Gait Analysis of Conventional Total Knee Arthroplasty and Bicruciate Stabilized Total Knee Arthroplasty Using a Triaxial Accelerometer

Tibiofemoral articulation and axial tibial rotation of the knee after a cruciate retaining total knee arthroplasty

PURPOSE

Numerous research has reported that total knee arthroplasty (TKA) cannot reproduce axial tibial rotations of normal knees. The objective of this study was to measure the tibiofemoral articular contact motions and axial tibial rotations of TKA knees to investigate the mechanism causing the knee kinematics change of after TKAs.

METHODS

Eleven patients with unilateral cruciate retaining (CR) TKA were tested for measurements of knee motion during a weight-bearing flexion from 0° to 105° using an imaging technique. The tibiofemoral contact kinematics were determined using the contact points on medial and lateral surfaces of the tibia and femoral condyles. Axial tibial rotations were calculated using the differences between the medial and lateral articulation distances on the femoral condyles and tibial surfaces at each flexion interval of 15°.

RESULTS

On femoral condyles, articular contact distances are consistently longer on the medial than on the lateral sides (p < 0.05) up to 60° of flexion, corresponding to internal tibial rotations (e.g., 1.3° ± 1.0° at 15-30° interval). On tibial surfaces, the articular contact point on the medial side moved more posteriorly than on the lateral side at low flexion angles, corresponding to external tibial rotations (e.g., -1.4° ± 1.8° at 15-30° interval); and more anteriorly than on the lateral sides at mid-range flexion, corresponding to internal tibial rotations (e.g., 0.8° ± 1.7° at 45-60° interval). At higher flexion, articular motions on both femoral condyles and tibial surfaces caused minimal changes in tibial rotations.

CONCLUSIONS

These results indicate that the axial tibial rotations of these TKA knees were mainly attributed to asymmetric articulations on the medial and lateral femoral condyles and tibial surfaces. The data can help understand the mechanisms causing axial tibial rotations of TKA knees and help improve implant designs for restoration of normal knee kinematics.

Comparison of the Journey II bicruciate stabilised (JII-BCS) and GENESIS II total knee arthroplasty for functional ability and motor impairment: the CAPAbility, blinded, randomised controlled trial

OBJECTIVES

To determine if a newer design of total knee replacement (TKR) (Journey II BCS) produces superior patient-reported outcomes scores and biomechanical outcomes than the older, more established design (Genesis II).

SETTING

Patients were recruited from an NHS University Hospital between July 2018 and October 2019 with surgery at two sites. Biomechanical and functional capacity measurements were at a University Movement and Exercise Laboratory.

PARTICIPANTS

80 participants undergoing single-stage TKR.

INTERVENTIONS

Patients were randomised to receive either the Journey II BCS (JII-BCS) or Genesis II TKR.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome was the Oxford Knee Score (OKS), at 6 months. Secondary outcomes were: OKS Activity and Participation Questionnaire, EQ-5D-5L and UCLA Activity scores, Timed Up and Go Test, 6 min walk test, lower limb kinematics and lower limb muscle activity during walking and balance.

RESULTS

This study found no difference in the OKS between groups. The OKS scores for the JII-BCS and Genesis II groups were mean (SD) 42.97 (5.21) and 43.13 (5.20) respectively, adjusted effect size 0.35 (-2.01,2.71) p=0.771In secondary outcome measures, the Genesis II group demonstrated a significantly greater walking range-of-movement (50.62 (7.33) vs 46.07 (7.71) degrees, adjusted effect size, 3.14 (0.61,5.68) p=0.02) and higher peak knee flexion angular velocity during walking (mean (SD) 307.69 (38.96) vs 330.38 (41.40) degrees/second, adjusted effect size was 21.75 (4.54,38.96), p=0.01) and better postural control (smaller resultant centre of path length) during quiet standing than the JII-BCS group (mean (SD) 158.14 (65.40) vs 235.48 (176.94) mm, adjusted effect size, 59.91 (-105.98, -13.85) p=0.01.).

CONCLUSIONS

In this study population, the findings do not support the hypothesis that the Journey II BCS produces a better outcome than the Genesis II for the primary outcome of the OKS at 6 months after surgery.

TRIAL REGISTRATION NUMBER

ISRCTN32315753.

Anatomical bi-cruciate retaining TKA improves gait ability earlier than bi-cruciate stabilized TKA based on triaxial accelerometery data: A prospective cohort study

Background

Total knee arthroplasty (TKA) is a common and cost-effective surgical treatment for osteoarthritis of the knee. However, only 82-89% of patients who performed TKA are satisfied with the postoperative outcomes. Therefore, bi-cruciate retaining (BCR) TKA is re-attracting attention. By retaining the anterior cruciate ligament (ACL), the knee may obtain the kinematic pathway that are closer to the native knee. The aim of the present study is to compare the ability to walk before and after surgery in patients who underwent bi-cruciate retaining total knee arthroplasty (BCR TKA) versus bi-cruciate stabilized (BCS) TKA during the early postoperative period.

Methods

Subjects included patients who underwent BCR TKA (10 knees) and BCS TKA (15 knees). We administered 10-meter gait tests before surgery and at 6 weeks and 3 months after surgery. We collected the following triaxial accelerometery data with a portable gait analyzer: walking time, number of steps, velocity, stride length, and coefficient of variability (CV) of double-leg support time while walking.

Results

Patients who underwent BCR TKA improved their gait ability [walking time (p < 0.01), number of steps (p < 0.05), velocity (p < 0.01), and stride length (p < 0.01) more than those who received BCS TKA at 6 weeks after surgery. BCR TKA improved gait ability (walking time, number of steps, velocity, and stride length) more than BCS TKA at 6 weeks after surgery. At 6 weeks after surgery, CV of double-leg support time while walking improved more in the BCR TKA group than in the BCS TKA group (p < 0.05).

Conclusions

BCR TKA is associated with improved gait ability in the early postoperative period.

Gait Analysis after Total Knee Arthroplasty Assisted by 3D-Printed Personalized Guide

Background

With the development of three-dimensional printing (3DP) technology, the patient-specific instrumentation (PSI) has been widely applied in total knee arthroplasty (TKA). The purpose of this study was to compare the gait parameters of patients with 3DP personalized guide-assisted and standard TKA.

Methods

Retrospective analysis of the advanced knee OA cases in our hospital between June 2017 and June 2018 was conducted. 30 cases received 3DP personalized guide-assisted TKA (group A), and 60 patients who underwent standard TKA during the same period were in group B and group C according to the computed tomography (CT) measurement results, each with 30 cases. Hip–knee–ankle angle (HKA), patella transverse axis-femoral transepicondylar axis angle (PFA), and gait parameters were statistically analyzed. The function was assessed by Hospital for Specific Surgery (HSS) and Knee Society Score (KSS).

Results

The mean follow-up period was 12.3 months in the three groups. The knee max flexion angle at the swing phase of group A was larger than group B and group C (P < 0.05), there was no statistically significant difference in other gait parameters. The mean PFA of group A was smaller than that of group B and group C (P < 0.05). While, the HKA, HSS, and KSS scores of three groups showed no significant difference.

Conclusion

3DP personalized guide technology could improve the gait parameters after surgery, specifically reflected in the knee max flexion angle at the swing phase. It could also assist in the reconstruction of more accurate patellar tracking and rotational alignment in TKA, avoiding the occurrence of insufficient or excessive extorsion.