Analysis of knee functional flexion axis in navigated TKA: identification and repeatability before and after implant positioning

Colle, Francesca; Lopomo, N.; Bruni, Danilo; Visani, Andrea; Iacono, Francesco; Zaffagnini, Stefano; Marcacci, Maurilio

doi:10.1007/s00167-013-2780-9

Cited by 13 publications

(24 citation statements)

References 47 publications

(85 reference statements)

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“…4,5 Several surgical techniques with functional or anatomical reference axes have been developed and introduced to achieve this goal. 6 A successful outcome is believed to be dependent on the restoration of a neutral mechanical axis in the lower extremity, with the femoral and tibial components aligned perpendicular to the mechanical axis in the coronal plane. Although mechanical alignment (MA) is the most common surgical technique in TKA for restoring patient function, 15 to 25% of the patients have reported dissatisfaction, and 10% required revision surgery within 10 years of the surgery.…”

mentioning

confidence: 99%

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

et al. 2019

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Kinematic alignment (KA), which co-aligns the rotational axes of the components with three kinematic axes of the knee by aligning the components to the prearthritic joint lines, has been a recently introduced surgical technique. However, whether KA and cruciate retaining (CR) implants provide better biomechanical function during activities than mechanical alignment (MA) in posterior stabilized (PS) implants is unclear. We evaluated the biomechanical functions during the stance phase gait and deep knee bend, with a computer simulation and measured forces in the medial and lateral collateral ligaments and medial and lateral contact stresses in the polyethylene insert and patellar button. The forces on the medial collateral ligament in KA were lower than those in MA in both CR and PS TKA in the stance phase gait and deep knee bend conditions, whereas those on the lateral collateral ligament did not show any difference between the two surgical alignment techniques in the stance phase gait condition. The maximum contact stresses on the medial PE inserts in KA were lower than those in MA in both CR and PS TKA in the stance phase gait and deep knee bend conditions. However, the maximum contact stresses on the lateral PE inserts and the patellar button did not differ between MA and KA. The biomechanical function was superior in KA TKA than in MA TKA, and KA was more effective in CR TKA. This comparison could be used as a reference by surgeons to reduce the failure rates by using KA TKA instead of MA TKA.

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confidence: 99%

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

et al. 2019

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“…Limitations. Firstly, previous studies have confirmed that the rotation axis fluctuates dynamically around sTEA during the knee movement [29]. In this study, a single sTEA was HKA: hip-knee-ankle angle; PFA: patella transverse axis-femoral transepicondylar axis angle; HSS: Hospital for Special Surgery, KSS Knee Society Score; "−" indicates that the angle opens inwards.…”

Section: Satisfactory Clinical Efficacymentioning

confidence: 54%

“…Firstly, previous studies have confirmed that the rotation axis fluctuates dynamically around sTEA during the knee movement [ 29 ]. In this study, a single sTEA was used as the reference standard, which might lead to inaccuracy in partial angle range.…”

Section: Discussionmentioning

confidence: 86%

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

Sun

Zhang

Peng

et al. 2020

BioMed Research International

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Background. With the development of three-dimensional printing (3DP) technology, the patient-specific instrumentation (PSI) has been widely applied in total knee arthroplasty (TKA). The purpose of this study was to compare the gait parameters of patients with 3DP personalized guide-assisted and standard TKA. Methods. Retrospective analysis of the advanced knee OA cases in our hospital between June 2017 and June 2018 was conducted. 30 cases received 3DP personalized guide-assisted TKA (group A), and 60 patients who underwent standard TKA during the same period were in group B and group C according to the computed tomography (CT) measurement results, each with 30 cases. Hip–knee–ankle angle (HKA), patella transverse axis-femoral transepicondylar axis angle (PFA), and gait parameters were statistically analyzed. The function was assessed by Hospital for Specific Surgery (HSS) and Knee Society Score (KSS). Results. The mean follow-up period was 12.3 months in the three groups. The knee max flexion angle at the swing phase of group A was larger than group B and group C (P<0.05), there was no statistically significant difference in other gait parameters. The mean PFA of group A was smaller than that of group B and group C (P<0.05). While, the HKA, HSS, and KSS scores of three groups showed no significant difference. Conclusion. 3DP personalized guide technology could improve the gait parameters after surgery, specifically reflected in the knee max flexion angle at the swing phase. It could also assist in the reconstruction of more accurate patellar tracking and rotational alignment in TKA, avoiding the occurrence of insufficient or excessive extorsion.

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“…8 In this work, the flexion axes were found to lie in a similar anatomical location to previous reports. 15,20,41,42 The FFA lay posterior and inferior with respect to the TEA. An interesting observation was that the implanted knee maintained an axis in proximity to the FFA (posterior and inferior to the TEA).…”

Section: Discussionmentioning

confidence: 94%

“…This has highlighted the potential clinical relevance of FFA. Colle et al 41 performed kinematic analysis on 87 patients undergoing TKA and analysed angle differences between the FFA and the TEA pre- and post-TKA in the frontal and axial planes. They noted that the most significant differences between the two were seen in the frontal plane and assigned such difference to condylar wear from osteoarthrosis.…”

Section: Discussionmentioning

confidence: 99%

Sagittal flexion arc evaluation for a modern generation single-radius femoral component design

Deehan

Ghosh

Blain

et al. 2018

Proc Inst Mech Eng H

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Single-radius femoral total knee design aims to deliver improved kinematic behaviour when compared to the standard two-radii geometry. This study has evaluated the behaviour, through a functional range of motion in the sagittal plane, of a single-radius femoral component compared to a dual-radius standard knee construct. Particular focus was placed on how the flexion axes of the native and replaced knee approximated to the transepicondylar axis through a loaded navigated knee design. Significant differences in flexion arcs were noted between the native and total knee arthroplasty state. These arcs were not uniform in all knees and did not display single-radius behaviour. There were no significant differences in the location of flexion axes in the native and total knee arthroplasty knee. Both exhibited similar posterior and inferior transverse axes of motion with respect to the anatomical epicondylar axis. This work has cast doubt on the reliability under loaded conditions of the single-radius concept, but the close proximity of the flexion axes of each replaced knee in relation to the functional flexion axis of the native knee may be the true basis of this purported improved kinematic performance.

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Analysis of knee functional flexion axis in navigated TKA: identification and repeatability before and after implant positioning

Abstract: Case series, Level IV.

Cited by 13 publications

References 47 publications

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

Kinematic Alignment in Cruciate Retaining Implants Improves the Biomechanical Function in Total Knee Arthroplasty during Gait and Deep Knee Bend

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

Sagittal flexion arc evaluation for a modern generation single-radius femoral component design

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