution MRI dataset (n = 11) was acquired in 4 configurations of knee flexion. In each configuration, the menisci were modeled based on the underlying osseous anatomy. Principal Polynomial Shape Analysis (PPSA) was employed for continuous meniscal modeling. Maximal medial anterior horn displacement occurred in 60° of flexion, equaling 6.24 mm posteromedial, while the posterior horn remained relatively stable. At 90° of flexion, the lateral anterior and posterior horn displaced posteromedially, amounting 5.70 mm and 6.51 mm respectively. The maximal observed Average Surface Distance (ASD) equaled 0.70 mm for lateral meniscal modeling in 90° of flexion. Based on our results, a strong relation between meniscal dynamics and tibiofemoral kinematics was confirmed. Expanding on static meniscal modeling and employing PPSA, we derived and validated a standardized and systematic methodological workflow.
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Affiliation(s)
- A Van Oevelen
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Electromechanics, InViLab research group, University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium
| | - M Peiffer
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - A Chevalier
- Cosys-Lab Research Group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium
| | - J Victor
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - G Steenackers
- Department of Electromechanics, InViLab research group, University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium
| | - E Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
- Department of Electromechanics, InViLab research group, University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium.
- Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - K Duquesne
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- imec-VisionLab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
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Cowie RM, Cullum CJ, Collins SN, Jennings LM. The wear and kinematics of two medially stabilised total knee replacement systems. Knee 2024; 47:160-170. [PMID: 38394995 DOI: 10.1016/j.knee.2024.01.004] [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: 07/20/2023] [Revised: 11/16/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Medially stabilised total knee replacement systems aim to provide a more natural feeling knee replacement by providing increased stability through flexion. The aim of this study was to compare the kinematics and wear of two different medially stabilised total knee replacement systems in an experimental simulation study. The Medial Rotation Knee™ system (MRK) is an early medially stabilised knee (>20 years clinical success); the SAIPH® knee system being a more modern and refined, bone conserving evolution of the original design with a larger size range. METHODS Three SAIPH and three MRK total knee replacements (MatOrtho Ltd, UK) were investigated. The study was performed on a knee simulator with load controlled input kinematic conditions (ISO 14243-1). 6 million cycles of simulation were carried out with the wear of the UHMWPE tibial components assessed gravimetrically. The resulting anterior-posterior translation and tibial rotation position was measured throughout the study. RESULTS The mean UHMWPE wear rate was 0.57 ± 0.71 and 1.24 ± 2.0 mm3/million cycles for SAIPH and MRK total knee replacement systems respectively with no significant difference in wear (p = 0.24). Analysis of simulator output kinematics showed a larger range of anterior-posterior motion for SAIPH total knee replacements compared to MRK. The magnitude of tibial rotation was low for both knee replacement systems. CONCLUSION The small magnitude of anterior-posterior displacement and tibial rotation motion demonstrates the inherent stability of this knee system design offered by the constrained medial compartment. This study shows the potential for medially stabilised knee systems as a low polyethylene surface wear solution.
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Affiliation(s)
- Raelene M Cowie
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK.
| | | | | | - Louise M Jennings
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK.
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Banks SA, Catani F, Deckard ER, Mahoney OM, Matsuda S, Meneghini RM, Victor JMK. Total Knee Arthroplasty Kinematics Predict Patient-Reported Outcome Measures: Implications for Clinical Kinematic Examinations. J Arthroplasty 2024:S0883-5403(24)00113-X. [PMID: 38360280 DOI: 10.1016/j.arth.2024.02.014] [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: 11/14/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND A core tenet of total knee arthroplasty (TKA) is that achieving more natural kinematics will lead to superior patient outcomes. Yet this relationship has not been proven for large representative cohorts of TKA patients because accurately measuring 3-dimensional TKA kinematics is time-consuming and expensive. But advanced imaging systems and machine learning-enhanced analysis software will soon make it practical to measure knee kinematics preoperatively and postoperatively in the clinic using radiographic methods. The purpose of this study was to assess the reported relationships between TKA kinematics and outcomes and distill those findings into a proposal for a clinically practical protocol for a clinical kinematic exam. METHODS This study reviewed the recent literature relating TKA kinematics to patient outcomes. There were 10 studies that reported statistical associations between TKA kinematics and patient outcome scores utilizing a range of functional activities. We stratified these activities by the complexity of the radiographic examination to create a proposed examination protocol, and we generated a list of requirements and characteristics for a practical TKA clinical kinematic examination. RESULTS Given considerations for a clinically practical kinematic exam, including equipment, time and other resources, we propose 3 exam levels. With basic radiographs, we suggest studying single-leg stance in extension, lunge or squat, and kneeling. For fluoroscopic systems with X-ray pulses up to 20 ms, we propose chair-rise or stair ascent to provide additional dynamic information. For fluoroscopic systems with X-ray pulses of less than 10 ms, we propose rapid open-chain knee flexion-extension to simulate the highly dynamic swing phase of gait. CONCLUSIONS It is our hope that this proposed examination protocol spurs discussion and debate so that there can be a consensus approach to clinical examination of knee and TKA kinematics when the rapidly advancing hardware and software capabilities are in place to do so.
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Affiliation(s)
- Scott A Banks
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, Florida
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - Ormonde M Mahoney
- Athens Orthopedic Clinic, Athens, Georgia; Department of Orthopedics, Medical College of Georgia, Augusta, Georgia
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Robert M Meneghini
- Indiana Joint Replacement Institute, Indianapolis, Indiana; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jan M K Victor
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Bühl L, Müller S, Nüesch C, Boyer KA, Casto E, Mündermann A, Egloff C. Ambulatory knee biomechanics and muscle activity 2 years after ACL surgery: InternalBrace TM-augmented ACL repair versus ACL reconstruction versus healthy controls. BMC Musculoskelet Disord 2023; 24:785. [PMID: 37794432 PMCID: PMC10548591 DOI: 10.1186/s12891-023-06916-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/24/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Little is known about knee mechanics and muscle control after augmented ACL repair. Our aim was to compare knee biomechanics and leg muscle activity during walking between the legs of patients 2 years after InternalBraceTM-augmented anterior cruciate ligament repair (ACL-IB) and between patients after ACL-IB and ACL reconstruction (ACL-R), and controls. METHODS Twenty-nine ACL-IB, 27 sex- and age-matched ACL-R (hamstring tendon autograft) and 29 matched controls completed an instrumented gait analysis. Knee joint angles, moments, power, and leg muscle activity were compared between the involved and uninvolved leg in ACL-IB (paired t-tests), and between the involved legs in ACL patients and the non-dominant leg in controls (analysis of variance and posthoc Bonferroni tests) using statistical parametric mapping (SPM, P < 0.05). Means and 95% confidence intervals (CI) of differences in discrete parameters (DP; i.e., maximum/minimum) were calculated. RESULTS Significant differences were observed in ACL-IB only in minimum knee flexion angle (DP: 2.4°, CI [-4.4;-0.5]; involved > uninvolved) and maximum knee flexion moment during stance (-0.07Nm/kg, CI [-0.13;-0.00]; involved < uninvolved), and differences between ACL-IB and ACL-R only in maximum knee flexion during swing (DP: 3.6°, CI [0.5;7.0]; ACL-IB > ACL-R). Compared to controls, ACL-IB (SPM: 0-3%GC, P = 0.015; 98-100%, P = 0.016; DP: -6.3 mm, CI [-11.7;-0.8]) and ACL-R (DP: -6.0 mm, CI [-11.4;-0.2]) had lower (maximum) anterior tibia position around heel strike. ACL-R also had lower maximum knee extension moment (DP: -0.13Nm/kg, CI [-0.23;-0.02]) and internal knee rotation moment (SPM: 34-41%GC, P < 0.001; DP: -0.03Nm/kg, CI [-0.06;-0.00]) during stance, and greater maximum semitendinosus activity before heel strike (DP: 11.2%maximum voluntary contraction, CI [0.1;21.3]) than controls. CONCLUSION Our results suggest comparable ambulatory knee function 2 years after ACL-IB and ACL-R, with ACL-IB showing only small differences between legs. However, the differences between both ACL groups and controls suggest that function in the involved leg is not fully recovered and that ACL tear is not only a mechanical disruption but also affects the sensorimotor integrity, which may not be restored after surgery. The trend toward fewer abnormalities in knee moments and semitendinosus muscle function during walking after ACL-IB warrants further investigation and may underscore the importance of preserving the hamstring muscles as ACL agonists. LEVEL OF EVIDENCE Level III, case-control study. TRIAL REGISTRATION clinicaltrials.gov, NCT04429165 (12/06/2020).
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Affiliation(s)
- Linda Bühl
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland.
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland.
| | - Sebastian Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, 4031, Switzerland
| | - Katherine A Boyer
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA, 01655, USA
| | - Erica Casto
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, 4031, Switzerland
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, 4123, Switzerland
- Department of Clinical Research, University of Basel, Basel, 4031, Switzerland
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Seidi F, Izadi M, Thomas AC, Bellafiore M. Lower limb muscle activation pattern in male soccer players with lumbar hyperlordosis. J Bodyw Mov Ther 2023; 36:263-269. [PMID: 37949570 DOI: 10.1016/j.jbmt.2023.03.004] [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] [Received: 01/27/2022] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE the aim of the current study was to compare the lower limb muscle activation pattern in soccer players with and without lumbar hyperlordosis during single-leg squat performance. METHODS thirty male collegiate soccer players (15 with and 15 without lumbar hyperlordosis) performed the SLS task. Surface EMG was used to record the activation of eleven lower limb muscles. The activation of these muscles reduces to 100 points during the SLS cycle, where 50% demonstrates the maximum knee flexion, and 0% and 99% demonstrate the maximum knee extension. RESULTS soccer players with lumbar hyperlordosis had higher muscle activation than those with normal lumbar lordosis in gluteus maximus, biceps femoris, and medial gastrocnemius. By contrast, they had lower gluteus medius, vastus medialis oblique, rectus femoris, soleus, and medial gastrocnemius (only in the final ascent phase of the SLS) muscle activity than the normal group during the SLS. CONCLUSION this alteration may negatively affect targeted muscle performance during the SLS. Subsequent study is required to specify whether such an alteration in the lower limb muscle could be accompanied by injury in soccer players and change in their athletic performance.
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Affiliation(s)
- Foad Seidi
- Department of Health and Sports Medicine, Faculty of Physical Education and Sport Science, University of Tehran, Iran
| | - Mohammad Izadi
- Department of Health and Sports Medicine, Faculty of Physical Education and Sport Science, University of Tehran, Iran; Sport and Exercise Research Unit, Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy.
| | - Abbey C Thomas
- Department of Kinesiology at University of North Carolina at Charlotte, USA
| | - Marianna Bellafiore
- Sport and Exercise Research Unit, Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
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Buzzatti L, Keelson B, van der Voort JW, Segato L, Scheerlinck T, Héréus S, Van Gompel G, Vandemeulebroucke J, De Mey J, Buls N, Cattrysse E, Serrien B. Dynamic CT scanning of the knee: Combining weight bearing with real-time motion acquisition. Knee 2023; 44:130-141. [PMID: 37597475 DOI: 10.1016/j.knee.2023.07.014] [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: 07/27/2022] [Revised: 06/14/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Imaging the lower limb during weight-bearing conditions is essential to acquire advanced functional joint information. The horizontal bed position of CT systems however hinders this process. The purpose of this study was to validate and test a device to simulate realistic knee weight-bearing motion in a horizontal position during dynamic CT acquisition and process the acquired images. METHODS "Orthostatic squats" was compared to "Horizontal squats" on a device with loads between 35% and 55% of the body weight (%BW) in 20 healthy volunteers. Intraclass Correlation Coefficient (ICC), and standard error of measurement (SEM), were computed as measures of the reliability of curve kinematic and surface EMG (sEMG) data. Afterwards, the device was tested during dynamic CT acquisitions on three healthy volunteers and three patients with patellofemoral pain syndrome. The respective images were processed to extract Tibial-Tuberosity Trochlear-Groove distance, Bisect Offset and Lateral Patellar Tilt metrics. RESULTS For sEMG, the highest average ICCs (SEM) of 0.80 (6.9), was found for the load corresponding to 42%BW. Kinematic analysis showed ICCs were the highest for loads of 42%BW during the eccentric phase (0.79-0.87) and from maximum flexion back to 20° (0.76). The device proved to be safe and reliable during the acquisition of dynamic CT images and the three metrics were computed, showing preliminary differences between healthy and pathological participants. CONCLUSIONS This device could simulate orthostatic squats in a horizontal position with good reliability. It also successfully provided dynamic CT scan images and kinematic parameters of healthy and pathological knees during weight-bearing movement.
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Affiliation(s)
- Luca Buzzatti
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium; School of Allied Health, Anglia Ruskin University (ARU), Young Street, CB1 1PT Cambridge, UK.
| | - Benyameen Keelson
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, 1050 Brussel, Belgium; imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - Joris Willem van der Voort
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Lorenzo Segato
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy
| | - Thierry Scheerlinck
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Orthopaedic Surgery and Traumatology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Savanah Héréus
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Gert Van Gompel
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Jef Vandemeulebroucke
- Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, 1050 Brussel, Belgium; imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - Johan De Mey
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Nico Buls
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erik Cattrysse
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Ben Serrien
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
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Fitzsimons M, van der Stok J, Queally JM, O'Donnell T. Fixed-Bearing Unicompartmental Knee Arthroplasty of the Lateral Compartment: A Series of 246 Cases. Arthroplast Today 2023; 23:101183. [PMID: 37731595 PMCID: PMC10507187 DOI: 10.1016/j.artd.2023.101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 06/07/2023] [Accepted: 07/02/2023] [Indexed: 09/22/2023] Open
Abstract
Background Isolated osteoarthritis of the lateral compartment of the knee is less common than that of the medial compartment, resulting in significantly fewer lateral unicompartmental knee arthroplasties (UKAs) being performed. This study aimed to evaluate results of a fixed-bearing UKA for the treatment of lateral compartment osteoarthritis of the knee. Methods A prospectively collected cohort of 255 patients undergoing fixed-bearing UKA of the lateral compartment using the Triathlon PKR (Stryker, Warsaw, IND) implant with a minimum 2-year follow-up was reviewed. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, radiographic alignment, complications, reoperations, and revisions were recorded. Patient factors and pre- and post-surgical alignment were assessed for their association with a minimum important change (MIC) of the total WOMAC score. Results A total of 246 implants with a mean follow-up of 6.6 years (2-10.8 years) were included (4% lost to follow-up). The total WOMAC score increased from 61.3 ± 3.5 to 85.3 ± 7.5, exceeding the MIC in 215 patients (88%). Exceeding the MIC was not associated with age, body mass index, or alignment. The 5-year implant revision rate was 1.6% (3/187). Conclusions The fixed-bearing Stryker Triathlon PKR implant for lateral UKA resulted in good clinical outcomes with a low revision rate at midterm follow-up. Body mass index, age, and pre- and post-surgical alignment did not correlate with the clinical outcome. Long-term follow-up is necessary to determine if the clinical improvement and low revision rate can be maintained.
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Affiliation(s)
| | | | | | - Turlough O'Donnell
- The Centre for Orthopaedics, Beacon Hospital, Dublin, Ireland
- UCD School of Medicine, University College Dublin, Dublin, Ireland
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10
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Delman CM, Ridenour D, Howell SM, Hull ML. The posterolateral upslope of a low-conforming insert blocks the medial pivot during a deep knee bend in TKA: a comparative analysis of two implants with different insert conformities. Knee Surg Sports Traumatol Arthrosc 2023; 31:3627-3636. [PMID: 34350484 DOI: 10.1007/s00167-021-06668-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Tibial insert conformity in total knee arthroplasty (TKA) is of interest due to the potential effect on tibiofemoral kinematics. This study determined differences in anterior-posterior movements of the femoral condyles, pivot locations, and internal tibial rotation in different arcs of flexion for two implants with different insert conformities in kinematically aligned TKA. METHODS Twenty-five patients treated with a medial and lateral low-conforming, posterior cruciate ligament (PCL) retaining (LC CR) implant followed by a medial ball-in-socket and flat, lateral PCL sacrificing (B-in-S CS) implant in the contralateral knee underwent single-plane fluoroscopy during a deep knee bend. Analysis following 3D-to-2D image registration determined tibiofemoral kinematics and patients completed validated outcome scores for both knees. RESULTS The mean follow-up of 1.6 ± 0.4 years for the knee with the B-in-S CS implant was shorter than the 2.7 ± 1.2 years for the LC CR implant. From 0º to 30º of flexion, a medial pivot occurred with the tibia rotating internally approximately 5º with both implants. From 30º to 90º, the pivot remained medial and internal rotation increased to 10º with the B-in-S CS implant. In contrast, neither femoral condyle moved more than 1 mm with the LC CR implant from 30º to 60º, but from 60º to 90º degrees, a lateral pivot occurred and internal rotation increased. Internal rotation of the tibia on the femur from 0° to maximum flexion occurred about a medial pivot similar to the native knee for the B-in-S CS implant and was 4.5° greater than that of the LC CR implant (10.4° vs 5.9°). There was no difference in the median patient-reported outcome scores between implant designs. CONCLUSIONS Tibial insert conformity is a primary determinant of a medial or lateral pivot during a deep knee bend. One explanation for the transition from a medial to lateral pivot between 30º and 60º with the LC CR implant is the chock-block effect of the insert's posterolateral upslope which impedes posterior movement of the lateral femoral condyle. Because there is no posterolateral upslope in the insert of the B-in-S CS implant, the tibia pivots medially throughout flexion similar to the native knee. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Connor M Delman
- Department of Orthopaedic Surgery, UC Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA.
| | - Delaney Ridenour
- Department of Biomedical Engineering, University of California Davis, One Shields Avenue, Davis, CA, 95616, USA
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California Davis, Davis, CA, 95616, USA
| | - Maury L Hull
- Department of Biomedical Engineering, Department of Mechanical Engineering, Department of Orthopaedic Surgery, UC Davis Medical Center, 4860 Y Street, Suite 3800, Sacramento, CA, 95817, USA
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11
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Kothurkar R, Lekurwale R, Gad M, Rathod CM. Finite element analysis of a healthy knee joint at deep squatting for the study of tibiofemoral and patellofemoral contact. J Orthop 2023; 40:7-16. [PMID: 37143926 PMCID: PMC10151221 DOI: 10.1016/j.jor.2023.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023] Open
Abstract
Background In non-western countries, deep squatting is a daily activity, and prolonged deep squatting is common among occupational squatters. Household tasks, taking a bath, socializing, using toilets, and performing religious acts are among the activities frequently carried out while squatting by the Asian population. High knee loading is responsible for a knee injury and osteoarthritis. Finite element analysis is an effective tool to determine stresses on the knee joint. Methods Magnetic Resonance Imaging (MRI) and Computed Tomographic (CT) images were acquired of one adult without knee injuries. The CT images were acquired at the fully extended knee and one more set of images was acquired with the knee at a deeply flexed knee position. The MRI was acquired with the fully extended knee. 3-Dimensional models of bones were created using CT and soft tissue using MRI with the help of 3D Slicer software. Kinematics and finite element analysis of the knee was performed for standing and deep squatting posture using Ansys Workbench 2022. Results High peak stresses were observed at deep squatting compared to standing along with the reduction in the contact area. Peak von Mises stresses on femoral cartilage, tibial cartilage, patellar cartilage, and meniscus were increased from 3.3 MPa to 19.9 MPa, 2.9 MPa to 12.4 MPa, 1.5 MPa to 16.7 MPa and 15.8 MPa to 32.8 MPa respectively during deep squatting. Posterior translation of 7.01 mm, and 12.58 mm was observed for medial and lateral femoral condyle respectively from full extension to 153° knee flexion. Conclusions Increased stresses in the knee joint at deep squat posture may cause cartilage damage. A sustained deep squat posture should be avoided for healthy knee joints. More posterior translations of the medial femoral condyle at higher knee flexion angle warrant further investigation.
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Affiliation(s)
- Rohan Kothurkar
- Department of Mechanical Engineering, K. J. Somaiya College of Engineering, Mumbai, India
| | - Ramesh Lekurwale
- Department of Mechanical Engineering, K. J. Somaiya College of Engineering, Mumbai, India
| | - Mayuri Gad
- St. Xavier's Gait Lab, Xavier Institute of Engineering, Mumbai, India
| | - Chasanal M. Rathod
- St. Xavier's Gait Lab, Xavier Institute of Engineering, Mumbai, India
- Department of Orthopaedics, SRCC Children's Hospital, Haji Ali, Mumbai, India
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12
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Park S, Lim W. Comparison of muscle activity of hamstrings as knee flexors and hip extensors and effect of tibial and hip rotation on the contribution of hamstrings. J Bodyw Mov Ther 2023; 34:1-5. [PMID: 37301549 DOI: 10.1016/j.jbmt.2023.04.029] [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] [Received: 09/22/2021] [Revised: 01/25/2023] [Accepted: 04/11/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Limited studies have compared the muscle activity of the medial and lateral hamstrings as knee flexors with tibial internal and external rotation and hip extensors with hip internal and external rotation. In particular, hamstring activity during hip extension with hip rotation has rarely been investigated. OBJECTIVE This study aimed to compare the muscle activity of the medial and lateral hamstrings as knee flexors and hip extensors and to compare the activity of these muscles according to tibial rotation during isometric knee flexion and hip rotation during isometric hip extension. METHODS A total of 23 healthy adults participated in the study. The electromyographic (EMG) activity of the hamstrings was measured during maximal isometric knee flexion and maximal isometric hip extension. In addition, tibial rotation was applied actively during maximal isometric knee flexion, whereas hip rotation was applied actively during maximal isometric hip extension. RESULTS EMG activity during maximal isometric knee flexion with tibial internal and external rotation was significantly higher than that during maximal isometric hip extension with hip internal and external rotation, respectively. For EMG activity according to tibial and hip rotation, there was no significant difference between tibial internal and external rotation during maximal isometric knee flexion, whereas there was a significant difference between hip internal and external rotation during maximal isometric hip extension. CONCLUSION Hamstring activity was higher for knee flexors than for hip extensors. However, hip rotation during maximal isometric hip extension is an effective intervention for selective muscle activation of the medial and lateral hamstrings.
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Affiliation(s)
- Sieun Park
- Department of Physical Therapy, Gumi University, Gumi, Republic of Korea
| | - Wootaek Lim
- Department of Physical Therapy, College of Health and Welfare, Woosong University, Daejeon, Republic of Korea; Woosong Institute of Rehabilitation Science, Daejeon, Republic of Korea.
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13
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Griffith JF, Leung CTP, Lee JCH, Leung JCS, Yeung DKW, Yung PSH. Positional MR imaging of normal and injured knees. Eur Radiol 2023; 33:1553-1564. [PMID: 36348091 DOI: 10.1007/s00330-022-09198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/10/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study uses a practical positional MRI protocol to evaluate tibiofemoral translation and rotation in normal and injured knees. METHODS Following ethics approval, positional knee MRI of both knees was performed at 35° flexion, extension, and hyperextension in 34 normal subjects (mean age 31.1 ± 10 years) and 51 knee injury patients (mean age 36.4 ± 11.5 years, ACL tear n = 23, non-ACL injury n = 28). At each position, tibiofemoral translation and rotation were measured. RESULTS Normal knees showed 8.1 ± 3.3° external tibial rotation (i.e., compatible with physiological screw home mechanism) in hyperextension. The unaffected knee of ACL tear patients showed increased tibial anterior translation laterally (p = 0.005) and decreased external rotation (p = 0.002) in hyperextension compared to normal knees. ACL-tear knees had increased tibial anterior translation laterally (p < 0.001) and decreased external rotation (p < 0.001) compared to normal knees. Applying normal thresholds, fifteen (65%) of 23 ACL knees had excessive tibial anterior translation laterally while 17 (74%) had limited external rotation. None (0%) of 28 non-ACL-injured knees had excessive tibial anterior translation laterally while 13 (46%) had limited external rotation. Multidirectional malalignment was much more common in ACL-tear knees. CONCLUSIONS Positional MRI shows (a) physiological tibiofemoral movement in normal knees, (b) aberrant tibiofemoral alignment in the unaffected knee of ACL tear patients, and (c) a high frequency of abnormal tibiofemoral malalignment in injured knees which was more frequent, more pronounced, more multidirectional, and of a different pattern in ACL-tear knees than non-ACL-injured knees. KEY POINTS • Positional MRI shows physiological tibiofemoral translation and rotation in normal knees. • Positional MRI shows a different pattern of tibiofemoral alignment in the unaffected knee of ACL tear patients compared to normal control knees. • Positional MRI shows a high prevalence of abnormal tibiofemoral alignment in injured knees, which is more frequent and pronounced in ACL-tear knees than in ACL-intact injured knees.
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Affiliation(s)
- James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.
| | - Cynthia T P Leung
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Jeremiah C H Lee
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C S Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China
| | - David K W Yeung
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick S H Yung
- Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
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14
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Larger Medial Contact Area and More Anterior Contact Position in Medial-Pivot than Posterior-Stabilized Total Knee Arthroplasty during In-Vivo Lunge Activity. Bioengineering (Basel) 2023; 10:bioengineering10030290. [PMID: 36978681 PMCID: PMC10045283 DOI: 10.3390/bioengineering10030290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
This study aimed to compare the in-vivo kinematics and articular contact status between medial-pivot total knee arthroplasty (MP-TKA) and posterior stabilized (PS) TKA during weight-bearing single-leg lunge. 16 MP-TKA and 12 PS-TKA patients performed bilateral single-leg lunges under dual fluoroscopy surveillance to determine the in-vivo six degrees-of-freedom knee kinematics. The closest point between the surface models of the femoral condyle and the polyethylene insert was used to determine the contact position and area. The nonparametric statistics analysis was performed to test the symmetry of the kinematics between MP-TKA and PS-TKA. PS-TKA demonstrated a significantly greater range of AP translation than MP-TKA during high flexion (p = 0.0002). Both groups showed a significantly greater range of lateral compartment posterior translation with medial pivot rotation. The contact points of PS-TKA were located significantly more posterior than MP-TKA in both medial (10°–100°) and lateral (5°–40°, 55°–100°) compartments (p < 0.0500). MP-TKA had a significantly larger contact area in the medial compartment than in the lateral compartment. In contrast, no significant differences were observed in PS-TKA. The present study revealed no significant differences in clinical outcomes between the MP and PS groups. The PS-TKA demonstrated significantly more posterior translations than MP-TKA at high flexion. The contact points are located more posteriorly in PS-TKA compared with MP-TKA. A larger contact area and medial pivot pattern during high flexion in MP-TKA indicated that MP-TKA provides enhanced medial pivot rotation.
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15
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Image-based robotic unicompartmental knee arthroplasty allowed to match the rotation of the tibial implant with the native kinematic knee alignment. INTERNATIONAL ORTHOPAEDICS 2023; 47:519-526. [PMID: 36422703 DOI: 10.1007/s00264-022-05637-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Image-based robotic tools improve the accuracy of unicompartmental knee arthroplasty (UKA) positioning, but few studies have examined its effect on axial alignment. The aim of this study was to compare the characteristics of tibial and femoral implant positioning, mainly the tibial rotation, during medial or lateral UKA, performed with an image-based robotic assisted system. METHODS A total of 71 UKA performed between September 2021 and June 2022 (53 medial and 18 lateral) were analyzed. All data regarding implant positioning (rotation, coronal and sagittal alignment) for tibial and femoral components were obtained using MAKO® software (Stryker®, Mahwah, USA) intra-operatively. RESULTS The lateral UKA had a mean internal tibial rotation of 15.4 ± 3°, a mean external femoral rotation of 0.96 ± 2.4°, and a mean tibial slope of 4.7 ± 1.3°. The medial UKA had a mean internal tibial rotation of 0.18 ± 2.7°, a mean internal femoral rotation of 0.35 ± 2.2°, and a mean tibial slope of 5.4 ± 1.3°. The tibial rotations, femoral valgus, tibial varus and tibial size significantly differed between medial and lateral UKA (p < 0.05). There was no significant difference in femoral rotation, flexion, femoral size, slope, and polyethylene thickness between medial and lateral UKA. CONCLUSION Medial and lateral UKA had significantly different implantation characteristics related to the biomechanics of the knee compartments. Image-based robotic UKA allowed precise femorotibial positioning per-operatively to match native kinematic alignment.
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16
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Posterior subtotal meniscectomy revealed the worst scenario for the progression of osteocartilaginous damage in cases of juvenile discoid lateral meniscus with peripheral tear. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04747-0. [PMID: 36595029 DOI: 10.1007/s00402-022-04747-0] [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: 09/02/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION We compared subtotal meniscectomy and saucerization with stabilization for osteocartilaginous damage based on injured location and further examined the factors related to osteocartilaginous damage in juvenile discoid lateral meniscus (DLM) with peripheral tear after a follow-up period of at least 5 years. MATERIALS AND METHODS We retrospectively reviewed juvenile DLM patients with peripheral tear who underwent arthroscopic surgery with more than 5 years of follow-up. Osteocartilaginous damage, which was identified by osteochondritis dissecans (OCD) development and the whole-organ magnetic resonance imaging score (WORMS) of cartilage grade ≥ 3, was compared between subtotal meniscectomy and saucerization with stabilization. A subgroup analysis examining the location of the tear site was performed. Factors for osteocartilaginous damage were analyzed between the damaged and non-damaged groups. RESULTS Forty-one patients, including 29 who underwent saucerization with stabilization and 12 who underwent subtotal meniscectomy, were included in this study. Seven patients developed OCD lesions; six patients showed cartilage WORMS of more than grade 3. Overall, there was a significant difference in the total cartilage and meniscus WORMS between the two groups at the final follow-up. The subgroup analysis demonstrated more severe osteocartilaginous damage developed in posterior subtotal meniscectomy than in posterior stabilization following saucerization. The damaged group showed significant difference compared to the non-damaged group in terms of age (p = 0.003), sex (p = 0.036), and posterior subtotal meniscectomy (p < 0.001). CONCLUSIONS Posterior subtotal meniscectomy revealed the worst scenario for the progression of osteocartilaginous damage in cases of juvenile DLM with peripheral tear over a minimum follow-up period of 5 years.
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Kinoshita T, Hino K, Kutsuna T, Watamori K, Miura H. Rotational Soft-Tissue Balance Is Highly Correlated with Rotational Kinematics in Total Knee Arthroplasty. J Knee Surg 2023; 36:47-53. [PMID: 33992034 DOI: 10.1055/s-0041-1729619] [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
Recovery of normal knee kinematics is critical for improving functional outcomes and patient satisfaction after total knee arthroplasty (TKA). The kinematics pattern after TKA varies from case to case, and it remains unclear how to reproduce normal knee kinematics. The present study aimed to evaluate rotational knee kinematics and soft-tissue balance using a navigation system and to assess the influence of intraoperative soft-tissue balance on the rotational knee kinematics. We evaluated 81 osteoarthritic knees treated with TKA using a posterior stabilized (50 knees) or cruciate retaining (31 knees) prosthesis. Rotational kinematics were assessed at 0, 30, 45, 60, and 90 degrees flexion angles by using a computer-assisted navigation system. Correlation between femorotibial rotational position and measured soft tissue balance was assessed by using Spearman's rank correlation coefficient. Rotational soft-tissue balance (the median angle of rotational stress) was significantly correlated with rotational kinematics (rotational axis of the femur relative to the tibia throughout the range of motion) at all measured angles after TKA. The correlation coefficients between the median angle of rotational stress and rotational kinematics were 0.97, 0.80, 0.74, 0.71, and 0.70 at 0, 30, 45, 60, and 90 degrees of flexion, respectively (p-values <0.0001 in all measured angles). The correlation coefficient increased as the knee approached full extension. Our findings suggest that soft-tissue balance is a key factor for rotational kinematics, following both cruciate-retaining and posterior-stabilized TKA.
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Affiliation(s)
- Tomofumi Kinoshita
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kazunori Hino
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Tatsuhiko Kutsuna
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Kunihiko Watamori
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hiromasa Miura
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
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Wittig U, Moshammer M, Vielgut I, Hauer G, Reinbacher P, Leithner A, Sadoghi P. Higher use of fixed-bearing over mobile-bearing and posterior-stabilized over medial pivot designs in total knee arthroplasty (TKA): a systematic comparative analysis using worldwide arthroplasty registers from England and Wales, Australia, Norway, New Zealand, Germany and Switzerland. Arch Orthop Trauma Surg 2023; 143:1021-1029. [PMID: 35303145 PMCID: PMC9925559 DOI: 10.1007/s00402-022-04410-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 02/27/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to compare the use of mobile-bearing, fixed-bearing, posterior-stabilized (PS) and medial pivot design to describe epidemiological differences and subsequent outcomes. MATERIALS AND METHODS A systematic literature search was performed using the NORE website to identify the relevant arthroplasty registers. Inclusion criteria were the following: (1) reports had to be publicly available, (2) reports had to be written in German or English language, (3) differentiation between mobile- and fixed-bearing, posterior-stabilized, and if possible, medial pivot designs had to be possible from the present reports, and (4) data had to be reported for at least three consecutive years and the latest report had to be from the year 2020 to retrieve recent data. RESULTS Six registries (England and Wales, Australia, Norway, New Zealand, Germany, Switzerland) offered sufficient data according to the inclusion criteria. In all countries, the dominant type of bearing used for total knee arthroplasty (TKA) was fixed-bearing, with percentages ranging from 60.8% to 84.1% in 2018, 63.6% to 85.7% in 2019 and 66.2% to 87.4% in 2020. A large variation was observed concerning mobile-bearing design, which showed a range from 2.8% to 39.2% in 2018, 2.6% to 36.4% in 2019 and 2.9% to 33.8% in 2020. Some variation was found regarding the use of PS TKA, as its percentage frequency ranged from 9.7% to 29.2% in 2018, 9.8% to 29.4% in 2019 and 10.1% to 28.5% in 2020. Medial pivot design had a share of 9.1% in 2018, 8.6% in 2019 and 8.4% in 2020 in Australia, while it only accounted for 1.4% in 2018, 2.1% in 2019 and 2.5% in 2020 in Germany. CONCLUSION The comparison of arthroplasty registers from England and Wales, Australia, Norway, New Zealand, Germany and Switzerland revealed large differences regarding the application of posterior-stabilized designs, but also common ground considering the overwhelming use of fixed-bearing inserts, which, when inserted correctly, eradicate the potential complication of bearing dislocation. Arthroplasty registers offer a real-world clinical perspective with the aim to improve quality and patient safety.
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Affiliation(s)
- Ulrike Wittig
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
| | - Maximilian Moshammer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
| | - Ines Vielgut
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
| | - Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria.
| | - Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5a, Graz, Austria
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Kim J, Park JH, Park JH, Son DW, Ahn JH. Prospective sequential comparison of femoral roll-back between cruciate-retaining and posterior-stabilized total knee arthroplasty using an intra-operative sensor. Knee 2022; 39:253-260. [PMID: 36283283 DOI: 10.1016/j.knee.2022.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/06/2022] [Accepted: 09/21/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Implant design and surgical techniques affect postoperative knee kinematics in total knee arthroplasty (TKA). This study aimed to compare femoral roll-back between cruciate-retaining (CR) and posterior-stabilized (PS) TKA in the same knee by objectively quantifying the contact point kinematics of the tibiofemoral joint using a sensor. METHODS In the present prospective study, we used an intraoperative sensor to compare medial and lateral roll-back during 0-120° knee flexion in 33 knees that underwent CR and PS TKA. We also examined the relationship between mediolateral balance and the lateral-to-medial roll-back ratio. We defined the contact percentage position as the vertical length to the contact point divided by the anteroposterior length of the tibial plate. RESULTS The roll-back percentage following PS TKA (19.8 ± 5.1%) was significantly higher than that after CR TKA in both the medial (19.8 ± 5.1% versus 7.1 ± 2.5%, P < 0.001) and lateral (26.8% ± 3.8% versus 18.7 ± 3.8%, P < 0.001) compartments. The medial contact pressure at 90° was significantly correlated with the increased lateral-to-medial roll-back ratio in both CR and PS TKA (both P < 0.001). CONCLUSION PS TKA resulted in a higher percentage of femoral roll-back in the medial and lateral compartments than CR TKA. CR TKA caused a higher lateral-to-medial roll-back ratio compared to PS TKA. To reproduce medial pivot knee motion similar to that of a normal knee, the medial soft tissue needed to be balanced more tightly than the lateral soft tissue during TKA. These findings provide some clinical evidence of TKA design selection and proper mediolateral balancing for successful TKA.
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Affiliation(s)
- Jaehyun Kim
- Department of Orthopedic Surgery, Moocheok Joeun Hospital, Paju, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jun Hyoung Park
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong-Wook Son
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Ji Hyun Ahn
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea.
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Postolka B, Taylor WR, Dätwyler K, Heller MO, List R, Schütz P. Interpretation of natural tibio-femoral kinematics critically depends upon the kinematic analysis approach: A survey and comparison of methodologies. J Biomech 2022; 144:111306. [DOI: 10.1016/j.jbiomech.2022.111306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/19/2022] [Accepted: 09/12/2022] [Indexed: 10/31/2022]
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Haberkamp LD, Garcia MC, Bazett-Jones DM. Validity of an artificial intelligence, human pose estimation model for measuring single-leg squat kinematics. J Biomech 2022; 144:111333. [DOI: 10.1016/j.jbiomech.2022.111333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/08/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022]
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22
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Li JS, Tsai TY, Clancy MM, Lewis CL, Felson DT, Li G. Cartilage contact characteristics of the knee during gait in individuals with obesity. J Orthop Res 2022; 40:2480-2487. [PMID: 35076128 PMCID: PMC9309196 DOI: 10.1002/jor.25288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
Obesity increases the risk of knee osteoarthritis (OA). Knee joint contact characteristics have been thought to provide insights into the pathogenesis of knee OA; however, the cartilage contact characteristics in individuals with obesity have not been fully described. We conducted cartilage-to-cartilage contact analyses through high-precision fluoroscopy imaging with subject-specific magnetic resonance cartilage models. Twenty-five individuals with obesity were recruited for this study, and previously published data consisted of eight nonobese individuals who were used as the comparator group. In both groups, knees were imaged by a dual fluoroscopic imaging system during treadmill walking, and the tibiofemoral cartilage contact locations were analyzed and described on the tibial plateau in the medial-lateral (ML) and anterior-posterior (AP) directions and on femoral condyle surfaces using contact angles in the sagittal plane and deviation angles in a plane perpendicular to the sagittal plane. On the medial tibial plateau, the ML contact locations in the individuals with obesity were located more medially than in the nonobese group throughout the stance phase. The medial plateau AP contact locations in individuals with obesity showed a different pattern compared with the nonobese group. The ML contact excursions on the medial plateau in the individuals with obesity were larger than in the nonobese group. These findings suggest that obesity affects the contact location mainly in the medial compartment, which explains, in part, the high prevalence of medial knee OA in the obese population.
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Affiliation(s)
- Jing-Sheng Li
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Margaret M. Clancy
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Cara L. Lewis
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts, USA
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David T. Felson
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Guoan Li
- Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, Newton, Massachusetts, USA
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Zeng X, Zhong G, Xie Z, Jiang Y, Chen W, Zhou Z, Ma L, Yang T, Huang W, Zhang Y. Upslope walking increases anterior tibial translation deficiency in patients with generalized joint hypermobility. Gait Posture 2022; 98:9-16. [PMID: 36027736 DOI: 10.1016/j.gaitpost.2022.08.010] [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: 03/17/2022] [Revised: 07/22/2022] [Accepted: 08/13/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Generalized joint hypermobility (GJH) is a highly prevalent disease that frequently affects the knee joint. The current literature has conflicting results about whether patients with GJH had knee kinematics deficiency during gait. This could be because most of the testing environment (level walking) was gentle and low-demanding for patients when studying their knee kinematics. With a high-demanding knee function and sagittal firm structure requirement, upslope walking was thought to stimulate sagittal knee kinematics deficiency in patients with GJH. RESEARCH QUESTIONS However, only little investigation reported whether upslope walking could stimulate knee kinematic deficiency or not. We hypothesize that upslope walking can increase sagittal knee kinematic deficiency between GJH subjects and healthy controls. METHODS A three-dimensional motion analysis was conducted to explore whether upslope walking could stimulate sagittal knee kinematic deficiency in patients with GJH. A total of 44 patients with GJH and 44 healthy controls were recruited. Subjects walked on both level and upslope (15%) conditions when the kinematic data were collected. SPM1D analysis was taken to explore the differences between groups. RESULTS Our results showed that upslope walking could significantly increase knee flexion angle and anterior tibial translation in both GJH patients and healthy controls (p < 0.05). The increments of anterior tibial translation (values in upslope walking minus values in level walking) of GJH patients were greater than those of healthy controls (magnitude varying from 2.5 to 2.9 mm during 0-3% gait cycles (GC), p = 0.034; 1.4-2.9 mm during 93-100%GC, p = 0.012). SIGNIFICANCES The findings partially confirmed our hypothesis and suggested that upslope walking could increase anterior tibial translation deficiency in patients with GJH. Upslope walking may be a practical motion task in studying the weakness of knee kinematics of GJH subjects for researchers and scholars. Patients with GJH may face a more challenging knee kinematic environment than healthy controls in up-sloped activities.
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Affiliation(s)
- Xiaolong Zeng
- School of medicine, South China University of Technology, Guangzhou 510006, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China
| | - Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China; Shantou University Medical College, Shantou 515041, China
| | - Zhenyan Xie
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China; Shantou University Medical College, Shantou 515041, China
| | - Yuxuan Jiang
- Shantou University Medical College, Shantou 515041, China
| | - Wentao Chen
- Shantou University Medical College, Shantou 515041, China
| | - Zhongming Zhou
- Shantou University Medical College, Shantou 515041, China
| | - Limin Ma
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China
| | - Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China.
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China.
| | - Yu Zhang
- School of medicine, South China University of Technology, Guangzhou 510006, China; Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong, China.
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Worlicek M, Schaumburger J, Springorum R, Maderbacher G, Zeman F, Grifka J, Baier C. In vivo knee kinematics of an innovative prosthesis design. Open Med (Wars) 2022; 17:1318-1324. [PMID: 35937001 PMCID: PMC9307144 DOI: 10.1515/med-2022-0518] [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: 03/24/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022] Open
Abstract
Up to 20% of patients after total knee arthroplasty (TKA) are not satisfied with the result. Several designs of new implants try to rebuild natural knee kinematics. We hypothesized that an innovative implant design leads to better results concerning femoral rollback compared to an established implant design. For this pilot study, 21 patients were examined during TKA, receiving either an innovative (ATTUNETM Knee System (DePuy Inc.), n = 10) or an established (PFCTM (DePuy Inc.), n = 11) knee system. All patients underwent computer navigation. Knee kinematics was assessed after implantation. Outcome measure was anterior–posterior translation between femur and tibia. We were able to demonstrate a significantly higher femoral rollback in the innovative implant group (p < 0.001). The mean rollback of the innovative system was 11.00 mm (95%-confidence interval [CI], 10.77–11.24), of the established system 8.12 mm (95%-CI, 7.84–8.42). This study revealed a significantly increased lateral as well as medial femoral rollback of knees with the innovative prosthesis design. Our intraoperative finding needs to be confirmed using fluoroscopic or radiographic three-dimensional matching under full-weight-bearing conditions after complete recovery from surgery.
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Affiliation(s)
- Michael Worlicek
- Department of Orthopaedic Surgery, University of Regensburg , Regensburg , Germany
| | - Jens Schaumburger
- Department of Orthopaedic Surgery, University of Regensburg , Regensburg , Germany
| | - Robert Springorum
- Department of Orthopaedic Surgery, University of Regensburg , Regensburg , Germany
| | - Guenther Maderbacher
- Department of Orthopaedic Surgery, University of Regensburg , Regensburg , Germany
| | - Florian Zeman
- Department of Orthopaedic Surgery, University of Regensburg, Centre for Clinical Studies , Regensburg , Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, University of Regensburg , Regensburg , Germany
| | - Clemens Baier
- Department of Orthopaedic Surgery, University of Regensburg , Regensburg , Germany
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Dreyer MJ, Trepczynski A, Hosseini Nasab SH, Kutzner I, Schütz P, Weisse B, Dymke J, Postolka B, Moewis P, Bergmann G, Duda GN, Taylor WR, Damm P, Smith CR. Standardized Tibio-Femoral Implant Loads and Kinematics. J Biomech 2022; 141:111171. [DOI: 10.1016/j.jbiomech.2022.111171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/10/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
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Borque KA, Jones M, Cohen M, Johnson D, Williams A. Evidence-based rationale for treatment of meniscal lesions in athletes. Knee Surg Sports Traumatol Arthrosc 2022; 30:1511-1519. [PMID: 34415368 DOI: 10.1007/s00167-021-06694-6] [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: 04/08/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022]
Abstract
Meniscal injuries in elite athletes are a common cause of missed game time and even have the potential to be career shortening. In this patient group, care must be paid not only to the pathology, but also to a player's contract status, time in the season, specific demands of his/her sport and position on the field, and future consequences. Successful treatment requires the clinician to understand the player's goals and needs, communicate effectively between all stakeholders, and a have knowledge of the challenges posed by the different types of meniscal tear seen in this population. Paramount is the distinction between injuries to the medial and lateral meniscus. Deficiency of the lateral meniscus, as a result of a tear or a meniscectomy, leads to frequent early problems and inexorably to chondral degeneration thereby affecting an athlete's ability to perform. Therefore, it is strongly recommended to repair the majority of lateral meniscal tears. Medial meniscal tears pose a more challenging treatment dilemma, as the success of partial meniscectomy in achieving reproducible, early return to play must be balanced against the long-term degenerative consequences. Many meniscal tears are correctly treated non-operatively.Level of evidence V.
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Affiliation(s)
- Kyle A Borque
- Houston Methodist Orthopedics and Sports Medicine, Houston, USA
| | | | - Moises Cohen
- Departamento de Ortopedia e Traumatologia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Darren Johnson
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
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Walker PS, Borukhov I, LiArno S. Obtaining anatomic motion and laxity characteristics in a total knee design. Knee 2022; 35:133-141. [PMID: 35313242 DOI: 10.1016/j.knee.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 01/03/2022] [Accepted: 02/25/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Since the introduction of the first total knee designs, a frequent design goal has been to reproduce normal knee motion. However, studies of many currently used total knee designs, have shown that this goal has not been achieved. We proposed that Guided Motion total knee designs, could achieve more anatomic motion than present standard designs. METHODS Several Guided Motion knees for application without cruciate ligaments were designed using a computer method where the bearing surfaces were generated by the motion required. A knee testing machine was constructed where physiological forces including compressive, shear and torque were applied during knee flexion. The neutral path of motion and the laxity about the neutral path were measured. This evaluation method was a modification of the ASTM standard Constraint Test. RESULTS The motions of the Guided Motion knees and a standard PS knee were compared with the anatomic motion of knee specimens determined in an earlier study The Guided Motion knees showed motion patterns which were closer to anatomic than the PS knee. CONCLUSIONS The results provided justification for carrying out further evaluations of functional conditions, using either knee simulators or computer modelling. If anatomic motions could be reproduced in vivo, it is possible that clinical outcomes could be improved.
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Affiliation(s)
- Peter S Walker
- NYU Langone Orthopedic Hospital, New York, NY, United States.
| | - Ilya Borukhov
- NYU Langone Orthopedic Hospital, New York, NY, United States.
| | - Sally LiArno
- NYU Langone Orthopedic Hospital, New York, NY, United States.
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28
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Implant survival of 3rd-condyle and post-cam posterior-stabilised total knee arthroplasty are comparable at follow-up > 10 years: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 30:1001-1024. [PMID: 33660055 DOI: 10.1007/s00167-021-06507-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/14/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To summarise the literature on 3rd-condyle total knee arthroplasty (TKA) designs and compare their survival rates to those of post-cam TKA designs. The null hypothesis was that 3rd-condyle TKAs would have equivalent survival rates compared to contemporary post-cam TKAs. METHODS An electronic literature search for Level I-V studies was independently conducted by two researchers using Medline® and Web of Science for studies published between January 1984 and October 2020 that specifically reported on rates of implant survival and complications, joint kinematics, clinical outcomes, and radiographic outcomes of 3rd-condyle TKA. The methodological quality of clinical studies was assessed according to the Downs and Black Quality Checklist for Health Care Intervention Studies, and for in vitro and in silico studies according to the Joanna Briggs Institute (JBI) tool for assessing analytical cross-sectional studies. Findings extracted for each TKA design were presented as reported and synthesised narratively. Survival rates at 5, 10 and > 10 years of 3rd-condyle TKA designs were graphically compared to rates of post-cam TKA designs published in joint registries. RESULTS A total of 38 studies were identified that reported on kinematics, clinical outcomes, radiographic alignment, and rates of complications and survival. Mean survival rates ranged from 96 to 98% at 5 years, 78-100% at 5-10 years, and 86-99% at > 10 years for 3rd-condyle PS TKAs. Mean survival rates ranged from 93 to 98% at 5 years, 89-99% at 5-10 years, and 88-95% at > 10 years for post-cam PS TKAs. CONCLUSION Implant survival rates of 3rd-condyle TKAs are comparable to those of post-cam TKAs at follow-up > 10 years. When compared to post-cam PS TKA, 3rd-condyle designs offer an alternative for younger and more active patients when considering the added benefits of a lowered point-of-contact and larger congruent contact area at the intercondylar tibial sulcus, that reduce risks of loosening and component wear. LEVEL OF EVIDENCE V.
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29
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Bessler-Etten J, Schaake L, Prange-Lasonder GB, Buurke JH. Assessing effects of exoskeleton misalignment on knee joint load during swing using an instrumented leg simulator. J Neuroeng Rehabil 2022; 19:13. [PMID: 35090501 PMCID: PMC8800279 DOI: 10.1186/s12984-022-00990-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background Exoskeletons are working in parallel to the human body and can support human movement by exerting forces through cuffs or straps. They are prone to misalignments caused by simplified joint mechanics and incorrect fit or positioning. Those misalignments are a common safety concern as they can cause undesired interaction forces. However, the exact mechanisms and effects of misalignments on the joint load are not yet known. The aim of this study was therefore to investigate the influence of different directions and magnitudes of exoskeleton misalignment on the internal knee joint forces and torques of an artificial leg.
Methods An instrumented leg simulator was used to quantify the changes in knee joint load during the swing phase caused by misalignments of a passive knee brace being manually flexed. This was achieved by an experimenter pulling on a rope attached to the distal end of the knee brace to create a flexion torque. The extension was not actuated but achieved through the weight of the instrumented leg simulator. The investigated types of misalignments are a rotation of the brace around the vertical axis and a translation in anteroposterior as well as proximal/distal direction. Results The amount of misalignment had a significant effect on several directions of knee joint load in the instrumented leg simulator. In general, load on the knee joint increased with increasing misalignment. Specifically, stronger rotational misalignment led to higher forces in mediolateral direction in the knee joint as well as higher ab-/adduction, flexion and internal/external rotation torques. Stronger anteroposterior translational misalignment led to higher mediolateral knee forces as well as higher abduction and flexion/extension torques. Stronger proximal/distal translational misalignment led to higher posterior and tension/compression forces. Conclusions Misalignments of a lower leg exoskeleton can increase internal knee forces and torques during swing to a multiple of those experienced in a well-aligned situation. Despite only taking swing into account, this is supporting the need for carefully considering hazards associated with not only translational but also rotational misalignments during wearable robot development and use. Also, this warrants investigation of misalignment effects in stance, as a target of many exoskeleton applications.
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30
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Articulation of the femoral condyle during knee flexion. J Biomech 2022; 131:110906. [PMID: 34923296 PMCID: PMC8760888 DOI: 10.1016/j.jbiomech.2021.110906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/11/2021] [Accepted: 12/06/2021] [Indexed: 01/03/2023]
Abstract
Femoral condyle motion of the knee is generally reported using a morphological trans-epicondyle axis (TEA) or geometric center axis (GCA) in the investigation of the knee kinematics. Axial rotation of the femur is recognized as a characteristic motion of the knee during flexion, but is controversial in the literature. This study investigated the biomechanical factors that could be associated to the axial rotations of the femur using both physiological and morphological measurement methods. Twenty healthy knees were investigated during a weightbearing flexion from 0° to 120° at a 15° increment using an imaging technique. A 3D model was constructed for each knee using MR images. Tibiofemoral cartilage contact points were determined at each flexion position to represent physiological knee motion. The contact distance on each condyle was measured between consecutive contact points. The TEA and GCA were used to measure morphological anteroposterior translations of the femoral condyles. The differences between the medial and lateral condyle motions were used to calculate the physiological and morphological axial rotations of the femur. Both the physiological and morphological methods measured external rotations of the femur at low flexion range (0°-45°) and minimal rotations at higher flexion angles. However, the morphological method measured larger posterior translations of the lateral femoral condyle than the medial condyle (p < 0.05), implying a medial pivoting rotation; in contrast, the physiological method measured larger contact distances on the medial condyle than on the lateral condyle (p < 0.05), implying a lateral pivoting rotation. These data could provide useful references for future investigation of kinematics of the knee before and after surgical repair, such as using total knee arthroplasty.
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31
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Rao L, Taylor WR, Horn N, List R, Preiss S, Schütz P. Can tibio-femoral kinematic and kinetic parameters reveal poor functionality and underlying deficits after total knee replacement? A systematic review. Knee 2022; 34:62-75. [PMID: 34883331 DOI: 10.1016/j.knee.2021.11.002] [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: 02/15/2021] [Revised: 09/13/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Extensive efforts have been made to understand joint kinematics and kinetics in total knee arthroplasty (TKA) in subjects with satisfactory outcomes during daily functional activities and clinical tests, but it remains unclear whether such movement characteristics hold the potential to indicate the underlying aetiology of unsatisfactory or bad TKA outcomes. PURPOSE To investigate which kinematic and kinetic parameters assessed during passive clinical tests and functional activities of daily living are associated with poor functionality and underlying deficits after total knee replacement. METHODS We focused on studies characterizing the kinematic or kinetic parameters of the knee joint that are associated with poor clinical outcome after TKA. Seventeen articles were included for the review, and kinematic and kinetic data from 719 patients with minimal follow up of 6 months were extracted and analyzed. RESULTS Passive posterior translation at 90°flexionexhibited good potential for differentiating stable and unstable TKAs. Anterior-posterior (A-P) translation of the medial condyle at 0-30° and 30-60° flexion, A-P translation of the lateral condyle at 60-90°during closed chain exercises, as well asknee extension moment during stair ascent and descent, knee abduction moment during stair descent, knee internal rotation moment and plantar flexion moment during walking, 2ndpeak ground reaction force during stair ascent and walkingshowed the greatest promise as functional biomarkers for a dissatisfied/poor outcome knee after TKA. CONCLUSION In this study, we systematically reviewed the state-of-the-art knowledge of kinematics and kinetics associated with functional deficits, and found 11 biomechanical parameters that showed promise for supportingdecision making in TKA.
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Affiliation(s)
- L Rao
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - W R Taylor
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland.
| | - N Horn
- Schulthess Clinic, Zürich, Switzerland
| | - R List
- Schulthess Clinic, Zürich, Switzerland
| | - S Preiss
- Schulthess Clinic, Zürich, Switzerland
| | - P Schütz
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
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32
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Song YD, Nakamura S, Kuriyama S, Nishitani K, Ito H, Morita Y, Yamawaki Y, Matsuda S. Biomechanical Comparison of Kinematic and Mechanical Knee Alignment Techniques in a Computer Simulation Medial Pivot Total Knee Arthroplasty Model. J Knee Surg 2021; 36:596-604. [PMID: 34891188 DOI: 10.1055/s-0041-1740392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several concepts may be used to restore normal knee kinematics after total knee arthroplasty. One is a kinematically aligned (KA) technique, which restores the native joint line and limb alignment, and the other is the use of a medial pivot knee (MPK) design, with a ball and socket joint in the medial compartment. This study aimed to compare motions, contact forces, and contact stress between mechanically aligned (MA) and KA (medial tilt 3° [KA3] and 5° [KA5]) models in MPK. An MPK design was virtually implanted with MA, KA3, and KA5 in a validated musculoskeletal computer model of a healthy knee, and the simulation of motion and contact forces was implemented. Anteroposterior (AP) positions, mediolateral positions, external rotation angles of the femoral component relative to the tibial insert, and tibiofemoral contact forces were evaluated at different knee flexion angles. Contact stresses on the tibial insert were calculated using finite element analysis. The AP position at the medial compartment was consistent for all models. From 0° to 120°, the femoral component in KA models showed larger posterior movement at the lateral compartment (0.3, 6.8, and 17.7 mm in MA, KA3, and KA5 models, respectively) and larger external rotation (4.2°, 12.0°, and 16.8° in the MA, KA3, and KA5 models, respectively) relative to the tibial component. Concerning the mediolateral position of the femoral component, the KA5 model was positioned more medially. The contact forces at the lateral compartment of all models were larger than those at the medial compartment at >60° of knee flexion. The peak contact stresses on the tibiofemoral joint at 90° and 120° of knee flexion were higher in the KA models. However, the peak contact stresses of the KA models at every flexion angle were <20 MPa. The KA technique in MPK can successfully achieve near-normal knee kinematics; however, there may be a concern for higher contact stresses on the tibial insert.
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Affiliation(s)
- Young Dong Song
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Advanced Medicine for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yugo Morita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Yamawaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Walker PS, Mhadgut A, Buchalter DB, Kirby DJ, Hennessy D. The effect of total knee geometries on kinematics: An experimental study using a crouching machine. J Orthop Res 2021; 39:2537-2545. [PMID: 33713363 DOI: 10.1002/jor.25026] [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: 09/08/2020] [Revised: 01/13/2021] [Accepted: 03/10/2021] [Indexed: 02/04/2023]
Abstract
Obtaining anatomic knee kinematics after a total knee is likely to improve outcomes. We used a crouching machine to compare the kinematics of standard condylar designs with guided motion designs. The standard condylars included femoral sagittal radii with constant radius, J-curve and G-curve; the tibial surfaces were of low and high constraint. The guided motion designs were a medial pivot and a design with asymmetric condylar shapes and guiding surfaces. The machine had a flexion range from 0° to 125°, applied quadriceps and hamstring loading, and simulated the collateral soft tissues. The kinematics of all standard condylar knees were similar, showing only small anterior-posterior displacements and internal-external rotations. The two asymmetric designs showed posterior displacements during flexion, but less axial rotations than anatomic knees. The quadriceps forces throughout flexion were very similar between all designs, reflecting similar lever arms. It was concluded that standard condylar designs, even with variations in sagittal radii, are unlikely to reproduce anatomic kinematics. On the other hand, designs with asymmetric constraint between medial and lateral sides, and other guiding features, are likely to be the way forward. The mechanical testing method could be further improved by superimposing shear forces and torques during the flexion-extension motion, to include more stressful in vivo functional conditions.
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Affiliation(s)
- Peter S Walker
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Aishwarya Mhadgut
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Daniel B Buchalter
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - David J Kirby
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Daniel Hennessy
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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Smith LA, LaCour MT, Dennis DA, Komistek RD. Anatomic vs Dome Patella: Is There a Difference Between Fixed- vs Mobile-Bearing Posterior-Stabilized Total Knee Arthroplasties? J Arthroplasty 2021; 36:3773-3780. [PMID: 34362598 DOI: 10.1016/j.arth.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It has been hypothesized that the patella, working in conjunction with both medial and lateral femoral condyles, can influence kinematic parameters such as posterior femoral rollback and axial rotation. The objective of this study is to determine the in vivo kinematics of subjects implanted with a fixed-bearing (FB) or mobile-bearing (MB) posterior-stabilized (PS) total knee arthroplasty (TKA), with a specific focus on evaluating the impact that Anatomic and Medialized Dome patellar components have on tibiofemoral kinematic patterns. METHODS Tibiofemoral kinematics were assessed for 40 subjects; 20 with an anatomic patella and 20 with a dome patella. Within these groups, 10 subjects received an FB PS TKA and 10 subjects received an MB PS TKA. All subjects were analyzed using fluoroscopy while performing a deep knee bend activity. Kinematics were collected during specific intervals to determine similarities and differences in regard to patella and bearing type. RESULTS The greatest variation in kinematics was detected between the 2 Anatomic patellar groups. Specifically, the MB-Anatomic subjects experienced greater translation of the lateral condyle, the highest magnitude of axial rotation, and the highest range of motion compared to the FB-Anatomic subjects. Subjects with a Dome Patella displayed much variability among the average kinematics, with all parameters between FB and MB cohorts being similar. CONCLUSION The findings in this study suggest that subjects with an Anatomic patellar component could have more normal kinematic patterns with an MB PS TKA as opposed to an FB PS TKA, while subjects with a Dome patella could achieve similar kinematics regardless of TKA type.
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Affiliation(s)
- Lauren A Smith
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, TN
| | - Michael T LaCour
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, TN
| | | | - Richard D Komistek
- Center for Musculoskeletal Research, University of Tennessee-Knoxville, Knoxville, TN
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35
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Jeon JW, Hong J. Comparison of screw-home mechanism in the unloaded living knee subjected to active and passive movements. J Back Musculoskelet Rehabil 2021; 34:589-595. [PMID: 33554884 DOI: 10.3233/bmr-200110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The screw-home mechanism (SHM) plays an important role in the stability of the knee. Accordingly, the analysis of tibial rotation patterns can be used to elucidate the effect of SHM-related factors. OBJECTIVE The purpose of this study was to compare the magnitude of the angle and the pattern of SHM between passive and active movements. METHODS We studied twenty healthy males, of which the angle of knee flexion-extension and tibial longitudinal rotation (TLR) during active and passive movements were measured using the inertial measurement unit. Student's t-tests were used to compare the magnitude of TLR. The waveform similarity was quantified using a coefficient of multiple correlation (CMC). RESULTS Significant differences were found in the TLR between the active and passive movements (p< 0.05). The knee flexion-extension waveform similarity was excellent (CMC = 0.956). However, the waveform similarity of TLR was weak (CMC = 0.629). CONCLUSION The SHM increased abruptly during the last 20∘ of the active (extension) movement compared with passive extension. The SHM occurred mainly owing to the geometry and shape of the articular surfaces of the knee joint. In addition, muscle contraction was considered to be an important factor in the articulation movement.
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36
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Wang ZW, Wen L, Luan YC, Ma DS, Dong X, Cheng CK, Qu TB. Restoration of Joint Inclination in Total Knee Arthroplasty Offers Little Improvement in Joint Kinematics in Neutrally Aligned Extremities. Front Bioeng Biotechnol 2021; 9:673275. [PMID: 33996784 PMCID: PMC8116507 DOI: 10.3389/fbioe.2021.673275] [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: 02/27/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022] Open
Abstract
Kinematically aligned total knee replacements have been shown to better restore physiological kinematics than mechanical alignment and also offer good postoperative satisfaction. The purpose of this study is to evaluate the extent to which an inclined joint line in a kinematically aligned knee can alter the postoperative kinematics. A multi-body dynamic simulation was used to identify kinematic changes in the joint. To accurately compare mechanical alignment, kinematic alignment and a natural knee, a “standard” patient with neutral alignment of the lower extremities was selected for modeling from a joint database. The arthroplasty models in this study were implanted with a single conventional cruciate-retaining prosthesis. Each model was subjected to a flexion movement and the anteroposterior translation of the femoral condyles was collected for kinematic analysis. The results showed that the mechanical alignment model underwent typical paradoxical anterior translation of the femoral condyles. Incorporating an inclined joint line in the model did not prevent the paradoxical anterior translation, but a 3° varus joint line in the kinematic alignment model could reduce the peak value of this motion by about 1 mm. Moreover, the inclined joint line did not restore the motion curve back to within the range of the kinematic curve of the natural knee. The results of this study suggest that an inclined joint line, as in the kinematic alignment model, can slightly suppress paradoxical anterior translation of the femoral condyles, but cannot restore kinematic motions similar to the physiological knee. This finding implies that prostheses intended to be used for kinematic alignment should be designed to optimize knee kinematics with the intention of restoring a physiological motion curve.
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Affiliation(s)
- Zhi-Wei Wang
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liang Wen
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yi-Chao Luan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - De-Si Ma
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiang Dong
- Beijing Naton Medical Technology Innovation Center Co., Ltd., Beijing, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tie-Bing Qu
- The Center of Diagnosis and Treatment for Joint Disease, China Rehabilitation Research Center, Capital Medical University, Beijing, China
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Skaro J, Hazelwood SJ, Klisch SM. Knee Angles After Crosstalk Correction With Principal Component Analysis in Gait and Cycling. J Biomech Eng 2021; 143:1096599. [PMID: 33462592 DOI: 10.1115/1.4049809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Indexed: 11/08/2022]
Abstract
Principal component analysis (PCA) has been used as a post-hoc method for reducing knee crosstalk errors during gait analysis. PCA minimizes correlations between flexion-extension (FE), abduction-adduction (AA), and internal-external rotation (IE) angles. However, previous studies have not considered PCA for exercises involving knee flexion angles that are greater than those typically experienced during gait. Thus, the goal of this study was to investigate using PCA to correct for crosstalk during one exercise (i.e., cycling) that involves relatively high flexion angles. Fifteen participants were tested in gait and cycling using a motion analysis system. Uncorrected FE, AA and IE angles were compared to those calculated with PCA performed on (1) all angles (FE-AA-IE PCA correction) and (2) only FE-AA angles (FE-AA PCA correction). Significant differences existed between uncorrected and FE-AA-IE PCA corrected AA and IE angles for both exercises, between uncorrected and FE-AA PCA corrected AA angles for both exercises, and between FE-AA-IE and FE-AA PCA corrected IE angles for cycling. Correlations existed before PCA correction and were eliminated following PCA correction with the exception that FE-IE correlations remained following FE-AA PCA correction. Since the two PCA analyses differed only in their IE angle predictions for the high flexion exercise (cycling), IE angle results were compared to previous studies. Using FE-AA PCA correction may be the preferred protocol for cycling as it appeared to retain physiological IE angle correlations at high flexion angles. However, there exists a critical need for studies aimed at obtaining more accurate IE angles in such exercises.
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Affiliation(s)
- Jordan Skaro
- Mechanical Engineering Department, California Polytechnic State University, San Luis Obispo, CA 93407
| | - Scott J Hazelwood
- Mechanical Engineering Department, California Polytechnic State University, San Luis Obispo, CA 93407; Biomedical Engineering Department, California Polytechnic State University, San Luis Obispo, CA 93407
| | - Stephen M Klisch
- Mechanical Engineering Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407; Biomedical Engineering Department, California Polytechnic State University, San Luis Obispo, CA 93407
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Cochetti A, Ghirardelli S, Iannotti F, Giardini P, Risitano S, Indelli PF. Sensor-guided technology helps to reproduce medial pivot kinematics in total knee arthroplasty. J Orthop Surg (Hong Kong) 2021; 28:2309499020966133. [PMID: 33146082 DOI: 10.1177/2309499020966133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
METHODS Two cohorts of 50 patients each were preoperatively matched to receive the same TKA, having a J-curve femoral design with an adapted "medially congruent" polyethylene insert; the second cohort (group B) underwent the intraoperative sensor-check. Intraoperative sensor data were recorded as tibiofemoral load at 10°, 45°, and 90°. We considered stable knees those with a pressure <50 lbs on the medial compartment, <35 lbs on the lateral, and a mediolateral inter-compartmental difference <15 lbs. Clinical outcomes were evaluated according to the Oxford Knee Score (OKS) and Knee Society Score (KSS). RESULTS All patients (group A: no sensor; group B: sensor) were available at 2-year minimum follow-up (FU; min. 24 months, max. 34 months); no preoperative statistical differences existed between groups in the average range of motion (ROM), OKS, KSS, and body mass index. There were no statistical differences at final FU between groups in the average OKS (group A: 41.1; group B: 41.5), in the average KSS (group A: 165.7; group B: 166.3), or in final ROM (group A: 123°; group B: 124°). One patient in each group required a manipulation under anesthesia. In the sensor group, an accessory soft tissue release/bone recut was necessary after sensor testing with trial components in 24% to obtain the desired loads; in the same group, the level of constraint in the final components was increased to posterior-stabilized in 12% because of an inter-compartmental difference >40 lbs. Surgical time was 8 min longer in the sensor group. CONCLUSION The use of this sensing technology did not improve the clinical outcome but supported multiple intraoperative decisions aimed to better reproduce the medial pivot kinematic of the normal knee.
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Affiliation(s)
- Andrea Cochetti
- Department of Orthopaedic Surgery, Stanford University, Stanford, USA
| | | | | | - Piero Giardini
- Department of Orthopaedic Surgery, Stanford University, Stanford, USA
| | | | - Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University, Stanford, USA.,Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, USA
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Lower Limb Movement Pattern Differences Between Males and Females in Squatting and Kneeling. J Appl Biomech 2021; 37:204-214. [PMID: 33690162 DOI: 10.1123/jab.2020-0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/15/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022]
Abstract
Movement pattern differences may contribute to differential injury or disease prevalence between individuals. The purpose of this study was to identify lower limb movement patterns in high knee flexion, a risk factor for knee osteoarthritis, and to investigate kinematic differences between males and females, as females typically develop knee osteoarthritis more commonly and severely than males. Lower extremity kinematic data were recorded from 110 participants completing 4 variations of squatting and kneeling. Principal component analysis was used to identify principal movements associated with the largest variability in the sample. Across the tasks, similar principal movements emerged at maximal flexion and during transitions. At maximal flexion, females achieved greater knee flexion, facilitated by a wider base of support, which may alter posterior and lateral tibiofemoral stress. Principal movements also detected differences in movement temporality between males and females. When these temporal differences occur due to alterations in movement velocity and/or acceleration, they may elicit changes in muscle activation and knee joint stress. Movement variability identified in the current study provides a framework for potential modifiable factors in high knee flexion, such as foot position, and suggests that kinematic differences between the sexes may contribute to differences in knee osteoarthritis progression.
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40
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Stephen JM, Teitge RA, Williams A, Calder JD, El Daou H. A Validated, Automated, 3-Dimensional Method to Reliably Measure Tibial Torsion. Am J Sports Med 2021; 49:747-756. [PMID: 33533633 PMCID: PMC7917570 DOI: 10.1177/0363546520986873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibial torsion is a twist in the tibia measured as an angle between a proximal axis line and a distal axis line. Abnormal torsion has been associated with a variety of painful clinical syndromes of the lower limb. Measurements of normal tibial torsion reported by different authors vary by 100% (ranging from 20° to 42°), making it impossible to determine normal and pathological levels. PURPOSE To address the problem of unreliable measurements, this study was conducted to define an automated, validated computer method to calculate tibial torsion. Reliability was compared with current clinical methods. The difference between measurements of torsion generated from computed tomography (CT) and magnetic resonance imaging (MRI) scans of the same bone, and between males and females, was assessed. STUDY DESIGN Controlled laboratory study. METHODS Previous methods of analyzing tibial torsion were reviewed, and limitations were identified. An automated measurement method to address these limitations was defined. A total of 56 cadaveric and patient tibiae (mean ± SD age, 37 ± 15 years; range, 17-71 years; 28 female) underwent CT scanning, and 3 blinded assessors made torsion measurements by applying 2 current clinical methods and the automated method defined in the present article. Intraclass correlation coefficient (ICC) values were calculated. Further, 12 cadaveric tibiae were scanned by MRI, stripped of tissue, and measured using a structured light (SL) scanner. Differences between torsion values obtained from CT, SL, and MRI scans, and between males and females, were compared using t tests. SPSS was used for all statistical analysis. RESULTS When the automated method was used, the tibiae had a mean external torsion of 29°± 11° (range, 9°-65). Automated torsion assessment had excellent reliability (ICC, 1), whereas current methods had good reliability (ICC, 0.78-0.81). No significant difference was found between the torsion values calculated from SL and CT (P = .802), SL and MRI (P = .708), or MRI and CT scans (P = .826). CONCLUSION The use of software to automatically perform measurements ensures consistency, time efficiency, validity, and accuracy not possible with manual measurements, which are dependent on assessor experience. CLINICAL RELEVANCE We recommend that this method be adopted in clinical practice to establish databases of normal and pathological tibial torsion reference values and ultimately guide management of related conditions.
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Affiliation(s)
- Joanna M. Stephen
- Department of Mechanical Engineering,
Imperial College London, London, UK,Fortius Clinic, London, UK,Joanna M. Stephen, PhD,
Department of Mechanical Engineering, Imperial College London, SW7 2AZ, UK
()
| | - Robert A. Teitge
- Department of Orthopedic Surgery, Wayne
State University, Detroit, Michigan, USA
| | - Andy Williams
- Department of Mechanical Engineering,
Imperial College London, London, UK,Fortius Clinic, London, UK
| | - James D.F. Calder
- Fortius Clinic, London, UK,Department of Bioengineering, Imperial
College London, London, UK
| | - Hadi El Daou
- Department of Mechanical Engineering,
Imperial College London, London, UK
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Faschingbauer M, Hacker S, Seitz A, Dürselen L, Boettner F, Reichel H. The tibial cut in total knee arthroplasty influences the varus alignment, the femoral roll-back and the tibiofemoral rotation in patients with constitutional varus. Knee Surg Sports Traumatol Arthrosc 2021; 29:641-651. [PMID: 32306132 DOI: 10.1007/s00167-020-05996-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Different alignment types for a better outcome after TKA were described. However, it is not clear how kinematic alignment influences knee joint kinematic. The purpose of this study was to analyze whether adapted tibial cuts in constitutional varus knees affect knee joint kinematics regarding femoral roll-back, varus/valgus angle, and femorotibial rotation. METHODS Seven cadaveric knees with constitutional varus alignment were examined in the native state and after implantation of a cruciate retaining (CR)-TKA with 0°, 3° and 6° tibia cuts using an established knee joint simulator. The effects of varus alignment on femorotibial rollback and rotation was determined. In addition, the native knee joint and different tibial cuts in CR-TKA were compared with Student's t test. RESULTS Total knee replacement with a 3° and 6° varus tibia cut had the greatest varus deviation to the native knee (mean 1.6° ± 0.09°, respectively); while, knees with a 0° (mean 0.2° ± 0.01°) tibia cut were most similar to the constitutional varus knee joint. The femoral roll-back in the medial compartment was increased in the native knee (5.7-12.5 mm). A 6° varus cut had a restricted translation in the medial compartment (2-3.2 mm). In the lateral compartment, the extensive translation was observed with a 0° varus cut, followed by 3° and 6° and the native knee. All cuts showed significantly different mean values. Only the cuts at 3° and at 6° in the medial compartment and the cuts at 0° and at 3° in the lateral compartment did not differ significantly. In respect to tibiofemoral rotation, 0° and 3° varus cuts across all loads had the least difference to the native knee (3.4°), with a 0° varus cut showing a higher absolute internal rotation of the tibia than the native knee. Changes in knee kinematics of the tibiofemoral rotation showed significantly different mean values. CONCLUSION The potentially improved outcome parameters in TKA with adapted tibia cuts in constitutional varus knees cannot be completely explained by the changes to knee kinematics. Mechanical alignment seems to result in more balanced load distribution and kinematics more closely resembling the native knee. From a kinematic point of view, it is not recommended to place the tibia in more than 3° of varus. LEVEL OF EVIDENCE Biomechanical study.
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Affiliation(s)
- Martin Faschingbauer
- Department of Orthopedic Surgery, RKU, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - S Hacker
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany
| | - A Seitz
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany
| | - L Dürselen
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany
| | - F Boettner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - H Reichel
- Department of Orthopedic Surgery, RKU, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
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Alesi D, Marcheggiani Muccioli GM, Roberti di Sarsina T, Bontempi M, Pizza N, Zinno R, Di Paolo S, Zaffagnini S, Bragonzoni L. In vivo femorotibial kinematics of medial-stabilized total knee arthroplasty correlates to post-operative clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2021; 29:491-497. [PMID: 32253483 DOI: 10.1007/s00167-020-05975-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/30/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate if there was a correlation between in vivo kinematics of a medial-stabilized (MS) total knee arthroplasty (TKA) and post-operative clinical scores. We hypothesized that (1) a MS-TKA would produce a medial pivot movement and that (2) this specific pattern would be correlated with higher clinical scores. METHODS 18 patients were evaluated through clinical and functional scores evaluation (Knee Society Score clinical and functional, Womac, Oxford), and kinematically through dynamic radiostereometric analysis (RSA) at 9 months after MS-TKA, during the execution of a sit-to-stand and a lunge motor task. The anteroposterior (AP) Low Point translation of medial and lateral femoral compartments was compared through Student's t test (p < 0.05). A correlation analysis between scores and kinematics was performed through the Pearson's correlation coefficient r. RESULTS A significantly greater (p < 0.0001) anterior translation of the lateral compartment with respect to the medial one was found in both sit-to-stand (medial 2.9 mm ± 0.7 mm, lateral 7.1 mm ± 0.6 mm) and lunge (medial 5.3 mm ± 0.9 mm, lateral 10.9 mm ± 0.7 mm) motor tasks, thus resulting in a medial pivot pattern in about 70% of patients. Significant positive correlation in sit-to-stand was found between the peak of AP translation in the lateral compartment and clinical scores (r = 0.59 for Knee Society Score clinical and r = 0.61 for Oxford). Moreover, we found that the higher peak of AP translation of the medial compartment correlated with lower clinical scores (r = - 0.55 for Knee Society Score clinical, r = - 0.61 for Womac and r = - 0.53 for Oxford) in the lunge. A negative correlation was found between Knee Society Score clinical and VV laxity during sit-to-stand (r = - 0.56) and peak of external rotation in the lunge motor task (r = - 0.66). CONCLUSIONS The MS-TKA investigated produced in vivo a medial pivot movement in about 70% of patients in both examined motor tasks. There was a correlation between the presence of medial pivot and higher post-operative scores. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Domenico Alesi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy. .,University of Bologna, Bologna, Italy.
| | - Tommaso Roberti di Sarsina
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Marco Bontempi
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Nicola Pizza
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Raffaele Zinno
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Stefano Di Paolo
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopaedic and Traumatologic Clinic, IRCCS, Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136, Bologna, Italy.,University of Bologna, Bologna, Italy
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Kawaguchi K, Inui H, Taketomi S, Yamagami R, Takagi K, Kage T, Sameshima S, Tanaka S. Rotational kinematics differ between mild and severe valgus knees in total knee arthroplasty. Knee 2021; 28:81-88. [PMID: 33310669 DOI: 10.1016/j.knee.2020.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/29/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no consensus regarding femorotibial rotational kinematics in total knee arthroplasty (TKA) for valgus knee deformity. Additionally, whether the degree of valgus deformity influences intraoperative rotational kinematics and postoperative clinical scores remains unclear. The objectives of this study were to investigate whether the valgus angle is associated with intraoperative rotational kinematics in TKA for valgus knee deformity and to examine the relationship between rotational kinematics and postoperative clinical results. MATERIALS AND METHODS A total of 24 knees with valgus deformity for TKA were included in this study and were divided into two groups depending on the femorotibial angle (FTA); there were 11 knees in the severe valgus group (FTA < 160°) and 13 knees in the mild valgus group (FTA ≥ 160°). Intraoperative femorotibial rotational kinematics from knee extension to flexion were evaluated using an image-free navigation system and postoperative clinical results (range of motion and subjective outcomes) were evaluated 1 year postoperatively. All parameters were compared between the two groups. RESULT Mild valgus knee showed tibial internal rotation during knee flexion before implantation, whereas severe valgus knee showed tibial external rotation during knee flexion before implantation. The postoperative flexion angle was positively correlated with the tibial internal rotation angle after implantation in the mild valgus group only. CONCLUSION Intraoperative rotational kinematics before implantation differed between mild and severe valgus knee deformity in TKA. Intraoperative tibial rotation influenced the postoperative knee flexion angle in mild, but not severe, valgus knee deformity. Ideal postoperative rotational kinematics may be different between the two groups and the difference may be taken into consideration in implant selections and surgical techniques.
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Affiliation(s)
- Kohei Kawaguchi
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Hiroshi Inui
- Department of Orthopaedics, Tokyo University Hospital, Japan.
| | - Shuji Taketomi
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Ryota Yamagami
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Kentaro Takagi
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Tomofumi Kage
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Shin Sameshima
- Department of Orthopaedics, Tokyo University Hospital, Japan
| | - Sakae Tanaka
- Department of Orthopaedics, Tokyo University Hospital, Japan
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Kingston DC, Acker SM. Development of a Full Flexion 3D Musculoskeletal Model of the Knee Considering Intersegmental Contact During High Knee Flexion Movements. J Appl Biomech 2020; 36:444-456. [PMID: 32846408 DOI: 10.1123/jab.2019-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/12/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022]
Abstract
A musculoskeletal model of the right lower limb was developed to estimate 3D tibial contact forces in high knee flexion postures. This model determined the effect of intersegmental contact between thigh-calf and heel-gluteal structures on tibial contact forces. This model includes direct tracking and 3D orientation of intersegmental contact force, femoral translations from in vivo studies, wrapping of knee extensor musculature, and a novel optimization constraint for multielement muscle groups. Model verification consisted of calculating the error between estimated tibial compressive forces and direct measurements from the Grand Knee Challenge during movements to ∼120° of knee flexion as no high knee flexion data are available. Tibial compression estimates strongly fit implant data during walking (R2 = .83) and squatting (R2 = .93) with a root mean squared difference of .47 and .16 body weight, respectively. Incorporating intersegmental contact significantly reduced model estimates of peak tibial anterior-posterior shear and increased peak medial-lateral shear during the static phase of high knee flexion movements by an average of .33 and .07 body weight, respectively. This model supports prior work in that intersegmental contact is a critical parameter when estimating tibial contact forces in high knee flexion movements across a range of culturally and occupationally relevant postures.
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45
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Marcheggiani Muccioli GM, Pizza N, Di Paolo S, Zinno R, Alesi D, Roberti Di Sarsina T, Bontempi M, Zaffagnini S, Bragonzoni L. Multi-radius posterior-stabilized mobile-bearing total knee arthroplasty partially produces in-vivo medial pivot during activity of daily living and high demanding motor task. Knee Surg Sports Traumatol Arthrosc 2020; 28:3773-3779. [PMID: 31955237 DOI: 10.1007/s00167-020-05846-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/02/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of the present study was to assess the kinematical behavior of a multi-radius posterior-stabilized (PS) mobile-bearing (MB) total knee arthroplasty (TKA) during an activity of daily living (Sit-To-Stand-STS) and a high demanding motor task (Deep-Knee-Lunge-DKL) using model-based dynamic RSA. We hypothesized the achievement of medial pivoting movement in both motor tasks due to the congruent geometry of the inlay with the femoral component, which should allow good stability of the medial compartment, and to the high magnitude of rotations guaranteed by the MB on the tibial side. METHODS Twenty-two randomly selected patients were recruited and prospectively evaluated. The PS MB cemented TKA was implanted with the standard technique (medial parapatellar approach, adjusted mechanical alignment). At minimum 9-month follow-up, patients were examined with model based Dynamic RSA developed in our Institute (BI-STAND DRX 2) during the execution of two motor tasks: STS and DKL. The motion parameters were evaluated using the Grood and Suntay decomposition and the low-point kinematics methods. RESULTS In the extension phase of DKL femur performed a greater antero posterior translation of 3.8 mm compared to STS between 0° and 20° of knee flexion (p < 0.05). Low-point analysis showed a medial pivoting movement in both motor tasks: in 62% of patients during STS and 48% during DKL. Varus-valgus rotations were lower than 1° during all the range-of-motion in both motor tasks without differences. CONCLUSIONS Medial pivot was partially produced by this multi-radius PS MB TKA with some differences during activity of daily living (STS) and high demanding motor task (DKL). LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Nicola Pizza
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Stefano Di Paolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Raffaele Zinno
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Domenico Alesi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Tommaso Roberti Di Sarsina
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Marco Bontempi
- Laboratorio di Biomeccanica, IRCCS Istituto Ortopedico Rizzoli, via di Barbiano 1/10, 40136, Bologna, BO, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, BO, Italy
| | - Laura Bragonzoni
- QUVI, Università di Bologna, corso D'Augusto 237, 47921, Rimini, RN, Italy
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List R, Schütz P, Angst M, Ellenberger L, Dätwyler K, Ferguson SJ. Videofluoroscopic Evaluation of the Influence of a Gradually Reducing Femoral Radius on Joint Kinematics During Daily Activities in Total Knee Arthroplasty. J Arthroplasty 2020; 35:3010-3030. [PMID: 32564968 DOI: 10.1016/j.arth.2020.05.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Paradoxical anterior translation in midflexion is reduced in total knee arthroplasties (TKAs) with a gradually reducing femoral radius, when compared to a 2-radii design. This reduction has been shown in finite element model simulations, in vitro tests, intraoperatively, and recently also in vivo during a lunge and unloaded flexion-extension. However, TKA kinematics are task dependent and this reduction has not been tested for gait activities. METHODS Thirty good outcome subjects (≥1 year postoperatively) with a unilateral cruciate-retaining TKA with a gradually reducing (n = 15) or dual (n = 15) femoral radius design were assessed during 5 complete cycles of level walking, stair descent (0.18-m steps), deep knee bend, and sitting down onto and standing up from a chair, using a moving fluoroscope (25 Hz, 1 ms shutter time). Kinematic data were extracted by 2D/3D image registration. RESULTS Tibiofemoral ranges of motion for flexion-extension, abduction-adduction, internal-external rotation, and anteroposterior (AP) translation were similar for both groups, whereas the pattern of AP translation-flexion-coupling differed. The subjects with the dual-radii design showed a sudden change in direction of AP translation around 30° of flexion, which was not present in the subjects with the gradually reducing femoral radius design. CONCLUSION Through the unique ability of moving fluoroscopy, the present study confirmed that the gradually reducing femoral radii eliminated the paradoxical sudden anterior translation at 30° present in the dual-radii design in vivo during daily activities, including gait and stair descent.
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Affiliation(s)
- Renate List
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Human Performance Lab, Schulthess Clinic, Zurich, Switzerland
| | - Pascal Schütz
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Michi Angst
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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Bori E, Innocenti B. Development and validation of an in-silico virtual testing rig for analyzing total knee arthroplasty performance during passive deep flexion: A feasibility study. Med Eng Phys 2020; 84:21-27. [PMID: 32977919 DOI: 10.1016/j.medengphy.2020.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022]
Abstract
The use of in-silico finite element (FE) models has become more common in orthopedic applications and in the design of biomedical devices, since they can provide results comparable to in vitro experiments while maintaining lower cost. The main downside of this kind of analysis is the high computing time, as it can reach hours or even days to complete; this limitation makes it then not suitable for time-sensitive applications, such as probabilistic analyses or helping clinicians in surgical pre-planning or intra-operative setting. In-silico multibody (MB) simulations, on the other hand, are significantly faster than FE simulations (considering each component of the model as a rigid body); although deformability of each model component is a necessary feature in some applications (e.g. simulation of implant-bone micromotions), several outputs of interest in orthopedic applications, such as implant kinematics and contact forces, do not require a fully deformable model. Therefore, this feasibility study aimed to develop a MB model of a human knee joint implanted with a Total Knee Arthroplasty; a 10 second flexion movement up to 105° was then simulated and the results compared with validated FE models results (under similar boundary conditions) from literature, to perform a preliminary validation in terms of kinematic and kinetic results between the two methods. The agreement and relatively low computing time obtaining with this approach represent a promising starting point for subsequent studies and applications of such techniques in the clinical field.
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Affiliation(s)
- Edoardo Bori
- BEAMS Engineering Department, Université Libre de Bruxelles, Ecole Polytechnique de Bruxelles, Av. F.D. Roosevelt 50 - CP165/56 1050 Brussels, Belgium.
| | - Bernardo Innocenti
- BEAMS Engineering Department, Université Libre de Bruxelles, Ecole Polytechnique de Bruxelles, Av. F.D. Roosevelt 50 - CP165/56 1050 Brussels, Belgium
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Ikuta F, Yoneta K, Miyaji T, Kidera K, Yonekura A, Osaki M, Gamada K. Knee kinematics of severe medial knee osteoarthritis showed tibial posterior translation and external rotation: a cross-sectional study. Aging Clin Exp Res 2020; 32:1767-1775. [PMID: 31598915 DOI: 10.1007/s40520-019-01361-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 09/21/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) gradually reduces knee function and limits activities of daily living with age. However, the progression of abnormal kinematics of the knee in knee OA is unclear. AIMS This study aimed to clarify the relationship between stage of knee OA and abnormal knee kinematics and to identify a strategy for prevention of knee OA. METHODS A total of 112 knees of 99 patients (45 men/54 women; 55.9 ± 18.2 years), comprising 28 (27/1) in Kellgren-Lawrence grade 0, 18 (8/10) in grade 1, 27 (2/25) in grade 2, 28 (6/22) in grade 3, and 11 (3/8) in grade 4, were enrolled in this cross-sectional study. In vivo knee kinematics was obtained using a three-dimensional-to-two-dimensional registration technique utilizing CT-based bone models and lateral fluoroscopy during knee extension-flexion in an upright sitting position and squatting. RESULTS The external rotation angle of the tibia relative to the femur was greater in grade 3/4 knees than in grade 0/1 knees and tibial posterior translation was greater in grade 3/4 knees than in grade 0-2 knees. DISCUSSION Age-related changes in muscle activity and joint instability are considered to be the cause of these abnormal kinematics. CONCLUSIONS As the stage of knee OA progresses, there was a tendency toward increasing tibial external rotation and tibial posterior translation during knee extension-flexion in sitting position and squatting. Prevention of the progress of the abnormal knee kinematics may prevent the progression of the knee OA.
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Affiliation(s)
- Futoshi Ikuta
- Department Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, 555-36 Kurosegakuendai, Higashihiroshima-shi, Hiroshima-ken, 739-2695, Japan.
- Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa, Shinagawa-ku, Tokyo, 140-0002, Japan.
| | - Kei Yoneta
- Department of Rehabilitation, Kobayashi Hospital, Kita 3 Jo Nishi 4-chome, Kitami-shi, Hokkaido, 090-0043, Japan
| | - Takeshi Miyaji
- Department of Orthopaedic Surgery, Aino Memorial Hospital, 3838-1 Ainomachiotsu, Unzen-shi, Nagasaki-ken, 854-0301, Japan
| | - Kenichi Kidera
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-ken, 852-8501, Japan
| | - Akihiko Yonekura
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-ken, 852-8501, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki-ken, 852-8501, Japan
| | - Kazuyoshi Gamada
- Department Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, 555-36 Kurosegakuendai, Higashihiroshima-shi, Hiroshima-ken, 739-2695, Japan
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Koh YG, Lee JA, Chung HS, Kim HJ, Kang KT. Restoration of normal knee kinematics with respect to tibial insert design in mobile bearing lateral unicompartmental arthroplasty using computational simulation. Bone Joint Res 2020; 9:421-428. [PMID: 32864113 PMCID: PMC7437519 DOI: 10.1302/2046-3758.97.bjr-2019-0384.r1] [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] [Indexed: 11/27/2022] Open
Abstract
Aims Mobile-bearing unicompartmental knee arthroplasty (UKA) with a flat tibial plateau has not performed well in the lateral compartment, leading to a high rate of dislocation. For this reason, the Domed Lateral UKA with a biconcave bearing was developed. However, medial and lateral tibial plateaus have asymmetric anatomical geometries, with a slightly dished medial and a convex lateral plateau. Therefore, the aim of this study was to evaluate the extent at which the normal knee kinematics were restored with different tibial insert designs using computational simulation. Methods We developed three different tibial inserts having flat, conforming, and anatomy-mimetic superior surfaces, whereas the inferior surface in all was designed to be concave to prevent dislocation. Kinematics from four male subjects and one female subject were compared under deep knee bend activity. Results The conforming design showed significantly different kinematics in femoral rollback and internal rotation compared to that of the intact knee. The flat design showed significantly different kinematics in femoral rotation during high flexion. The anatomy-mimetic design preserved normal knee kinematics in femoral rollback and internal rotation. Conclusion The anatomy-mimetic design in lateral mobile UKA demonstrated restoration of normal knee kinematics. Such design may allow achievement of the long sought normal knee characteristics post-lateral mobile UKA. However, further in vivo and clinical studies are required to determine whether this design can truly achieve a more normal feeling of the knee and improved patient satisfaction. Cite this article: Bone Joint Res 2020;9(7):421–428.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Jin-Ah Lee
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Hyun-Seok Chung
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Kim
- Department of Sport and Healthy Aging, Korea National Sport University, Seoul, Republic of Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
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Hull ML. Coordinate system requirements to determine motions of the tibiofemoral joint free from kinematic crosstalk errors. J Biomech 2020; 109:109928. [PMID: 32807309 DOI: 10.1016/j.jbiomech.2020.109928] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/18/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023]
Abstract
The relative rigid body motions between the femur and the tibia (termed tibiofemoral kinematics) during flexion activities can provide an objective measure of knee function. Clinically meaningful tibiofemoral kinematics are defined as the six relative rigid body motions expressed in a joint coordinate system where the motions about and along the axes conform to clinical definitions and are free from kinematic crosstalk errors. To obtain clinically meaningful tibiofemoral kinematics, coordinate systems must meet certain requirements which neither have been explicitly stated nor in fact satisfied in any previous publication known to the author. Starting with the joint coordinate system of Grood and Suntay (1983) where motions conform to clinical definitions, the body-fixed axes must correspond to the functional (i.e. actual) axes in flexion-extension and internal-external axial rotation to avoid kinematic crosstalk errors in rotations and both functional axes must be body-fixed throughout knee flexion. To avoid kinematic crosstalk errors in translations, the origins of the femoral and tibial Cartesian coordinate systems, which serve as stepping stones for computing translations, must lie on the functional body-fixed axes. Neither the paper by Grood and Suntay nor the ISB recommendation (Wu et al., 2002) which adopted the joint coordinate system of Grood and Suntay explains these requirements. Indeed meeting these requirements conflicts with the ISB recommendation thus indicating the need for revision to this recommendation. Future studies where clinically meaningful tibiofemoral kinematics are of interest should be guided by the requirements described herein.
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Affiliation(s)
- Maury L Hull
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, United States; Department of Mechanical Engineering, University of California Davis, Davis, CA 95616, United States; Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA 95817, United States.
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