Biomechanical analysis on total knee replacement patients during gait: Medial pivot or posterior stabilized design?

Esposito, Francesco; Freddolini, Marco; Marcucci, Massimiliano; Latella, Leonardo

doi:10.1016/j.clinbiomech.2020.105068

Cited by 11 publications

(16 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In terms of the postoperative QS recovery, both groups experienced a signi cant drop in NQS and OL-QS at 2 weeks, but then recovered 6 weeks after TKR. These ndings were different than the previous studies that demonstrated the signi cant postoperative QS de cit as 59%-62% at the rst month and the recovery to the preoperative level at 6 months after TKR [7,15,21]. This difference could be explained by the following areas with differences in methodology between the previous studies and the present study: the QS assessment method (electromechanical dynamometer vs. handheld dynamometer), the knee position during the measurement (60 o -75 o knee exion vs. 30 o knee exion), the inhibitory effect of preoperative pain and postoperative pain recovery on QS measurement, and the possible effect of blood loss reduction on functional recovery by tranexamic acid injection [9].…”

Section: Discussioncontrasting

confidence: 99%

“…Second, although this study was a double-blinded RCT, our sample size was relatively small and might not detect some postoperative complications related to the CLS technique, such as suture breakage or wound infection. Third, our study did not explore the other factors that might affect the QS recovery, such as surgeon experience [13], prosthesis design [7], and the use of barbed suture [25]. Therefore, future prospective and multicenter RCTs with a large sample size are required to assess the effect of CLS in the general population.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Is Continuous Locking Suture with Braided Suture Sufficient for Arthrotomy Repair in the Conventional TKR? A Randomized Controlled Trial Study

Wongsak

Chulsomlee

Jarungvittayakon

et al. 2020

Preprint

View full text Add to dashboard Cite

Introduction: Medial parapatellar arthrotomy is the standard approach for total knee replacement (TKR) but usually requires adequate arthrotomy repair to allow for early rehabilitation. Nonetheless, no previous studies have clarified the postoperative outcome as quadriceps strength (QS) and functional recovery after using the other simple suture technique for the arthrotomy repair, continuous locking suture (CLS). Methods: 80 patients were randomly assigned into a CLS group (n=40) and an interrupted horizontal mattress (IHM) group (n=40). With the same surgical and rehabilitation protocol, and all arthrotomy repair used only the traditional braided suture. QS was calculated into normalized quadriceps strength (N-QS) and operative leg quadriceps strength compared with contralateral QS (OL-QS). QS, visual analog scale (VAS), modified timed up and go (TUGT) test, Western Ontario and McMasters Universities Osteoarthritis Index [WOMAC] and Knee Society Score [KSS] were followed for 6 months’ period. Results: No significant difference in demographic and perioperative data, except a significant shorter capsular closure time in CLS (233±40 seconds) compared to IHM (388±47 seconds) (p<0.0001). There was no significant difference in N-QS and OL-QS between both groups during the 6-month follow-up period (p>0.05 all). Both groups also did not show any significant difference in the postoperative VAS, TUGT, WOMAC, and KSS (p>0.05 all). Finally, no wound complications or infections manifested during this study. Conclusion: Arthrotomy repair with the CLS technique in TKR and using only the braided suture is safe and effective as demonstrated a recovery of the QS and knee function outcome comparable to the standard IHM technique. Trial registration: This study was registered in Thai Clinical Trials Registry on December 2015 (https://www.clinicaltrials.in.th). The registration number was TCTR20151208003.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is Continuous Locking Suture with Braided Suture Sufficient for Arthrotomy Repair in the Conventional TKR? A Randomized Controlled Trial Study

Wongsak

Chulsomlee

Jarungvittayakon

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Also, a small range of motion during gait activity and low walking speed may weaken the benefit of the particular design of the MP implant. The medial pivoting motion is expected to be more prevalent in more active patients during activities of a more extensive range of motion, as reported by other investigators ( Miyazaki et al, 2011 ; Esposito et al, 2020 ).…”

Section: Discussionsupporting

confidence: 60%

“…To the author’s best knowledge, there is no data available regarding in vivo knee kinematics in Chinese MP TKA patients during daily activities, such as walking. Some studies have investigated knee kinematics during gait activity in Caucasian patients ( Papagiannis et al, 2016 ; Benjamin et al, 2018 ; Esposito et al, 2020 ; Miura et al, 2020 ), reporting better mimicking of normal knee kinematics of MP TKA than other designs. Nevertheless, Chinese patients are manifested with more severity of osteoarthritis and walking disabilities than Caucasian patients before surgery ( Zhang et al, 2001 ; Kang et al, 2009 ; Lin et al, 2010 ; Liu et al, 2017 ), which may restrict their function restoration after TKA surgery, such as adopting a slow walking speed.…”

Section: Introductionmentioning

confidence: 99%

Loss of Knee Flexion and Femoral Rollback of the Medial-Pivot and Posterior-Stabilized Total Knee Arthroplasty During Early-Stance of Walking in Chinese Patients

Tan

Zou

Zhang

et al. 2021

Front. Bioeng. Biotechnol.

View full text Add to dashboard Cite

Background The medial-pivot (MP) prosthesis was developed to produce more physiological postoperative knee kinematics and better patient satisfaction than traditional prostheses, but outcomes are inconsistent in different studies of Caucasian patients. This study aimed to investigate the postoperative patient satisfaction and in vivo knee kinematics of the MP and posterior-stabilized (PS) prosthesis during gait activity in Chinese patients.Methods A retrospective analysis of 12 patients was received for this study in each MP group and PS group. Patient-reported satisfaction level and Forgotten Joint Score (FJS) were evaluated with questionnaires. A dual fluoroscopic imaging system was used to investigate in vivo knee kinematics of MP and PS total knee arthroplasty (TKA) during treadmill walking at a speed of 0.4 m/s.Results Comparable promising patient satisfaction and overall FJS (MP 60.7 ± 15.35 vs. PS 51.3 ± 17.62, p = 0.174) were found between the MP and PS groups. Peak flexion appeared at around 70% of gait cycle with values of 52.4 ± 7.4° for MP and 50.1 ± 3.6° for PS groups (no difference). Both groups maintained a stable position at the stance phase and began to translated anteriorly at toe-off with an amount of 4.5 ± 2.3 mm in the MP and 6.6 ± 2.7 mm in the PS (p = 0.08) group until late swing. The range of this external rotation motion was 5.9 ± 4.8 and 6.2 ± 4.1° (p = 0.79) for the MP and PS, respectively.Conclusion A similar knee kinematics pattern characterized by a loss of early-stance knee flexion and femoral rollback during walking was observed in the MP and PS TKAs. Our study confirmed similar effectiveness of MP TKA compared to PS TKA in Chinese patients, while the change of knee kinematics of both implants during slow walking should be noted.

show abstract

“…Some of the hypothesized kinematic improvements of MP designs have been realized in gait analysis, but postoperative kinematics for MP (and CR and PS) bearings still do not match a native, nonarthritic joint 3 nor is benefit always seen. 25 Along with the hypothetical benefits, there are hypothetical disadvantages too. The increased conformity may lead to component impingement, which may limit femoral roll back and flexion in some patients.…”

Section: Discussionmentioning

confidence: 99%

Medial Pivot Designs Versus Conventional Bearing Types in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2022

View full text Add to dashboard Cite

Background:Medial pivot (MP) designs are growing in popularity. They provide increased sagittal plane stability and theoretically replicate some aspects of native joint kinematics, which may improve total knee arthroplasty outcomes.Methods:A systematic review was performed of randomized controlled trials (RCTs) that compared MP designs with cruciate-retaining, posterior-stabilized (PS), ultracongruent, or mobile-bearings in primary total knee arthroplasty, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome measures were all clinical function scores, patient-reported outcome measures, and range of motion. The secondary outcome was complications. Two authors independently selected studies, performed data extraction, and risk-of-bias assessment. Studies at high risk of bias were excluded from meta-analysis. Treatment effects were assessed using random-effects meta-analysis and quantified using pooled mean differences or incidence rate differences as appropriate.Results:Eight RCTs met inclusion criteria. Five compared MP with PS, two with ultracongruent, and one with cruciate-retaining and mobile-bearing. In total, 350 knees were randomized to MP and 375 to conventional bearings. One RCT was excluded from meta-analysis because of high risk of bias. Meta-analysis comparing MP with PS only was possible and found no differences at any time points for any outcome measure, including 2-year follow-up for Oxford Knee Score (MD = 0.35 favoring PS; 95% CI −0.49 to 1.20) and range of motion (MD = 1.58 favoring MP; 95% CI −0.76 to 11.92, P = 0.30) and 12 months for Western Ontario Arthritis Index (MD = 4.42 favoring MP; 95% CI −12.04 to 3.20, P = 0.09).Conclusions:There is no difference in clinical outcomes, with contemporary measurement tools, at any time points, between MP and PS. There are insufficient RCTs comparing MP with other bearings.

show abstract

Biomechanical analysis on total knee replacement patients during gait: Medial pivot or posterior stabilized design?

Cited by 11 publications

References 51 publications

Is Continuous Locking Suture with Braided Suture Sufficient for Arthrotomy Repair in the Conventional TKR? A Randomized Controlled Trial Study

Is Continuous Locking Suture with Braided Suture Sufficient for Arthrotomy Repair in the Conventional TKR? A Randomized Controlled Trial Study

Loss of Knee Flexion and Femoral Rollback of the Medial-Pivot and Posterior-Stabilized Total Knee Arthroplasty During Early-Stance of Walking in Chinese Patients

Medial Pivot Designs Versus Conventional Bearing Types in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Contact Info

Product

Resources

About