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1
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Gu X, Zhou C, Zhu X, Cao J, Li H. Early postoperative gait characteristics after unicompartmental knee arthroplasty: results and clinical implications. BMC Musculoskelet Disord 2025; 26:472. [PMID: 40375309 PMCID: PMC12080156 DOI: 10.1186/s12891-025-08628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/07/2025] [Indexed: 05/18/2025] Open
Abstract
BACKGROUND AND OBJECTIVE Despite the established efficacy of unicompartmental knee arthroplasty (UKA), quantitative assessments of early postoperative changes in gait and stability remain limited. This study investigated preoperative and postoperative alterations in gait and stability following UKA. METHODS A cohort of 30 patients undergoing unilateral UKA at the Joint Surgery Department of the Affiliated Hospital of Xuzhou Medical University between May 2021 and 2022 was compared with a control group of 15 healthy elderly individuals without a history of hip or knee pathology. Evaluated parameters included Hospital for Special Surgery (HSS) scores, center of pressure path length, 95% confidence ellipse area, pace, stride length, stride frequency, gait cycle, and single support time percentage. Measurements were obtained preoperatively and at 1 and 3 months postoperatively for both groups. RESULTS Step frequency remained unchanged between preoperative and 1-month postoperative assessments (p > 0.05). Stability declined at 1 month postoperatively relative to baseline, whereas other gait parameters showed significant improvement (p < 0.05). By 3 months, HSS scores and all gait and stability metrics exhibited substantial enhancement compared to baseline (p < 0.05). CONCLUSIONS Early gait recovery following UKA demonstrated a positive trajectory; however, step frequency showed minimal improvement, and stability remained compromised at 1 month postoperatively. Quantitative gait analysis provides a robust framework for monitoring rehabilitation progress after UKA.
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Affiliation(s)
- Xu Gu
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Chengqiang Zhou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - XinFei Zhu
- Department of Orthopedics, Xuzhou Ren Ci Hospital, Xuzhou, China
| | - Jie Cao
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hongwei Li
- Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University, Quanshan District, Xuzhou, 221000, Jiangsu, China.
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Zhang M, Wang H, Zhang Y, Zhang H, Zhang Q, Zu X, Chai W, Li X. Gradual restoration of gait following unicompartmental knee arthroplasty: a prospective study. J Orthop Surg Res 2025; 20:315. [PMID: 40141006 PMCID: PMC11938596 DOI: 10.1186/s13018-025-05662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 02/27/2025] [Indexed: 03/28/2025] Open
Abstract
BACKGROUND This study investigates the gait characteristics and clinical outcomes following Unicompartmental Knee Arthroplasty (UKA) to provide scientific evidence for optimizing postoperative rehabilitation and patient management. METHODS Between December 2022 and November 2023, 34 patients with unilateral medial compartment knee osteoarthritis (KOA) underwent UKA. Preoperative and postoperative videos of patients in standing, walking (side view), squatting, and supine knee-bending positions were captured using smartphones. Gait parameters including gait cycle, swing time, swing phase, stance time, stance phase, double support time, walking speed, step time, cadence, step length, stride length, stride width, active knee flexion angle, and maximum hip and knee flexion angles during squatting were analyzed using the MediaPipe framework for human pose estimation. RESULTS Postoperative WOMAC scores were significantly lower than preoperative scores (P < 0.001), while postoperative KSS scores were significantly higher than preoperative scores (P < 0.001).Compared to preoperatively, postoperative affected-side gait speed, step length, step width, and active knee flexion angle all increased (P < 0.05). Additionally, postoperative gait cycle time and double-limb support time were reduced compared to preoperative values (P < 0.05). Among the 17 patients who could perform squats preoperatively and postoperatively, the maximum knee flexion angle and hip flexion angle in the squat position increased from preoperative values of (96.41 ± 20.65)° and (113.77 ± 22.56)° to postoperative values of (110.15 ± 20.79)° and (124.84 ± 21.13)°. CONCLUSIONS UKA significantly enhances knee joint kinematics, facilitating the transition from basic to advanced functional activities.
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Affiliation(s)
- Ming Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
- Medical School of Chinese People'S Liberation Army, Beijing, 100853, People's Republic of China
| | - Haoyue Wang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Yu Zhang
- BinZhou People's Hospital, Binzhou, 256600, People's Republic of China
| | - Haochong Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Quanlei Zhang
- Medical School of Chinese People'S Liberation Army, Beijing, 100853, People's Republic of China
| | - Xiaoran Zu
- Medical School of Chinese People'S Liberation Army, Beijing, 100853, People's Republic of China
| | - Wei Chai
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China.
| | - Xiang Li
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China.
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Tone S, Naito Y, Wakabayashi H, Sudo A, Hasegawa M. Association between femorotibial rotational mismatch and early clinical outcomes after bi-cruciate retaining total knee arthroplasty. BMC Musculoskelet Disord 2025; 26:251. [PMID: 40082845 PMCID: PMC11905545 DOI: 10.1186/s12891-025-08478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/28/2025] [Indexed: 03/16/2025] Open
Abstract
BACKGROUND Bi-cruciate retaining (BCR) total knee arthroplasty (TKA) is considered to provide improved clinical function and kinematics compared with conventional TKA, but it is unclear which factors affect clinical outcomes after BCR TKA. This study aimed to investigate whether rotational alignment of the femoral and tibial components and rotational mismatch between the femoral and tibial components affected early clinical outcomes after BCR TKA, according to the 2011 version of the Knee Society Score (2011KSS). METHODS This retrospective cohort study included 39 knees that underwent BCR TKA. Rotational alignment of the femoral and tibial components and rotational mismatch between the components were measured by computed tomography based three-dimensional evaluation software. 2011KSS was obtained at 3, 6, and 12 months postoperatively. The relationship of each of rotational alignment and rotational mismatch with 2011KSS was analyzed. RESULTS Rotational alignment of the femoral and tibial components was not correlated with symptoms, patient satisfaction, patient expectations, or functional activities at 3, 6, or 12 months postoperatively. Rotational mismatch was negatively correlated with symptoms, patient satisfaction and functional activities at 3 months; negatively correlated with symptoms and functional activities at 6 months; and negatively correlated with symptoms, patient satisfaction, patient expectations and functional activities at 12 months postoperatively. CONCLUSIONS Rotational mismatch between the femoral and tibial components was negatively correlated with 2011KSS, whereas no relationship of rotational alignment of the femoral and tibial components with 2011KSS was observed. Excessive external rotation of the tibial component relative to the femoral component resulted in worse early clinical outcomes.
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Affiliation(s)
- Shine Tone
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Mie, Japan
| | - Yohei Naito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Mie, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Mie, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, 2-174 Edobashi, Tsu, 514-8507, Mie, Japan.
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Wang YL, Li Y, Zhuge J, Li XY. Meta-analysis of the efficacy of lateral unicompartmental knee arthroplasty and total knee arthroplasty in the treatment of isolated lateral compartment knee osteoarthritis. J Orthop Surg Res 2025; 20:49. [PMID: 39815335 PMCID: PMC11736982 DOI: 10.1186/s13018-025-05457-0] [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: 11/20/2024] [Accepted: 01/03/2025] [Indexed: 01/18/2025] Open
Abstract
OBJECTIVES To systematically evaluate the efficacy of lateral unicompartmental knee arthroplasty (LUKA) and total knee arthroplasty (TKA) in the treatment of isolated lateral compartment knee osteoarthritis (LCKO), and to provide guidance and a basis for selecting surgery in clinical practice. METHODS Inclusion and exclusion criteria for literature were established, appropriate effect indicators were selected, and PubMed, Web of Science, Embase, Medline, Cochrane Library, and CNKI databases were searched using a computer. The Newcastle Ottawa scale (NOS) was used to evaluate the quality of the literature. After data extraction, Meta-analysis was performed using Revman5.4 software. RESULTS A total of 8 studies were included in this meta-analysis, involving 490 patients, with 204 in the TKA group and 286 in the LUKA group. Meta-analysis found that, there was no significant statistical difference in operation time between the LUKA group and the TKA group. Nevertheless, LUKA offers advantages such as reduced intraoperative blood loss and shorter hospitalization time. At the same time, the LUKA group also had advantages over the TKA group in postoperative visual analogue scale (VAS) score, knee joint range of motion, Oxford Knee Score (OKS)score and Hospital for Special Surgery (HSS) score. CONCLUSION When LUKA and TKA are used to treat isolated LCKO, LUKA has the advantages of less intraoperative blood loss, shorter hospital stay, lower postoperative VAS score, and better knee function score and range of motion.
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Affiliation(s)
- Yong-le Wang
- Department of Orthopaedics, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, No. 9, Jiaowei Road, Liuhongqiao, Wenzhou, 325000, People's Republic of China
| | - Yue Li
- Department of Orthopaedics, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, No. 9, Jiaowei Road, Liuhongqiao, Wenzhou, 325000, People's Republic of China
| | - Jingle Zhuge
- Department of Orthopaedics, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, No. 9, Jiaowei Road, Liuhongqiao, Wenzhou, 325000, People's Republic of China
| | - Xi-Yong Li
- Department of Orthopaedics, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, No. 9, Jiaowei Road, Liuhongqiao, Wenzhou, 325000, People's Republic of China.
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5
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Chen J, Wang Q, Zhao Z, Song Q, Zhao P, Wang D. Acute effects of tissue flossing on boxers with chronic knee pain. Front Bioeng Biotechnol 2025; 12:1508054. [PMID: 39877264 PMCID: PMC11772274 DOI: 10.3389/fbioe.2024.1508054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 12/17/2024] [Indexed: 01/31/2025] Open
Abstract
Objectives To explore the acute intervention effects of tissue flossing on chronic knee pain (CKP) in boxers. Methods Eighteen boxers with CKP (12 male/6 female) were randomly divided into an experimental group (EG) with tissue flossing (n = 9) and a control group (CG) (n = 9). The visual analog scale (VAS), Lysholm knee function score, flexion range of motion (ROM), maximal isometric extensor muscle strength, and stability of the knee were measured pre- and post-intervention (EG: 3-minute tissue flossing, CG: rest). Results VAS (F = 15.849, p = 0.001, η 2 p = 0.498) and Lysholm knee function (F = 9.327, p = 0.008, η 2 p = 0.357) significantly improved more in the EG than in the CG. There was a significant difference for maximal isometric extensor muscle strength (F = 17.769, p = 0.001, η 2 p = 0.542) and knee stability (F = 13.844, p = 0.002, η 2 p = 0.464) but no significant difference for ROM (F = 1.218, p = 0.287, η 2 p = 0.075) between the EG and CG. Conclusion Tissue flossing can reduce knee pain, improve knee function, increase knee extensor strength, and improve knee stability in boxers with CKP.
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Affiliation(s)
- Jie Chen
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
| | - Qirong Wang
- Sports Nutrition Center, National Institute of Sports Medicine, Beijing, China
| | - Zhiguang Zhao
- Sports Nutrition Center, National Institute of Sports Medicine, Beijing, China
| | - Qipeng Song
- College of Sports and Health, Shandong Sport University, Jinan, China
| | - Peng Zhao
- Sports Science Research Institute of the State Sports General Administration, Beijing, China
| | - Dan Wang
- School of Athletic Performance, Shanghai University of Sport, Shanghai, China
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Kyriakidis T, Hernigou J, Pitsilos C, Verdonk R, Koulalis D. No clinical superiority of bi-cruciate retaining versus posterior stabilized total knee arthroplasty at two years follow-up. Acta Orthop Belg 2024; 90:409-414. [PMID: 39851011 DOI: 10.52628/90.3.11905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2025]
Abstract
The purpose of the present study was to evaluate and compare the clinical outcomes of two groups of patients subject to bi-cruciate retaining (BCR) or posterior-stabilized (PS) implants. It was hypothesized that patients treated with BCR prostheses would present higher flexion and better clinical and functional results than those treated with PS implants. This prospective study included thirty-two patients treated for primary knee osteoarthritis and assigned to two matched groups for their demographic characteristics and comorbidities. Those with functioning cruciate ligaments received bi- cruciate retaining prostheses. In the case of ligaments' insufficiency, the posterior-stabilised design was selected. The primary outcome was knee flexion, and secondary outcomes included the patient's reported outcomes as recorded by the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, visual analogue scale (VAS) for pain, treatment- related complications, and surgical time. Complete data were recorded for all patients with a minimum of 2 years of follow-up. This study found a statistically significant improvement in all the analysed clinical and functional assessment tools from baseline to the latest follow-up (p<0.05) for both groups. However, no statistically significant difference was found between the two groups. Furthermore, bi-cruciate retaining design is surgical time. There was no evidence of clinical superiority of bi-cruciate retaining compared to posterior stabilized knee implants. Therefore, further randomized studies with more participants and a longer follow-up on comparing bi-cruciate retaining and posterior stabilized implants in primary knee osteoarthritis could be rewarding.
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Özden F, Uysal İ, Tümtürk İ, Özkeskin M, Özyer F. Does backward gait require more proprioception and balance in older adults after total knee arthroplasty? J Orthop 2024; 54:86-89. [PMID: 38560588 PMCID: PMC10972762 DOI: 10.1016/j.jor.2024.03.013] [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: 03/03/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Some basic and instrumental daily living activities include backward gait. There is a need to clarify which parameters should be focused more on to improve backward gait in older individuals. This research investigated the proprioception, and balance in forward-backward gait of older individuals with total knee arthroplasty (TKA). Methods A prospective cross-sectional research was conducted with 105 older adults with TKA. Individuals' forward and backward gait performance was assessed with the Timed Up & Go Test (TUG) and 3 Meter Walk Back Test (3MBWT), respectively. Proprioception was measured with a mobile application-based inclinometer. Berg Balance Scale (BBS) and Activity Specific Balance Confidence Scale (ABC) were used to assess balance and balance confidence levels, respectively. A single clinician evaluated the individuals. Results TUG was weakly and positively correlated with the Right and Left Leg Proprioception Test (RLPT and LLPT) (r1 = 0.386, r2 = 0.391, p < 0.01). Also, the 3MBWT was weakly and positively correlated with RLPT and LLPT, respectively (r1 = 0.293, r2 = 0.251, p < 0.01). In addition, TUG was strongly and negatively correlated with BBS and ABC, respectively (r1 = -0,693, r2 = -0.722, p < 0.01). Besides, 3MBWT was strongly and negatively correlated with BBS and ABC (r1 = -0.642, r2 = -0.645, p < 0.01). Conclusion The study revealed that forward and backward walking were similarly associated with balance and proprioception in older adults with TKA. Clinicians should focus more on balance ability than proprioception to improve backward walking performance in older individuals with THA.
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Affiliation(s)
- Fatih Özden
- Muğla Sıtkı Koçman University, Köyceğiz Vocational School of Health Services, Department of Health Care Services, Muğla, Turkey
| | - İsmail Uysal
- Muğla Sıtkı Koçman University, Fethiye Vocational School of Health Services, Department of Health Care Services, Muğla, Turkey
| | - İsmet Tümtürk
- Süleyman Demirel University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Isparta, Turkey
| | - Mehmet Özkeskin
- Ege University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, İzmir, Turkey
| | - Fatih Özyer
- Fethiye State Hospital, Department of Orthopaedics and Traumatology, Muğla, Turkey
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Barberis L, Sabatini L, Pellegrino A, Galletta C, Risitano S, Capella M, Massè A, Schiraldi M, Indelli PF. Bi-cruciate retaining total knee arthroplasty is here to stay: A consecutive series transitioning from manual instrumentation to enabling technologies. Technol Health Care 2024; 32:3761-3768. [PMID: 38607775 DOI: 10.3233/thc-231608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Bicruciate-retaining (BCR) total knee arthroplasty (TKA) has seen renewed interest due to the potential for more natural knee kinematics with anterior cruciate ligament (ACL) retention. OBJECTIVE The present study attempts to determine differences in the 2-year survivorship and patient-reported outcomes between two surgical strategies (traditional instrumentation versus robotics) applied to the extensive use of a modern, 2nd generation BCR TKA design. METHODS We performed a retrospective study with prospectively collected data of 113 patients who underwent primary TKA between 2018 and 2020 using a 2nd generation BCR TKA implant. Patient demographics, PROMS, and intra/post-operative complications were collected. Patients were also evaluated according to the use or not of robotics. A Kaplan-Meier analysis was used to evaluate revision-free survival at follow up. RESULTS 102 patients were enrolled: 90 received traditional surgery and 12 robotic-assisted surgery. The mean age was 68 years (SD 7.76) with an average BMI of 29.6 kg/m2 (SD 3.56). The mean follow up (FU) was 32.4 ± 6.2 months (range 24-45 months). Survivorship at 2 years was 98% (95% CI: 92.4-99.5). Revisions/reoperations were performed for anterior cruciate ligament (ACL) tear (1/4), pain (1/4), arthrofibrosis (1/4) and acute periprosthetic joint infection (PJI) (1/4). At final FU, 92 patients (90.2%) considered themselves satisfied, showing a mean OKS of 40.6 (SD 5.1) and a mean FKS of 76.7 (SD 11.8). No differences in the outcome were found between traditional and robotic-assisted procedures. CONCLUSION The modern BCR design evaluated in this study achieved excellent results in terms of implant survivorship, low rate of reoperation and clinical results, independently from the use of enabling technologies.
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Affiliation(s)
- Luca Barberis
- School of Medicine, University of Turin, Turin, Italy
| | | | | | | | | | | | | | | | - Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
- SOC Ortopedia Protesica - CESAT, USL Toscana Centro, Fucecchio, Italy
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Inui H, Yamagami R, Kono K, Kawaguchi K, Kage T, Murakami R, Nakamura H, Saita K, Taketomi S, Tanaka S. Short-term clinical results of bicruciate-retaining total knee arthroplasty using personalized alignment. BMC Musculoskelet Disord 2023; 24:965. [PMID: 38087214 PMCID: PMC10714564 DOI: 10.1186/s12891-023-07083-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Bicruciate-retaining (BCR) prosthesis has been introduced to recreate normal knee movement by preserving both the anterior and posterior cruciate ligaments. However, the use of BCR total knee arthroplasty (TKA) is still debatable because of several disappointing reports. We have been performing BCR TKAs with personalized alignment (PA). This study aimed to reveal the limb alignment and soft tissue balance of FA-BCR TKAs and compare the clinical outcomes of FA-BCR TKAs with those of unicompartmental knee arthroplasty (UKA). METHODS Fifty BCR TKAs and 58 UKAs were included in this study. The joint component gaps of BCR TKA were evaluated intraoperatively and the postoperative hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA) were measured using full-length standing radiography. The short-term clinical outcomes of BCR TKAs were compared with those of UKA using the scoring system of 2011 Knee Society Scoring (KSS) and the knee injury and osteoarthritis outcome score (KOOS) at an average of 2 years postoperatively (1-4yeras). RESULTS The coronal alignment values of PA-BCR TKA were as follows: HKA angle, 177.9° ± 2.3°; MPTA, 85.4° ± 1.9°; and LDFA, 87.5° ± 1.9°. The joint component gaps at flexion angles of 10°, 30°, 60°, and 90° were 11.1 ± 1.2, 10.9 ± 1.4, 10.7 ± 1.3, and 11.2 ± 1.4 mm for the medial compartment and 12.9 ± 1.5, 12.6 ± 1.8, 12.5 ± 1.8 and 12.5 ± 1.7 mm for the lateral compartment, respectively. The patient expectation score and maximum extension angle of PA-BCR TKA were significantly better than those of UKAs. CONCLUSIONS The short-term clinical outcomes of PA-BCR TKA were comparable or a slightly superior to those of UKAs.
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Affiliation(s)
- Hiroshi Inui
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan.
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ryo Murakami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Haruhiko Nakamura
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan
| | - Kazuo Saita
- Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe City, Saitama, 350-8500, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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10
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Tone S, Hasegawa M, Naito Y, Wakabayashi H, Sudo A. Association between pre- and postoperative rotational mismatches of the femorotibial components and bones in bi-cruciate retaining and posterior stabilized total knee arthroplasty. Sci Rep 2023; 13:14902. [PMID: 37689778 PMCID: PMC10492851 DOI: 10.1038/s41598-023-42243-6] [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: 05/07/2023] [Accepted: 09/07/2023] [Indexed: 09/11/2023] Open
Abstract
To clarify the association between pre- and postoperative rotational mismatches of the femorotibial components and bones for total knee arthroplasty (TKA) with bi-cruciate retaining (BCR) design and with fixed bearing posterior stabilized (PS) design. This retrospective cohort study included 40 BCR TKAs and 50 PS TKAs. Pre- and postoperative rotational mismatches of the femorotibial components and bones were measured by three-dimensional assessment based on computed tomography imaging. The mean value and percentage within ± 5° of pre- and postoperative rotational mismatches were compared between BCR TKA and PS TKA. Correlations between pre- and postoperative rotational mismatches of the femorotibial components and bones were investigated in BCR TKA and PS TKA. There was no significant difference in mean preoperative rotational mismatch of femorotibial components and bones between BCR TKA and PS TKA. Mean postoperative rotational mismatch of femorotibial components and bones was significantly greater in BCR TKA than in PS TKA. Postoperative rotational mismatch of the femorotibial components was within ± 5° in 21 knees (52.5%) for BCR TKA and in 43 knees (86.0%) for PS TKA. The rate of postoperative rotational mismatch of the femorotibial components and bones within ± 5° was significantly lower for BCR TKA than for PS TKA. In BCR TKA, there was a positive correlation between pre- and postoperative rotational mismatches of the femorotibial components and of bones. We consider these results can be attributed to the retention of both cruciate ligaments, which may affect the reduction of rotational permittance of the components and bones.
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Affiliation(s)
- Shine Tone
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University, Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
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11
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Sun K, Wu Y, Wu L, Shen B. Comparison of clinical outcomes among total knee arthroplasties using posterior-stabilized, cruciate-retaining, bi-cruciate substituting, bi-cruciate retaining designs: a systematic review and network meta-analysis. Chin Med J (Engl) 2023; 136:1817-1831. [PMID: 37365688 PMCID: PMC10406014 DOI: 10.1097/cm9.0000000000002183] [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: 09/24/2022] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Despite the advent of innovative knee prosthesis design, a consistent first-option knee implant design in total knee arthroplasty (TKA) remained unsettled. This study aimed to compare the clinical effects among posterior-stabilized (PS), cruciate-retaining (CR), bi-cruciate substituting (BCS), and bi-cruciate retaining designs for primary TKA. METHODS Electronic databases were systematically searched to identify eligible randomized controlled trials (RCTs) and cohort studies from inception up to July 30, 2021. The primary outcomes were the range of knee motion (ROM), and the secondary outcomes were the patient-reported outcome measures (PROMs) and complication and revision rates. Confidence in evidence was assessed using Confidence in Network Meta-Analysis. The Bayesian network meta-analysis was performed for synthesis. RESULTS A total of 15 RCTs and 18 cohort studies involving 3520 knees were included. The heterogeneity and inconsistency were acceptable. There was a significant difference in ROM at the early follow-up when PS was compared with CR (mean difference [MD] = 3.17, 95% confidence interval [CI] 0.07, 7.18) and BCS was compared with CR (MD = 9.69, 95% CI 2.18, 17.51). But at the long-term follow-up, there was no significant difference in ROM in any one knee implant compared with the others. No significant increase was found in the PROMs and complication and revision rates at the final follow-up time. CONCLUSIONS At early follow-up after TKA, PS and BCS knee implants significantly outperform the CR knee implant in ROM. But in the long run, the available evidence suggests different knee prostheses could make no difference in clinical outcomes after TKA with extended follow-up.
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Affiliation(s)
- Kaibo Sun
- Department of Orthopedics Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Bicruciate-retaining total knee arthroplasty non-inferior to posterior-stabilized prostheses after 5 years: a randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:1034-1042. [PMID: 36329189 DOI: 10.1007/s00167-022-07210-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Bicruciate-retaining (BCR) prostheses may improve satisfaction of patient undergoing total knee arthroplasty (TKA). The objective of this randomized controlled trial was to assess whether BCR prostheses provide better clinical outcomes than posterior-stabilized (PS) prostheses. MATERIALS AND METHODS This is a randomized single-blind control trial involving a total of 77 patients with knee osteoarthritis, randomly assigned to undergo TKA with a BCR or PS implant between 2015 and 2019. Mean follow-up period was 39 months. Clinical and demographic data were extracted manually from medical records. Data acquisition included patient demographics, knee range of motion, and patient-reported outcomes via KSS, KOOS, WOMAC, and SF-12 scores. RESULTS A total of 38 patients were randomized to the PS group and 39 to the BCR group. At the 5-year follow-up, no statistical differences were noted for knee range of motion or patient-reported outcomes between the two groups, except for a greater knee flexion in the early follow-up period in the PS group. Five adverse events occurred in the BCR group compared to none in the PS group (p = 0.02). CONCLUSION BCR TKA yield similar clinical and patient-reported outcomes 5 years following the intervention compared with PS TKA. The BCR TKA had more complications. LEVEL OF EVIDENCE I (Randomized Controlled Trial).
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13
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Yamagami R, Inui H, Taketomi S, Kono K, Kawaguchi K, Sameshima S, Kage T, Tanaka S. Proximal tibial morphology is associated with risk of trauma to the posteromedial structures during tibial bone resection reproducing the anatomical posterior tibial slope in bicruciate-retaining total knee arthroplasty. Knee 2022; 36:1-8. [PMID: 35381571 DOI: 10.1016/j.knee.2022.03.008] [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: 09/14/2020] [Revised: 07/23/2021] [Accepted: 03/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A tibial cut with the native posterior tibial slope (PTS) is a theoretical prerequisite in bicruciate-retaining total knee arthroplasty (BCRTKA) to regain physiological knee kinematics. The present study reveals tibial morphological risk factors of trauma to the posteromedial structures of the knee during tibial bone resection in BCRTKA. METHODS Fifty patients undergoing BCRTKA for varus knee osteoarthritis were analyzed. A three-dimensional tibial bone model was reconstructed using a computed tomography-based preoperative planning system, and the coronal tibial slope (CTS) and medial PTS (MPTS) were measured. Then, we set the simulated tibial cutting plane neutral on the coronal plane, posteriorly inclined in accordance with the MPTS on the sagittal plane, and 9 mm below the surface of the subchondral cortical bone (i.e., 11 mm below the surface of the cartilage) of the lateral tibial plateau. The association between the tibial morphology and the distance from the simulated cutting plane to the semimembranosus (SM) insertion (Dsm) was analyzed. RESULTS Of the 50 patients, 19 (38%) had negative Dsm values, indicating a cut into the SM (namely, below the posterior oblique ligament) insertion. The MPTS was negatively correlated with Dsm (r = -0.396, p = 0.004), whereas the CTS was positively correlated with Dsm (r = 0.619, p < 0.001). On multivariate linear regression analysis, the MPTS and CTS were independent predictors of Dsm. CONCLUSION In the setting of tibial cuts reproducing the native MPTS in BCRTKA, patients with larger PTS and smaller CTS had more risk of trauma to the posteromedial structures.
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Affiliation(s)
- Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin Sameshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Eggenberger EE, Hurst JM, Morris MJ, Berend KR, Lombardi AV, Crawford DA. Midterm Outcomes of a Bicruciate-Retaining Compared With the Bicruciate-Sacrificing Knee System. J Arthroplasty 2022; 37:S245-S249. [PMID: 35190243 DOI: 10.1016/j.arth.2021.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/03/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to report midterm outcomes and survivorship of a bicruciate retaining knee arthroplasty compared with a bicruciate sacrificing anterior stabilized knee arthroplasty. METHODS A retrospective comparative cohort analysis was performed of all patients who underwent primary total knee arthroplasty with the bicruciate retaining (XP) knee arthroplasty compared with an anterior stabilized (AS) cruciate sacrificing bearing. The XP system was used in 195 knees and was compared with 1471 knees in which the AS bearing was used. Patients were included in analysis if they had minimum 2-year follow-up or had a revision at any point. Preoperative and postoperative range of motion, Knee Society Scores, complications, and reoperations were evaluated. Unpaired t-test and chi-square analysis were performed. Kaplan-Meier survival analysis was performed for all-cause and aseptic survival. RESULTS At an average of 5.2-year follow-up, 22 (11.3%) XP knees had been revised, compared with 23 (1.6%) AS knees (P < .001). Nineteen (9.7%) XP knees were revised for aseptic tibial loosening; one (0.1%) of the AS knees was revised for the same (P < .001). Nineteen of the XR revision surgeries (86.4%) were for aseptic tibial loosening. Compared with AS knees, the XP knees had significantly lower improvement in range of motion (3.2 deg vs 2.2 deg, P < .001), Knee Society (KS) pain scores (39 vs 35.7, P = .014), KS clinical scores (52.4 vs 46, P < .001), and KS functional scores (20.9 vs 15.5, P = .01). CONCLUSION The bicruciate retaining Vanguard XP Total Knee System demonstrated an unacceptably high rate of aseptic tibial loosening without conferring the benefit of improved postoperative function relative to other available bearings.
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Affiliation(s)
| | - Jason M Hurst
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Michael J Morris
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Keith R Berend
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Adolph V Lombardi
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - David A Crawford
- Joint Implant Surgeons, Inc, New Albany, OH; Mount Carmel Health System, New Albany, OH
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15
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Van Criekinge T, Winnock de Grave P, Luyckx T, Claeys K. Trunk control, motion and alignment after total knee arthroplasty: a systematic review and meta-analysis. Gait Posture 2022; 94:173-188. [PMID: 35339965 DOI: 10.1016/j.gaitpost.2022.03.006] [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: 08/17/2021] [Revised: 03/07/2022] [Accepted: 03/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Trunk control improves mobility, balance and quality of life early after total knee arthroplasty (TKA) and is therefore considered an important parameter during the recovery process. However, little is known about trunk control, motion and alignment after TKA. Increasing our understanding aids in optimizing treatment strategies to enhance functional mobility after TKA. RESEARCH QUESTION Does trunk control, motion and alignment return to normal after TKA and is this related to functional mobility? METHODS Five scientific databases were searched until July 2021. Eligibility criteria consisted of outcomes assessing trunk control and alignment in a population of adults undergoing TKA. Two reviewers independently screened studies and risk of bias was assessed by Mixed Methods Appraisal Tool (MMAT). Meta-analysis was performed for subgroups gait and alignment. RESULTS Of the 362 studies retrieved, 24 were included. Study designs were cohorts with mixed methods (pre-post treatment, case-control and case-case) and three randomized controlled trials. The mean MMAT score was 75%, corresponding to low bias. In total 1178 patients and 197 controls were included. Results showed that pre-operative trunk motion was characterized by increased amplitudes in all three planes and altered alignment which did not all return to normal after TKA. Frontal plane motion and alignment recovered faster than the sagittal and transversal plane. Although pelvic tilt improved after surgery, sagittal imbalance (anteriorly shifted trunk position) was still present. SIGNIFICANCE Recovery of trunk motion after TKA is time-, speed- and technique-dependent. The observed differences in trunk motion with the healthy controls persisted after TKA. This indicates that incorporating a full biomechanical chain approach, including trunk motion and gait-retraining exercises with a strong focus on postural alignment could improve functional mobility after TKA. Limited studies are available assessing trunk control and trunk motion during functional tasks besides walking which warrant further investigation.
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Affiliation(s)
- Tamaya Van Criekinge
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Bruges, Belgium.
| | | | - Thomas Luyckx
- Dept. Orthopedic Surgery, AZ Delta Roeselare, Roeselare, Belgium
| | - Kurt Claeys
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Bruges, Belgium
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16
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van Houten AH, Heesterbeek PJC, Hannink G, Labey L, Wymenga AB. Limited effect of anatomical insert geometry on in vitro laxity in balanced anatomic posterior cruciate ligament retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:1273-1281. [PMID: 33860338 DOI: 10.1007/s00167-021-06564-1] [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] [Received: 01/10/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The present study assessed the effect of insert articular surface geometry (anatomical versus conventional insert design) on anteroposterior (AP) translation and varus-valgus (VV) laxity in balanced posterior cruciate ligament (PCL) retaining total knee arthroplasty (TKA). Secondly, we evaluated if the AP translation and VV laxity in the reconstructed knee resembled the stability of the native knee. METHODS Nine fresh-frozen full-leg cadaver specimens were used in this study. After testing the native knee, anatomical components of a PCL-retaining implant were implanted. The knee joints were subjected to anteriorly and posteriorly directed forces (at 20° and 90° flexion) and varus-valgus stresses (at 20°, 45° and 90° flexion) in both non-weightbearing and weightbearing situations in a knee kinematics simulator. Measurements were performed in the native knee, TKA with anatomical insert geometry (3° built-in varus, medial concave, lateral convex), and TKA with symmetrical insert geometry. RESULTS In weightbearing conditions, anterior translations ranged between 2.6 and 3.9 mm at 20° flexion and were < 1 mm at 90° flexion. Posterior translation at 20° flexion was 2.7 mm for the native knee versus 4.0 mm (p = 0.047) and 7.0 mm (p = 0.02) for the symmetrical insert and the anatomical insert, respectively. Posterior translation at 90° flexion was < 1.1 mm and not significantly different between the native knee and insert types. In non-weightbearing conditions, the anterior translation at 20° flexion was 5.9 mm for the symmetrical and 4.6 mm for the anatomical insert (n.s.), compared with 3.0 mm for the native knee (p = 0.02). The anterior translation at 90° flexion was significantly higher for the reconstructed knees (anatomical insert 7.0 mm; symmetrical insert 9.2 mm), compared with 1.6 mm for the native knee (both p = 0.02). Varus-valgus laxity at different flexion angles was independent of insert geometry. A valgus force in weightbearing conditions led to significantly more medial laxity (1°-3° opening) in the native knee at 45° and 90° flexion compared with the reconstructed knee for all flexion angles. CONCLUSIONS Insert geometry seems to have a limited effect with respect to AP translation and VV laxity, in the well-balanced PCL-retaining TKA with an anatomical femoral component. Secondly, AP translation and VV laxity in the reconstructed knee approximated the laxity of the native knee.
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Affiliation(s)
- Albert H van Houten
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands.
- OCON Centre for Orthopaedic Surgery, Hengelo, The Netherlands.
| | - Petra J C Heesterbeek
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands
- Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Luc Labey
- Department of Mechanical Engineering, KU Leuven, Geel, Belgium
| | - Ate B Wymenga
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, Hengstdal 3, 6522 JV, Nijmegen, The Netherlands
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Sabatini L, Barberis L, Camazzola D, Centola M, Capella M, Bistolfi A, Schiraldi M, Massè A. Bicruciate-retaining total knee arthroplasty: What’s new? World J Orthop 2021; 12:732-742. [PMID: 34754829 PMCID: PMC8554348 DOI: 10.5312/wjo.v12.i10.732] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/23/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Primary total knee arthroplasty (TKA) is a widespread procedure to address end stage osteoarthritis with good results, clinical outcomes, and long-term survivorship. Although it is frequently performed in elderly, an increased demand in young and active people is expected in the next years. However, a considerable dissatisfaction rate has been reported by highly demanding patients due to the intrinsic limitations provided by the TKA. Bicruciate-retaining (BCR) TKA was developed to mimic knee biomechanics, through anterior cruciate ligament preservation. First-generation BCR TKA has not gained popularity due to its being a challenging technique and having poor survival outcomes. Thanks to implant design improvement and surgeon-friendly instrumentation, second-generation BCR TKA has seen renewed interest. This review will focus on surgical indications, kinematical basis, clinical results and latest developments of second-generation BCR TKA.
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Affiliation(s)
- Luigi Sabatini
- Orthopaedics and Traumatology Department, Presidio CTO, Torino 10126, Italy
| | - Luca Barberis
- Orthopaedics and Traumatology Department, Presidio CTO, Torino 10126, Italy
| | - Daniele Camazzola
- Orthopaedics and Traumatology Department, CTO Hospital, Torino 10126, Italy
| | - Michele Centola
- Orthopaedics and Traumatology Department, Presidio CTO, Torino 10126, Italy
| | - Marcello Capella
- Orthopaedics and Traumatology Department, CTO Hospital, Torino 10126, Italy
| | | | - Marco Schiraldi
- Orthopedics and Traumaology Department, Michele e Pietro Ferrero Hospital, Verduno 12060, Italy
| | - Alessandro Massè
- Orthopaedics and Traumatology Department, CTO Hospital, Torino 10126, Italy
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18
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Bravi M, Santacaterina F, Bressi F, Papalia R, Campi S, Sterzi S, Miccinilli S. Does Posterior Cruciate Ligament Retention or Sacrifice in Total Knee Replacement Affect Proprioception? A Systematic Review. J Clin Med 2021; 10:jcm10163470. [PMID: 34441765 PMCID: PMC8396862 DOI: 10.3390/jcm10163470] [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] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Proprioception is an important part of the somatosensory system involved in human motion control, which is fundamental for activities of daily living, exercise, and sport-specific gestures. When total knee arthroplasty (TKA) is performed, the posterior cruciate ligament (PCL) can be retained, replaced, or discarded. The PCL seems to be responsible for maintaining the integrity of the joint position sense (JPS) and joint kinesthesia. The aim of this review was to assess the effect of PCL on knee joint proprioception in total knee replacement. Methods: This systematic review was conducted within five electronic databases: PubMed, Scopus, Web of Science, Cochrane, and PEDro with no data limit from inception to May 2021. Results: In total 10 publications were evaluated. The analysis was divided by proprioception assessment method: direct assessment (JPS, kinesthesia) and indirect assessment (balance). Conclusions: The current evidence suggest that the retention of the PCL does not substantially improve the joint proprioception after TKA. Due to the high heterogeneity of the studies in terms of design, proprioception outcomes, evaluation methods, further studies are needed to confirm the conclusions. In addition, future research should focus on the possible correlation between joint proprioception and walking function.
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Affiliation(s)
- Marco Bravi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
- Correspondence:
| | - Fabio Santacaterina
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
| | - Federica Bressi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.P.); (S.C.)
| | - Stefano Campi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.P.); (S.C.)
| | - Silvia Sterzi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
| | - Sandra Miccinilli
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
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Toyoda S, Kaneko T, Igarashi T, Takada K, Yoshizawa S. Higher patellofemoral compressive force does not affect anterior knee pain in anatomical bi-cruciate retaining total knee arthroplasty: In vivo prospective analysis of guided motion prosthesis. Clin Biomech (Bristol, Avon) 2021; 88:105444. [PMID: 34364101 DOI: 10.1016/j.clinbiomech.2021.105444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purposes of the present study are 1) to measure intraoperative patellofemoral compressive force in patients undergoing anatomical bi-cruciate retaining total knee arthroplasty and to assess the relationship between intraoperative patellofemoral compressive force and patient reported outcome measurements and 2) to compare patellofemoral compressive force and patient reported outcome measurements among patients who underwent anatomical bi-cruciate retaining, cruciate retaining, and bi-cruciate stabilized total knee arthroplasty. METHODS Twenty-two patients with varus osteoarthritis of the knee who underwent anatomical bi-cruciate retaining total knee arthroplasty, 20 patients who underwent cruciate retaining total knee arthroplasty, and 24 patients who underwent bi-cruciate stabilized total knee arthroplasty were assessed. Patient reported outcome measurements were evaluated at 1.5 years after surgery. FINDINGS Intraoperative patellofemoral compressive force was significantly lower with anatomical bi-cruciate retaining total knee arthroplasty than with cruciate retaining total knee arthroplasty at 60° to 140° of flexion and nearly equivalent to intraoperative patellofemoral compressive force with bi-cruciate stabilized total knee arthroplasty at all knee flexion angles examined. With anatomical bi-cruciate retaining total knee arthroplasty, there were no significant correlations between intraoperative patellofemoral compressive force and almost all patient reported outcome measurements except for 2011 Knee Society Score expectations, which was positively correlated with patellofemoral compressive force at 10° of flexion, and Patella score quadriceps strength, which was negatively correlated with patellofemoral compressive force at 60° of flexion. INTERPRETATION There were no significant correlations between intraoperative patellofemoral compressive force and anterior knee pain after anatomical bi-cruciate retaining total knee arthroplasty. Evidence level: 3.
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Affiliation(s)
- Shinya Toyoda
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan
| | - Takao Kaneko
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan.
| | | | - Kazutaka Takada
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan
| | - Shu Yoshizawa
- Ichinomiya Onsen Hospital, Adult Reconstruction Center, Japan
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20
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Zhang Q, Chen Z, Jin Z, Muratoglu OK, Varadarajan KM. Patient-specific musculoskeletal models as a framework for comparing ACL function in unicompartmental versus bicruciate retaining arthroplasty. Proc Inst Mech Eng H 2021; 235:861-872. [PMID: 33913346 DOI: 10.1177/09544119211011827] [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] [Indexed: 11/16/2022]
Abstract
Unicompartmental knee arthroplasty has been shown to provide superior functional outcomes compared to total knee arthroplasty and have motivated development of advanced implant designs including bicruciate retaining knee arthroplasty. However, few validated frameworks are available to directly compare the effect of implant design and surgical techniques on ligament function and joint kinematics. In the present study, the subject-specific lower extremity models were developed based on musculoskeletal modeling framework using force-dependent kinematics method, and validated against in vivo telemetric data. The experiment data of two subjects who underwent TKA were obtained from the SimTK "Grand Challenge Competition" repository, and integrated into the subject-specific lower extremity model. Five walking gait trials and three different knee implant models for each subject were used as partial inputs for the model to predict knee biomechanics for unicompartmental, bicruciate retaining, and total knee arthroplasty. The results showed no significant differences in the tibiofemoral contact forces or angular kinematic parameters between three groups. However, unicompartmental knee arthroplasty demonstrated significantly more posterior tibial location between 0% and 40% of the gait cycle (p < 0.017). Significant differences in range of tibiofemoral anterior/posterior translation and medial/lateral translation were also observed between unicompartmental and bicruciate retaining arthroplasty (p < 0.017). Peak values of anterior cruciate ligament forces differed between unicompartmental and bicruciate retaining arthroplasty from 10% to 30% of the gait cycle. Findings of this study indicate that unicompartmental and bicruciate retaining arthroplasty do not have identical biomechanics and point to the complementary role of anterior cruciate ligament and articular geometry in guiding knee function. Further, the patient-specific musculoskeletal model developed provides a reliable framework for assessing new implant designs, and effect of surgical techniques on knee biomechanics following arthroplasty.
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Affiliation(s)
- Qida Zhang
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.,Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), School of Mechanical Engineering, Chang'an University, Xi'an, China
| | - Zhongmin Jin
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, China.,Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China.,Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
| | - Orhun K Muratoglu
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kartik M Varadarajan
- Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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21
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Bi-cruciate retaining total knee arthroplasty: a systematic literature review of clinical outcomes. Arch Orthop Trauma Surg 2021; 141:293-304. [PMID: 33047230 DOI: 10.1007/s00402-020-03622-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/30/2020] [Indexed: 12/21/2022]
Abstract
Total knee arthroplasty (TKA) has been shown to have good long-term outcomes and survivorship. Nonetheless, dissatisfied patients are frequently reported in the literature. Bi-cruciate retaining total knee prostheses (BCR TKA) were designed to address the demand for more kinematically functional implants that better reconstruct natural knee kinematics. In BCR TKA, the anterior cruciate ligament (ACL) is preserved. Improved patient-reported outcomes and satisfaction levels are expected. This review aimed to summarize indications for and clinical outcomes of BCR TKA. A systematic literature review on BCR TKA was performed. 24 articles were included for data analysis. Indications covered osteoarthritis, inflammatory arthritis and others. The degree of deformity was often but not always limited to minor axial deformity and contractures: maximum acceptable varus/valgus deformity reached 10°-30° and flexion contractures of 15°-65°. ACL intactness was macroscopically examined intraoperatively in nine studies and clinically tested in ten studies (e.g., Lachmann Test, drawer-test). Objective and patient-reported outcome scores were reported for follow-up periods of up to 22 years. Survival rates varied significantly. For first generation implants, 22-year survival reached 82% while a second generation design was associated with 13.5% revision rate at 18 months. Reasons for varying outcomes were not clear and may be attributed to the implant itself, surgical techniques and patient specific variables including changed expectations and functional demand. The literature has not shown clear indications and guidelines for the use of BCR implants. The promising results of first generation BCR TKA designs may be optimized through improved implant designs in the future. Further studies are advocated to provide the necessary evidence of second generation BCR TKA designs.
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Takasago T, Hamada D, Wada K, Nitta A, Tamaki Y, Goto T, Tsuruo Y, Sairyo K. Insufficient lateral joint laxity after bicruciate-retaining total knee arthroplasty potentially influences kinematics during flexion: A biomechanical cadaveric study. Knee 2021; 28:311-318. [PMID: 33477002 DOI: 10.1016/j.knee.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/10/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Soft tissue balancing in bicruciate-retaining (BCR) total knee arthroplasty (TKA) is a challenge that must be overcome to achieve excellent clinical outcomes. However, the optimal degree of joint laxity has yet to be clarified. This cadaveric study sought to examine joint laxity after BCR TKA using a navigation system. METHODS Knee joint laxity was quantified using an image-free navigation system in 8 intact fresh frozen cadavers under three conditions: the native knee, BCR TKA knee, and BCR TKA knee after anterior cruciate ligament resection. Rotational kinematics in the BCR TKA knee during flexion were compared according to whether joint laxity was increased or decreased. RESULTS Knee joint laxity after BCR TKA under varus-valgus movement, anterior translation, and internal-external rotation loadings was similar to that of the native knee. However, lateral joint laxity was decreased during flexion in some cases. BCR TKA-treated knees with decreased lateral joint laxity at 90° of flexion demonstrated more limited tibial internal rotation in deep flexion than the native knee (p < 0.05). The loss of internal rotation in deep flexion was partly recovered by using a lateral insert with a posterior slope of +3°. CONCLUSIONS Restoring optimal joint laxity was not always straightforward in BCR TKA if the 4 ligaments were preserved. Lateral joint laxity was potentially decreased in BCR TKA and may result in kinematic conflict during flexion. Surgeons should be aware of the need to achieve sufficient lateral joint laxity in this type of BCR TKA.
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Affiliation(s)
- Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Akihiro Nitta
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Yasuaki Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Yoshihiro Tsuruo
- Department of Anatomy, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
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Early results with a bicruciate-retaining total knee arthroplasty: a match-paired study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:785-790. [PMID: 33215307 DOI: 10.1007/s00590-020-02834-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study is to compare 2 groups of total knee arthroplasties (TKAs): the bicruciate-retaining (BCR-group) and cruciate-retaining total knee arthroplasty (CR-group), evaluating the functional results in the short-term follow-up. METHODS 24 BCR were included in the study and were compared with a group of 24 TKAs performed with the same implant, but with sacrifice of the ACL and retention of the posterior cruciate ligament. For preoperative and postoperative clinical evaluation, the visual analogue score (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used. Radiological evaluation included weight-bearing long-leg view, a Rosemberg view, lateral view of the knee and tangential view of the patella. Hip-knee-ankle angle (HKA) was recorded pre and postoperatively. Radiolucent lines (RLLs) were evaluated according the Knee Society Roentgenographic Evaluation System (KSRES). RESULTS At last follow-up the mean VAS score was 1.81 for BCR group and 1.43 for CR group (p = 0.61). The mean WOMAC score was 8.68 for BCR group and 12.81 for CR group (p = 0.33). As for the radiological evaluation, preoperative HKA angle was 0.53° varus for BCR group and 3.14° varus for CR group (p = 0.24); postoperative HKA was 0.72° valgus for BCR group and 0.38° valgus for CR group (p = 0.75). The percentage of RLLs was similar between the two groups (12% versus 15%). CONCLUSIONS BCR-TKA has showed to give similar functional and radiographic outcomes compared to conventional CR-TKA in a similar cohort of patients. An higher operative times and higher number of complications respect were found in BCR group. These results can be explained by the early learning curve experiences. Future randomized controlled trials should be performed to support new implant designs such as BCR. LEVEL OF EVIDENCE Level of evidence Case-control study, level III.
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Watanabe M, Kuriyama S, Nakamura S, Nishitani K, Tanaka Y, Sekiguchi K, Ito H, Matsuda S. Abnormal knee kinematics caused by mechanical alignment in symmetric bicruciate-retaining total knee arthroplasty are alleviated by kinematic alignment. Knee 2020; 27:1385-1395. [PMID: 33010752 DOI: 10.1016/j.knee.2020.07.099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 06/16/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bicruciate-retaining total knee arthroplasty (BCR-TKA) was developed to maintain anterior cruciate ligament function and thus reproduce natural knee kinematics postoperatively. Traditional surgical techniques, however, may cause several complications secondary to kinematic conflict and ligament overtension. The objective of this study was to use a computer simulation of symmetric BCR-TKA to evaluate the effects of alternative surgical techniques on knee kinematics and ligaments. METHODS A musculoskeletal computer model of a healthy knee was constructed and was used to simulate a BCR model with mechanical alignment (MA). Five adjusted models were investigated, characterized, respectively, by kinematic alignment (KA), two degrees increased tibial slope, two-millimeter distal setting of the tibial component, and an undersized femoral component with either MA or KA. RESULTS All models exhibited a normal femoral position against the tibia at knee extension, with no anterior paradoxical motion during mid-flexion. The healthy knee model showed medial pivot motion and rollback. In contrast, the BCR MA model demonstrated abnormal bi-condylar rollback with excessive tensions of the lateral collateral ligament and posterior cruciate ligament during knee flexion, whereas the undersized femoral model with MA partly reduced both tensions. The BCR KA model retained relatively physiological kinematics and suppressed excessive ligament tensions. However, no adjusted model completely reproduced healthy knee conditions. CONCLUSIONS The BCR MA model showed abnormal biomechanics due to kinematic conflict between the retained ligaments and the replaced joint surface. Surgeons using symmetric BCR-TKA should consider using the KA method to achieve sufficient ligament laxity throughout knee flexion.
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Affiliation(s)
- Mutsumi Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Orthopedic Surgery, JCHO Tamatsukuri Hospital, Shimane, Japan
| | - Shinichi Kuriyama
- 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
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshihisa Tanaka
- Department of Orthopaedic Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Kazuya Sekiguchi
- Department of Orthopaedic Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Hiromu Ito
- 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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Instrumented platforms for balance and proprioceptive assessment in patients with total knee replacement: A systematic review and meta-analysis. Gait Posture 2020; 81:230-240. [PMID: 32810699 DOI: 10.1016/j.gaitpost.2020.07.080] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/06/2020] [Accepted: 07/25/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The functional outcome of total knee replacement (TKR) is usually satisfying. However, patients may show functional limitations for years after surgery, which have been ascribed to impairments in balance and proprioception, mainly during standing tasks. A number of instrumentations and parameters have been used, rising confusion for clinical decisions on the assessment of patients. RESEARCH QUESTION Which are the most widespread and consistent procedures to assess balance and proprioception following TKR? METHODS A literature review was conducted in Pubmed, PEDro, and Cochrane database. From a total sample of 112 articles, 23 original studies published between 2008 and 2019 met inclusion criteria. The primary outcomes selected were variables related to balance and proprioception assessment in static and dynamic tasks performed with instrumented platforms. Data from papers using the same instrumentation, on patients with unilateral TKA and at least 12 months postoperatively were synthesized quantitatively in a random effect meta-analysis. RESULTS Fourteen articles were appropriate for the review. A large variability was found both in the instrumentation and the parameters used. The Neurocom Balance Master System™ was the most used instrument (four articles). On a total population of 186 patients with unilateral TKR 12 months postoperatively, a low degree of heterogeneity was found adopting the random effect in the four tasks explored (Firm and Foam Surface both with Eyes Open and Eyes Closed). SIGNIFICANCE This review found a large variability in the instrumentation used to assess balance and proprioception in patients operated on TKR. The meta-analysis demonstrated that the Neurocom Balance Master System™ for static assessment of balance showed an acceptable consistency and can be considered as a reference for further studies. However, balance and proprioception impairments following TKR have not been widely quantified by means of instrumented platforms. Further research is needed to address this issue, and improve clinical practice.
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Kwon YM, Arauz P, Peng Y, Klemt C. In vivo kinematics of deep lunges and sit-to-stand activities in patients with bicruciate-retaining total knee arthroplasty. Bone Joint J 2020; 102-B:59-65. [PMID: 32475273 DOI: 10.1302/0301-620x.102b6.bjj-2019-1552.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS The removal of the cruciate ligaments in total knee arthroplasty (TKA) has been suggested as a potential contributing factor to patient dissatisfaction, due to alteration of the in vivo biomechanics of the knee. Bicruciate retaining (BCR) TKA allows the preservation of the cruciate ligaments, thus offering the potential to reproduce healthy kinematics. The aim of this study was to compare in vivo kinematics between the operated and contralateral knee in patients who have undergone TKA with a contemporary BCR design. METHODS A total of 29 patients who underwent unilateral BCR TKA were evaluated during single-leg deep lunges and sit-to-stand tests using a validated computer tomography and fluoroscopic imaging system. In vivo six-degrees of freedom (6DOF) kinematics were compared between the BCR TKA and the contralateral knee. RESULTS During single-leg deep lunge, BCR TKAs showed significantly less mean posterior femoral translation (13 mm; standard deviation (SD) 4) during terminal flexion, compared with the contralateral knee (16.6 mm, SD 3.7; p = 0.001). Similarly, BCR TKAs showed significantly less mean femoral rollback (11.6 mm (SD 4.5) vs 14.4 mm (SD 4.6); p < 0.043) during sit-to-stand. BCR TKAs showed significantly reduced internal rotation during many parts of the strenuous flexion activities particularly during high-flexion lunge (4° (SD 5.6°) vs 6.5° (SD 6.1°); p = 0.051) and during sit-to-stand (4.5° (SD 6°) vs 6.9° (SD 6.3°); p = 0.048). CONCLUSION The contemporary design of BCR TKA showed asymmetrical flexion-extension and internal-external rotation, suggesting that the kinematics are not entirely reproduced during strenuous activities. Future studies are required to establish the importance of patient factors, component orientation and design, in optimizing kinematics in patients who undergo BCR TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):59-65.
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Affiliation(s)
- Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Arauz
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yun Peng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Klemt
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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De Faoite D, Ries C, Foster M, Boese CK. Indications for bi-cruciate retaining total knee replacement: An international survey of 346 knee surgeons. PLoS One 2020; 15:e0234616. [PMID: 32542002 PMCID: PMC7295230 DOI: 10.1371/journal.pone.0234616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/29/2020] [Indexed: 12/18/2022] Open
Abstract
There is limited evidence on total knee arthroplasty (TKA) that retains the anterior and the posterior cruciate ligaments. Bi-cruciate retaining (BCR) TKA is considered to show improved clinical function and kinematics. This survey aimed to (1) identify interest in and acceptance of BCR TKA surgery and (2) to capture the range of indications for BCR in the opinion of practicing knee surgeons. 346 surgeons with experience in TKA surgery completed a bi-lingual online survey. Demographics, arthroplasty experience as well as acceptance of and indications for BCR TKA were collected. 53 surgeons were experienced in BCR TKA and 225 would consider implanting it. A mean of 19.5% of TKA patients were considered eligible for BCR TKA. 56.3% were thought to have intact ACL at the time of TKA surgery. Surgeons were not likely to perform BCR TKA in patients with inflammatory arthritis, aged over 80, BMI above 34.9 kg/m2, a varus or valgus deformity of more than 10° and flexion contractures of more than 10°. There is strong interest among orthopedic surgeons to perform BCR TKA and the percentage of potentially eligible patients is high. Significant joint deformity is a limitation of BCR TKA, while age and high BMI are less relevant. BCR TKA experienced surgeons are less restrictive.
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Affiliation(s)
| | - Christian Ries
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Christoph Kolja Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
- Smith + Nephew GmbH, Hamburg, Germany
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Wang HR, Li ZL, Li J, Wang YX, Zhao ZD, Li W. Arthroscopy combined with unicondylar knee arthroplasty for treatment of isolated unicompartmental knee arthritis: A long-term comparison. World J Clin Cases 2019; 7:4196-4207. [PMID: 31911900 PMCID: PMC6940339 DOI: 10.12998/wjcc.v7.i24.4196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/24/2019] [Accepted: 11/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Knee osteoarthritis is the most prevalent form of osteoarthritis and is becoming the main reason for progressive pain in knee joints. Arthroscopy combined with unicondylar knee arthroplasty (UKA) is one of the effective methods for the treatment of severe unicompartmental knee arthritis. This surgical approach gives us the capacity to explore all the articular cavities and plays a vital role in UKA patient selection. However, some scholars think that the surgical procedure is traumatic and may increase the rate of surgical infection, and its clinical efficacy needs further study.
AIM To compare the clinical effect of arthroscopy combined with UKA and UKA alone for patients suffering from unicompartmental osteoarthritis (OA).
METHODS A retrospective study was conducted on patients who were diagnosed with unicompartmental OA (Kellgren–Laurence grade ≥ III) and underwent UKA between October 2012 and November 2006. The patients were followed at 3, 6, and 12 mo and every 2 years thereafter. During each follow-up, the radiographic materials, the range of motion of knee and hospital for special surgery (HSS) score, knee society score and knee function score as recorded, and the modes and time of failure and revision details were collected as well.
RESULTS Data on 104 patients (118 knees), including 54 patients (60 knees) in the arthroscopy combined with UKA group (group A) and 51 (58 knees) in UKA alone group (group B) were collected during an average follow-up duration of 7.25 years, excluding the cases who were lost to follow-up. At the final follow-up, 3 (5.0%) of 60 knees in group A compared with 4 (6.9%) of 58 knees in group B failed and converted to total knee arthroplasty, with no statistically significant difference between the two groups (P = 0.933). The percentage of patients receiving blood transfusion was 40% in group A, significantly lower than that in group B (67.2%; P = 0.003). Total volume of blood transfusion in group A was also significantly lower than that of group B (P = 0.001). Both groups improved significantly after operation in clinical symptoms and functions. HSS score, knee society score, and knee function score increased significantly at the latest follow-up compared to pre-operation in group A, from 59.6 ± 10.9 to 82.7 ± 9.3 (mean difference [MD], 23.2; 95%CI: 19.3-27.0; P = 0.000), 47.3 ± 6.3 to 76.2 ± 13.1 (MD, 28.9; 95%CI: 25.1-32.7; P = 0.000), and 57.5 ± 6.3 to 75.1 ± 19.6 (MD, 17.5; 95% CI: 12.1-23.0; P = 0.000); and in group B, from 59.3 ± 15.6 to 84.3 ± 10.1 (MD, 23.7; 95%CI: 18.9-28.5; P = 0.000), 49.1 ± 9.2 to 75.1 ± 13.2 (MD, 24.7; 95%CI: 19.9-29.5; P = 0.000), and 59.3 ± 9.0 to 77.4 ± 13.8 (MD, 17.2; 95%CI: 12.8-21.6; P = 0.000).
CONCLUSION Arthroscopy combined with UKA and UKA alone both provide benefits in clinical symptom improvement and alignment correction. Arthroscopy combined with UKA does not increase the infection probability and surgical complications, and has an advantage in reducing the total volume of blood transfusion and the percentage of patients receiving blood transfusion.
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Affiliation(s)
- Hao-Ran Wang
- Department of Orthopedics, General Hospital of People’s Liberation Army, Beijing 100853, China
| | - Zhong-Li Li
- Department of Orthopedics, General Hospital of People’s Liberation Army, Beijing 100853, China
| | - Ji Li
- Department of Orthopedics, General Hospital of People’s Liberation Army, Beijing 100853, China
| | - Yu-Xing Wang
- Department of Orthopedics, General Hospital of People’s Liberation Army, Beijing 100853, China
| | - Zhi-Dong Zhao
- Department of Orthopedics, General Hospital of People’s Liberation Army, Beijing 100853, China
| | - Wei Li
- Department of Orthopedics, General Hospital of People’s Liberation Army, Beijing 100853, China
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Angerame MR, Holst DC, Jennings JM, Komistek RD, Dennis DA. Total Knee Arthroplasty Kinematics. J Arthroplasty 2019; 34:2502-2510. [PMID: 31229370 DOI: 10.1016/j.arth.2019.05.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023] Open
Abstract
Knee kinematics is an analysis of motion pattern that is utilized to assess a comparative, biomechanical performance of healthy nonimplanted knees, injured nonimplanted knees, and various prosthetic knee designs. Unfortunately, a consensus between implanted knee kinematics and outcomes has not been reached. One might hypothesize that the kinematic variances between the nonimplanted and implanted knee might play a role in patient dissatisfaction following TKA. There is a wide range of TKA designs available today. With such variety, it is important for surgeons and engineers to understand the various geometries and kinematic profiles of available prostheses. The purpose of this review is to provide readers with the pertinent information related to TKA kinematics.
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Affiliation(s)
| | - David C Holst
- Department of Orthopedic Surgery, Duke University, Raleigh, NC
| | - Jason M Jennings
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Denver, Denver, CO
| | - Richard D Komistek
- Department of Biomedical Engineering, University of Tennessee, Knoxville, TN
| | - Douglas A Dennis
- Colorado Joint Replacement, Porter Adventist Hospital, Denver, CO; Department of Biomedical Engineering, University of Denver, Denver, CO; Department of Biomedical Engineering, University of Tennessee, Knoxville, TN; Department of Orthopaedics, University of Colorado Health School of Medicine, Aurora, CO
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30
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Tsai TY, Liow MHL, Li G, Arauz P, Peng Y, Klemt C, Kwon YM. Bi-Cruciate Retaining Total Knee Arthroplasty Does Not Restore Native Tibiofemoral Articular Contact Kinematics During Gait. J Orthop Res 2019; 37:1929-1937. [PMID: 31062398 DOI: 10.1002/jor.24333] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 04/12/2019] [Indexed: 02/04/2023]
Abstract
Bi-cruciate retaining (BCR) total knee arthroplasty (TKA) design preserves both anterior and posterior cruciate ligaments with the potential to restore normal posterior femoral rollback and joint kinematics. Abnormal knee kinematics and "paradoxical" anterior femoral translation in conventional TKA designs have been suggested as potential causes of patient dissatisfaction. However, there is a paucity of data on the in vivo kinematics and articular contact behavior of BCR-TKA. This study aimed to investigate in vivo kinematics, articular contact position, and pivot point location of the BCR-TKA during gait. In vivo kinematics of 30 patients with unilateral BCR-TKA during treadmill walking was determined using validated dual fluoroscopic imaging tracking technique. The BCR-TKA exhibited less extension than the normal healthy knee between heel strike and 48% of gait cycle. Although the average external rotation trend observed for BCR TKA was similar to the normal healthy knee, the range of motion was not fully comparable. The lowest point of the medial condyle showed longer anteroposterior translation excursion than the lateral condyle, leading to a lateral-pivoting pattern in 60% of BCR TKA patients during stance phase. BCR-TKA demonstrated no statistical significant differences in anterior-posterior translation as well as varus rotation, when compared to normal healthy knees during the stance phase. However, sagittal plane motion and tibiofemoral articular contact characteristics including pivoting patterns were not fully restored in BCR TKA patients during gait, suggesting that BCR TKA does not restore native tibiofemoral articular contact kinematics. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1929-1937, 2019.
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Affiliation(s)
- Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Guoan Li
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Paul Arauz
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Yun Peng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Christian Klemt
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
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31
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Ouattas A, Wellsandt E, Hunt NH, Boese CK, Knarr BA. Comparing single and multi-joint methods to detect knee joint proprioception deficits post primary unilateral total knee arthroplasty. Clin Biomech (Bristol, Avon) 2019; 68:197-204. [PMID: 31238189 PMCID: PMC7197211 DOI: 10.1016/j.clinbiomech.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The use of various single-joint proprioception measurements has resulted in contradictory findings after knee arthroplasty. The use of balance as a surrogate measure to assess knee proprioception post-operation has resulted in further confusion. The aim of this study was to measure single joint knee proprioception in participants after unilateral knee arthroplasty, and compares it to multi-joint balance. METHODS Eleven participants at 1 year after unilateral total knee arthroplasty and twelve age-matched controls were enrolled. The threshold to detect passive motion and the sensory organization test were used to measure single joint knee proprioception and multi-joint balance respectively. Two-way ANOVA and independent t-tests were used to measure differences between and within groups. Regression analysis was used to measure the association between proprioception and balance measurements. FINDINGS Surgical knees demonstrated significantly more deficient proprioception compared to the non-surgical knees and both knees of the control groups during flexion (P < 0.01) and extension (P < 0.05). Non-surgical knees showed similar proprioception to both knees of the control group during flexion and extension. Within the knee arthroplasty group, only deficiencies during flexion showed significant correlation with Sensory Organization Test visual ratio. No additional differences between both groups during balance measurements, nor any correlations between local joint proprioception and balance were seen. INTERPRETATION These findings indicate deficient surgical knee proprioception in participants one year after unilateral total knee arthroplasty. Limited associations between measurements indicate that balance may be a poor measure of single-joint proprioception.
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Affiliation(s)
- Abderrahman Ouattas
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA.
| | - Elizabeth Wellsandt
- Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Nathaniel H Hunt
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - C Kent Boese
- Miller Orthopedic Specialists, Council Bluffs, IA 51503, USA
| | - Brian A Knarr
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
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Bragonzoni L, Rovini E, Barone G, Cavallo F, Zaffagnini S, Benedetti MG. How proprioception changes before and after total knee arthroplasty: A systematic review. Gait Posture 2019; 72:1-11. [PMID: 31129387 DOI: 10.1016/j.gaitpost.2019.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/12/2019] [Accepted: 05/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Proprioception is one of the most significant factors in balance, joint stability, graceful movement, coordination, and injury prevention. It involves a wide set of receptors located within joints, muscles, and tendons. Given the neurophysiological processes involved in proprioception response are multiple and complex, there is not one single method to measure it. Particularly, proprioception of the knee joint, whether it is healthy, affected by osteoarthritis, or after replacement, is the most investigated by in literature. RESEARCH QUESTION This review addresses the analysis of proprioception in the knee joint before and after total knee arthroplasty (TKA). The aim is to obtain an overview of the proprioceptive skills in subjects who suffered from osteoarthritis and were subjected to knee replacement, evaluating changes in proprioception before and after the surgery. METHODS The research was conducted within four databases: Web of Science®, PubMed Central®, Cochrane®, and PEDro®, between January 2008 and February 2018. Accurate exclusion criteria and selection strategy were applied to screen the 170 articles found. RESULTS Ultimately, 13 papers were fully evaluated and included in this review, divided into two classes: i) works directly measuring proprioception, ii) studies indirectly evaluating proprioception. Contrasting results emerged from the analysis, and no consensus was found in the literature about the improvement or worsening in proprioception before and after TKA. SIGNIFICANCE Since currently there is high variability in methods, protocol and parameters used to evaluate knee proprioception, further investigations based on a consistent dataset, a well-defined protocol, measurable outcomes, timeline follow-ups, and rehabilitation programs should be performed in order to obtain reliable results on the effects of TKA on knee proprioception and balance.
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Affiliation(s)
- Laura Bragonzoni
- University of Bologna - Department for Life Quality Studies, Bologna, BO, Italy
| | - Erika Rovini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, PI, Italy; II Orthopaedic and Traumatologic Clinic - IRCCS - Istituto Ortopedico Rizzoli, Bologna, BO, Italy.
| | - Giuseppe Barone
- II Orthopaedic and Traumatologic Clinic - IRCCS - Istituto Ortopedico Rizzoli, Bologna, BO, Italy
| | - Filippo Cavallo
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, PI, Italy
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic - IRCCS - Istituto Ortopedico Rizzoli, Bologna, BO, Italy; University of Bologna, Bologna, BO, Italy
| | - Maria Grazia Benedetti
- Functional Recovery and Rehabilitation - IRCCS - Istituto Ortopedico Rizzoli, Bologna, BO, Italy
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Wilson HA, Middleton R, Abram SGF, Smith S, Alvand A, Jackson WF, Bottomley N, Hopewell S, Price AJ. Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis. BMJ 2019; 364:l352. [PMID: 30792179 PMCID: PMC6383371 DOI: 10.1136/bmj.l352] [Citation(s) in RCA: 214] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To present a clear and comprehensive summary of the published data on unicompartmental knee replacement (UKA) or total knee replacement (TKA), comparing domains of outcome that have been shown to be important to patients and clinicians to allow informed decision making. DESIGN Systematic review using data from randomised controlled trials, nationwide databases or joint registries, and large cohort studies. DATA SOURCES Medline, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Clinical Trials.gov, searched between 1 January 1997 and 31 December 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies published in the past 20 years, comparing outcomes of primary UKA with TKA in adult patients. Studies were excluded if they involved fewer than 50 participants, or if translation into English was not available. RESULTS 60 eligible studies were separated into three methodological groups: seven publications from six randomised controlled trials, 17 national joint registries and national database studies, and 36 cohort studies. Results for each domain of outcome varied depending on the level of data, and findings were not always significant. Analysis of the three groups of studies showed significantly shorter hospital stays after UKA than after TKA (-1.20 days (95% confidence interval -1.67 to -0.73), -1.43 (-1.53 to -1.33), and -1.73 (-2.30 to -1.16), respectively). There was no significant difference in pain, based on patient reported outcome measures (PROMs), but significantly better functional PROM scores for UKA than for TKA in both non-trial groups (mean difference -0.58 (-0.88 to -0.27) and -0.32 (-0.48 to -0.15), respectively). Regarding major complications, trials and cohort studies had non-significant results, but mortality after TKA was significantly higher in registry and large database studies (risk ratio 0.27 (0.16 to 0.45)), as were venous thromboembolic events (0.39 (0.27 to 0.57)) and major cardiac events (0.22 (0.06 to 0.86)). Early reoperation for any reason was higher after TKA than after UKA, but revision rates at five years remained higher for UKA in all three study groups (risk ratio 5.95 (1.29 to 27.59), 2.50 (1.77 to 3.54), and 3.13 (1.89 to 5.17), respectively). CONCLUSIONS TKA and UKA are both viable options for the treatment of isolated unicompartmental osteoarthritis. By directly comparing the two treatments, this study demonstrates better results for UKA in several outcome domains. However, the risk of revision surgery was lower for TKA. This information should be available to patients as part of the shared decision making process in choosing treatment options. SYSTEMATIC REVIEW REGISTRATION PROSPERO number CRD42018089972.
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Affiliation(s)
- Hannah A Wilson
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
| | - Rob Middleton
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
| | - Simon G F Abram
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
| | - Stephanie Smith
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
| | - Abtin Alvand
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
| | - William F Jackson
- Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Nicholas Bottomley
- Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Sally Hopewell
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Oxford, UK
| | - Andrew J Price
- University of Oxford, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, BOTNAR Research Centre, Headington, Oxford OX3 7LD, UK
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Hamada D, Wada K, Takasago T, Goto T, Nitta A, Higashino K, Fukui Y, Sairyo K. Native rotational knee kinematics are lost in bicruciate-retaining total knee arthroplasty when the tibial component is replaced. Knee Surg Sports Traumatol Arthrosc 2018; 26:3249-3256. [PMID: 29368122 DOI: 10.1007/s00167-018-4842-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 01/17/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare the kinematics between native knees and knees that have undergone bicruciate-retaining (BCR) total knee arthroplasty (TKA) with cruciate-retaining (CR) TKA converted from BCR TKA in the same whole-body cadaveric specimen using a navigation system and, if differences exist, to investigate the point at which normal kinematics are lost during the procedure. METHODS The rotational kinematics throughout passive flexion of the native knee and of knees after meniscectomy, femoral replacement, BCR TKA, or CR TKA were assessed in nine fresh frozen cadavers using an image-free navigation system. RESULTS The rotational kinematic pattern of a knee after BCR TKA was different from that of a native knee, especially in the early flexion phase, and was similar to that after CR TKA. Screw-home movement was not observed after BCR TKA, but still occurred after meniscectomy or femoral replacement with intact cruciate ligaments and an intact tibial articular surface. CONCLUSION The rotational kinematics of the native knee are not always preserved after BCR TKA. Native rotational kinematics are preserved after meniscectomy and femoral replacement, but are lost after tibial replacement in BCR TKA. Surgeons should pay close attention to maintain the anteroposterior stabilizing function of the ACL in BCR TKA, rather than to restore the native rotational kinematics.
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Affiliation(s)
- Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan.
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Akihiro Nitta
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Kosaku Higashino
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan.,Department of Anatomy and Developmental Neurobiology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Yoshihiro Fukui
- Department of Anatomy and Developmental Neurobiology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
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Baumann F. Bicruciate-retaining total knee arthroplasty compared to cruciate-sacrificing TKA: what are the advantages and disadvantages? Expert Rev Med Devices 2018; 15:615-617. [PMID: 30132366 DOI: 10.1080/17434440.2018.1514256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Florian Baumann
- a Department of Trauma Surgery , Regensburg University Medical Center , Regensburg , Germany
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36
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Modern Day Bicruciate-Retaining Total Knee Arthroplasty: A Short-Term Review of 146 Knees. J Arthroplasty 2018; 33:2485-2490. [PMID: 29666029 DOI: 10.1016/j.arth.2018.03.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Bicruciate retaining (BCR) implants were first proposed in the 1960s with the polycentric knee. Given the technical difficulty of implanting these devices, and the mixed results at the time, the BCR concept had stalled, until recently. This study seeks to provide a short-term review of the BCR implant design, describe patient-reported outcomes, and discuss key aspects to ensure successful implantation of the modern-day BCR implant design. METHODS Between October 2014 and December 2016, the senior author performed 146 primary total knee arthroplasties using BCR implants. Arthritic knees, with minimal soft tissue damage and an intact anterior cruciate ligament, were the general indications used for this cohort. All patients implanted with the BCR device were included in this analysis. One hundred forty-six (100%) BCR knees were available for follow-up at an average of 12 months (range, 1-33 months) postoperatively. RESULTS Ninety-one percent of respondents reported their knee always or sometime feels normal, with only 9% of respondents reporting their knee never feels normal. Our study reports 94% of patients reported neutral satisfaction or higher, with only 6% of patients reporting dissatisfaction and 1% reported being very dissatisfied. Of all 146 BCR devices implanted, there were 2 (1.4%) revisions and 1 (0.7%) reoperation, a manipulation under anesthesia. CONCLUSION This is the largest consecutive series of BCR total knee arthroplasties using the modern-day implant design with 1-year follow-up in the United States. The results of our study show great patient-reported satisfaction, function, and short-term outcomes for patients implanted with the new BCR design.
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Baumann F, Krutsch W, Worlicek M, Kerschbaum M, Zellner J, Schmitz P, Nerlich M, Tibesku C. Reduced joint-awareness in bicruciate-retaining total knee arthroplasty compared to cruciate-sacrificing total knee arthroplasty. Arch Orthop Trauma Surg 2018; 138:273-279. [PMID: 29124363 DOI: 10.1007/s00402-017-2839-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE There is rising impact of patient-reported outcome (PRO) measurement in joint arthroplasty over the past years. Bicruciate-retaining implants have shown more physiologic knee kinematics and provide superior proprioceptive capacities. The aim of this study was to evaluate if the functional properties of this new implant design lead to improved PRO results after total knee arthroplasty (TKA). METHODS This prospective, controlled trial compares PRO of bicruciate-retaining total knee arthroplasty (BCR-TKA) to unicondylar knee arthroplasty (UKA) and standard posterior-stabilized total knee arthroplasty (PS-TKA). We evaluated 102 patients (34 patients in each group) 18 months postoperatively after knee arthroplasty. Primary outcome measure was the Forgotten Joint Score (FJS). RESULTS The BCR-group showed the same level of joint awareness as the UKA-group (p = 0.999). The second control group of PS-TKA patients had a lower mean score value in the FJS compared to the BCR-group (p = 0.035) and UKA-group (p = 0.031). There was no correlation of age, gender, body mass index (BMI) and the FJS. No relevant floor- or ceiling effects occurred. CONCLUSIONS This study found reduced joint awareness for BCR-TKA compared to a standard total knee arthroplasty. The score values of the BCR-group were equal to the UKA-group. Further prospective, randomized studies to investigate long-term survivorship of bicruciate-retaining implants are needed. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Florian Baumann
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany.
| | - Werner Krutsch
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Michael Worlicek
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Johannes Zellner
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Paul Schmitz
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, Regensburg University Medical Center, 93042, Regensburg, Germany
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Heyse TJ, Slane J, Peersman G, Dirckx M, van de Vyver A, Dworschak P, Fuchs-Winkelmann S, Scheys L. Kinematics of a bicruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:1784-1791. [PMID: 28078394 DOI: 10.1007/s00167-016-4414-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/13/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE The recently reintroduced bicruciate-retaining Total Knee Arthroplasty (BCR TKA) is an interesting approach in the quest for close replication of knee joint biomechanics and kinematics closer to the native knee. Therefore, this study aimed at providing a detailed biomechanical view on the functional resemblance of BCR TKA to the native knee joint. METHODS Seven fresh-frozen full leg cadaver specimens (76 ± 10 year) were mounted in a 6 degrees-of-freedom kinematic rig that applied a dynamic squatting motion knee flexion. Two motion patterns were performed pre- and post-implantation of a fixed bearing BCR TKA: passive flexion-extension and squatting while an infrared camera system tracked the location of reflective markers attached to the tibia and femur. Additionally, specimen laxity was assessed using Lachman tests and varus/valgus stress tests in triplicate. RESULTS Overall, differences in tibiofemoral kinematics between native knee and BCR TKA were small. Some minor differences appeared under the load of a squat: less internal tibial rotation and some minor paradoxical anterior translation of the medial femoral condyle during mid-flexion. BCR TKA may slightly elevate the joint line. Knee laxity as measured by the Lachman and varus/valgus tests was not significantly influenced by BCR TKA implantation. CONCLUSION As both cruciate ligaments are preserved with BCR TKA the unloaded knee closely resembles native knee kinematics including preserving the rollback mechanism. The loss of the conforming anatomy of menisci and tibial cartilage and replacement via a relatively flat polyethylene inlay may account for the loss of tibial internal rotation and the slight paradoxical AP motion of the medial femoral condyle with BCR TKA. This phenomenon reproduces findings made earlier with fixed bearing unicondylar knee arthroplasty.
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Affiliation(s)
- Thomas J Heyse
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Joshua Slane
- Department of Orthopaedics, Katholieke Universiteit Leuven, Campus Pellenberg, Louvain, Belgium
| | | | | | | | - Philipp Dworschak
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Susanne Fuchs-Winkelmann
- Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Lennart Scheys
- Department of Orthopaedics, Katholieke Universiteit Leuven, Campus Pellenberg, Louvain, Belgium
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Becker R, Hirschmann MT, Karlsson J. The role of ligament tension and sensomotoric system in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:1663-1665. [PMID: 28551833 DOI: 10.1007/s00167-017-4581-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Roland Becker
- Department of Orthopaedics and Traumatology, Hospital Brandenburg, Brandenburg Medical School "Theodor Fontane", Hochstrasse 26, 14776, Brandenburg, Germany.
| | - Michael Tobias Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska University, Hospital, Sahlgrenska Academy, Gothenburg, Sweden
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