Validity of repeated-measures analyses of in vitro arthroplasty kinematics and kinetics

Constraint of Different Knee Implant Designs Under Anterior-Posterior Shear Forces and Internal-External Rotation Moments in Human Cadaveric Knees

Instability remains one of the most common indications for revision after total knee arthroplasty. To gain a better understanding of how an implant will perform in vivo and support surgeons in selecting the most appropriate implant design for an individual patient, it is crucial to evaluate the implant constraint within clinically relevant ligament and boundary conditions. Therefore, this study investigated the constraint of three different implant designs (symmetrical implants with and without a post-cam mechanism and an asymmetrical medial-stabilized implant) under anterior-posterior shear forces and internal-external rotation moments at different flexion angles in human cadaveric knees using a six-degrees-of-freedom joint motion simulator. Both symmetrical designs showed no significant differences between the anterior-posterior range of motion of the medial and lateral condyles. In contrast, the medial-stabilized implant exhibited less anterior-posterior translation medially than laterally, without constraining the medial condyle to a fixed position. Furthermore, the post-cam implant design showed a significantly more posterior position of the femoral condyles in flexion compared to the other designs. The results show that despite the differences in ligament situations and individual implant positioning, specific characteristics of each implant design can be identified, reflecting the different geometries of the implant components.

Kinematic Patterns of Different Loading Profiles Before and After Total Knee Arthroplasty: A Cadaveric Study

One of the major goals of total knee arthroplasty (TKA) is to restore the physiological function of the knee. In order to select the appropriate TKA design for a specific patient, it would be helpful to understand whether there is an association between passive knee kinematics intraoperatively and during complex activities, such as ascending stairs. Therefore, the primary objective of this study was to compare the anterior-posterior (AP) range of motion during simulated passive flexion and stair ascent at different conditions in the same knees using a six-degrees-of-freedom joint motion simulator, and secondary, to identify whether differences between TKA designs with and without a post-cam mechanism can be detected during both activities, and if one design is superior in recreating the AP translation of the native knee. It was shown that neither TKA design was superior in restoring the mean native AP translation, but that both CR/CS and PS TKA designs may be suitable to restore the individual native kinematic pattern. Moreover, it was shown that passive and complex loading scenarios do not result in exactly the same kinematic pattern, but lead to the same choice of implant design to restore the general kinematic behavior of the native individual knee.

A New Methodology for the Accurate Measurement of Tibiofemoral Kinematics in Human Cadaveric Knees: An Evaluation of the Anterior-Posterior Laxity Pre- and Post-Cruciate Ligament Resection

Anterior-posterior (AP) stability is an important measure of knee performance after total knee arthroplasty (TKA). To improve the stabilizing effect of implants designed to compensate for the loss of the cruciate ligaments, it is important to understand the tibiofemoral contact situation within the native ligamentous situation of the knee and how it changes after cruciate ligament resection. This in vitro study introduces a new approach to accurately measure the tibiofemoral kinematics in a six-degrees-of-freedom joint motion simulator by tracking landmark-based coordinate systems and their corresponding bone geometries. The tibiofemoral contact situation was investigated by projecting the medial and lateral flexion facet centers onto the tibial plateau under AP shear forces across various flexion angles in thirteen knees. Tests were conducted pre- and post-cruciate ligament resection. Post-cruciate ligament resection, the femoral condyles shifted closer to or even exceeded the posterior border of the tibial plateau, but only slightly closer to the anterior border. This study presents a new methodology for measuring the tibiofemoral kinematics that can be applied to multiple loading profiles. It provides a basis for further investigations, including passive or active muscle forces, to enhance the design of total knee protheses and improve surgical outcomes.

Bi-unicondylar arthroplasty : a biomechanics and clinical outcomes study

AIMS

Bi-unicondylar arthroplasty (Bi-UKA) is a bone and anterior cruciate ligament (ACL)-preserving alternative to total knee arthroplasty (TKA) when the patellofemoral joint is preserved. The aim of this study is to investigate the clinical outcomes and biomechanics of Bi-UKA.

METHODS

Bi-UKA subjects (n = 22) were measured on an instrumented treadmill, using standard gait metrics, at top walking speeds. Age-, sex-, and BMI-matched healthy (n = 24) and primary TKA (n = 22) subjects formed control groups. TKA subjects with preoperative patellofemoral or tricompartmental arthritis or ACL dysfunction were excluded. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were compared. Bi-UKA, then TKA, were performed on eight fresh frozen cadaveric knees, to investigate knee extensor efficiency under controlled laboratory conditions, using a repeated measures study design.

RESULTS

Bi-UKA walked 20% faster than TKA (Bi-UKA mean top walking speed 6.7 km/h (SD 0.9),TKA 5.6 km/h (SD 0.7), p < 0.001), exhibiting nearer-normal vertical ground reaction forces in maximum weight acceptance and mid-stance, with longer step and stride lengths compared to TKA (p < 0.048). Bi-UKA subjects reported higher OKS (p = 0.004) and EQ-5D (p < 0.001). In vitro, Bi-UKA generated the same extensor moment as native knees at low flexion angles, while reduced extensor moment was measured following TKA (p < 0.003). Conversely, at higher flexion angles, the extensor moment of TKA was normal. Over the full range, the extensor mechanism was more efficient following Bi-UKA than TKA (p < 0.028).

CONCLUSION

Bi-UKA had more normal gait characteristics and improved patient-reported outcomes, compared to matched TKA subjects. This can, in part, be explained by differences in extensor efficiency. Cite this article: Bone Joint Res 2021;10(11):723-733.