Comparison of posterior‐stabilized, cruciate‐retaining, and medial‐stabilized knee implant motion during gait

Abstract

Accurate knowledge of knee joint motion is needed to evaluate the effects of implant design on functional performance and component wear. We conducted a randomized controlled trial to measure and compare 6-degree-of-freedom (6-DOF) kinematics and femoral condylar motion of posterior-stabilized (PS), cruciate-retaining (CR) and medial-stabilized (MS) knee implant designs for one cycle of walking. A mobile biplane X-ray imaging system was used to accurately measure 6-DOF tibiofemoral motion as patients implanted with PS (n = 23), CR (n = 25) or MS (n = 26) knees walked over ground at their self-selected speeds. Knee flexion angle (maximum, minimum, and peak-to-peak range) did not differ significantly between the three designs. Relative movements of the femoral and tibial components were generally similar for PS and CR with significant differences observed only for anterior tibial drawer. Knee kinematic profiles measured for MS were appreciably different: external rotation and abduction of the tibia were increased while peak-to-peak anterior drawer was significantly reduced for MS compared to PS and CR. Anterior-posterior drawer and medial-lateral shift of the tibia were strongly coupled to internal-external rotation for MS, as was anterior-posterior translation of the contact center in the lateral compartment. MS exhibited the least amount of paradoxical anterior translation of the femur relative to the tibia during knee flexion. The joint center of rotation in the transverse plane was located in the lateral compartment for PS and CR and in the medial compartment for MS. Substantial differences were evident in 6-DOF knee kinematics between the healthy knee and all three prosthetic designs. Overall, knee kinematic profiles observed for MS resemble those of the healthy joint more closely than PS and CR.

Comparison of the Effectiveness of Portable Ultrasound vs Portable X-Ray as Diagnostic Imaging of Knee Structures in Clinical Medicine

“…The study was conducted with a population of 15 healthy individuals (9 males and 6 females), and assessed movements and rotations including flexion-extension, internal-external rotation, and abduction-adduction. The data collected from this study yielded valuable information for the assessment of knee function in normal and pathologic gait [16]. The findings in this study support the hypothesis that portable xrayimaging is useful as a diagnostic instrument of certain components of the knee.…”

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

“…For the first time, we reported the knee kinematics of MP and PS TKA of Chinese patients in this study with the anatomical coordinate system and femoral transepicondylar axis. Gray et al (2020) reported similar peak flexion angle at mid-swing in the MP and the PS TKA (MP 52.5 vs. 54.8° PS, p = 0.64), which was less than healthy knees [70.7° by Gray et al (2019) and 65.6° by Postolka et al (2020) ]. In our study, the two TKA groups showed similar peak flexion angles (MP 52.4 ± 7.4 vs. 50.1 ± 3.6 PS, p = 0.47) and were consistent with previous studies ( Yoshida et al, 2012 ; Arauz et al, 2018 ; Grieco et al, 2018 ; Gray et al, 2020 ).…”

“… Gray et al (2020) reported similar peak flexion angle at mid-swing in the MP and the PS TKA (MP 52.5 vs. 54.8° PS, p = 0.64), which was less than healthy knees [70.7° by Gray et al (2019) and 65.6° by Postolka et al (2020) ]. In our study, the two TKA groups showed similar peak flexion angles (MP 52.4 ± 7.4 vs. 50.1 ± 3.6 PS, p = 0.47) and were consistent with previous studies ( Yoshida et al, 2012 ; Arauz et al, 2018 ; Grieco et al, 2018 ; Gray et al, 2020 ). To note, different from TKA knees in other studies of Caucasian patients ( Hanson et al, 2006 ; Gray et al, 2020 ), no flexion peak in the early-stance phase was found in our patients ( Figure 3A ).…”

“…However, clinical outcomes of MP TKA are inconsistent in the literature. Numerous studies reported satisfactory clinical results of MP TKA ( Hossain et al, 2011 ; Youm et al, 2014 ; Steinbruck et al, 2016 ; Gray et al, 2020 ; Jones et al, 2020 ) and patient preference over PS and other prostheses ( Schmidt et al, 2003 ; Pritchett, 2011 ). On the contrary, other authors reported that the MP design was not superior to other designs in patient-reported outcomes and knee kinematics ( Chinzei et al, 2014 ; Papagiannis et al, 2016 ; Choi et al, 2017 ; Kim et al, 2017 ; Jones et al, 2020 ; Nisar et al, 2020 ).…”

Accuracy of the tibiofemoral contact forces estimated by a subject-specific musculoskeletal model with fluoroscopy-based contact point trajectories

“…Typically, in the case of knee osteoarthritis, the contact point trajectories, among other joint and muscle factors, are modified by the pathology (Scarvell et al, 2018) and restored by the arthroplasty (Li et al, 2015). The alteration of the contact points appears to be a clinically relevant parameter to assess joint pathology (Farrokhi et al, 2014;Zeighami et al, 2017) as well as prosthetic performance (Gray et al, 2020;Nicolet-Petersen et al, 2020). For instance, the contact point trajectories can help estimating the in vivo slip velocity (Andriacchi et al, 2003;Dumas et al, 2020a;Hamilton et al, 2005) which is an important parameter, together with the estimated in vivo contact force, for characterising wear in the prosthetic components.…”