Gait analysis of patients with an off-the-shelf total knee replacement versus customized bi-compartmental knee replacement

Wang, Henry E.; Foster, Jonathan B.; Franksen, Natasha; Estes, Jill; Rolston, Lindsey

doi:10.1007/s00264-017-3622-z

Cited by 22 publications

(31 citation statements)

References 21 publications

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“…have shown that knee-joint kinematics in patients with unilateral BKR replicate the kinematics of their contra-lateral non-involved limb and also that of healthy external controls. Wang et al [38] evaluated knee strength and biomechanics during walking in patients with BKR, TKR and healthy control subjects. They found that BKR patients reported higher satisfaction while performing activities of daily living and improved their quadriceps strength to a level that was close to healthy controls.…”

Section: Discussionmentioning

confidence: 99%

Unicompartmental vs. segmental bicompartmental vs. total knee replacement: comparison of clinical outcomes

Al‐Dadah

Hawes

Chapman-Sheath

et al. 2020

Knee Surg & Relat Res

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Purpose: Combined medial tibiofemoral and symptomatic patellofemoral osteoarthritis is not amenable to unicompartmental knee replacement (UKR). Total knee replacement (TKR) is an invasive option in younger adults with high functional demands. The aim of this study was to compare the clinical outcome of patients who have undergone UKR, bicompartmental knee replacement (BKR) and TKR up to 2 years post-operatively. Materials and methods: This prospective study comprised 133 subjects including 30 patients in the medial UKR group, 53 patients in the BKR group (combined medial UKR with patellofemoral joint replacement) and 50 patients in the TKR group. All subjects were evaluated using the Oxford Knee Score (OKS) and the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Patients in each group were assessed using both scoring systems pre-operatively and 6 months, 1 year and 2 years post-operatively. Results: Significant improvement of OKS was found at 6 months compared to baseline for UKR (22.7 to 38.1, p = 0.046), BKR (22.6 to 36.8, p < 0.001) and TKR (16.6 to 34.5, p < 0.001). Significant improvement was also found for the WOMAC sub-scores for all three groups during this time period. After 6 months, there was no further statistically significant improvement in either outcome score in any of the groups up to the 2-year follow-up results. There was no significant difference in either outcome score post-operatively between the three groups. Conclusion: The magnitude of clinical improvement following knee replacement is greatest at 6 months; thereafter, only modest improvements continue to occur. This study also found no significant differences of outcomes at 2 years after surgery among UKR, BKR and TKR. BKR is a good alternative option for combined symptomatic medial and patellofemoral arthritis of the knee.

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Section: Discussionmentioning

confidence: 99%

Unicompartmental vs. segmental bicompartmental vs. total knee replacement: comparison of clinical outcomes

Al‐Dadah

Hawes

Chapman-Sheath

et al. 2020

Knee Surg & Relat Res

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“…Patientspecific instrument has been developed to overcome the problems caused by altered geometry in variations in implant alignment. In short, effect of soft tissue, not an implant design, is important in nonweight bearing condition (44). The interest finding was the verification that customized TKA provides more normal-like healthy knee kinematics than standard OTS TKA does.…”

Section: Discussionmentioning

confidence: 99%

“…This trend was similar to previous study. In short, effect of soft tissue, not an implant design, is important in nonweight bearing condition (44). In addition, we recently showed bicruciate retaining TKA restored closer native knee kinematics using computational simulation (45).…”

Section: Discussionmentioning

confidence: 99%

Computational analysis of customized cruciate retaining total knee arthroplasty restoration of native knee joint biomechanics

et al. 2018

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The purpose of this study was to verify if customized prosthesis better preserves the native knee joint kinematics and provides lower contact stress on the polyethylene (PE) insert owing to the wider bone preservation than that of standard off-the-shelf prosthesis in posterior cruciate-retaining type total knee arthroplasty (TKA).Validated finite element (FE) models for were developed to evaluate the knee joint kinematics and contact stress on the PE insert after TKA with customized and standard off-the-shelf (OTS) prostheses as well as in normal healthy knee through FE analysis under dynamic loading conditions. The contact stresses on the customized prosthesis decreased by 18% and 8% under gait cycle loading conditions, and 24%and 9% under deep-knee-bend loading conditions, in the medial and lateral sides of the PE insert, respectively, compared with the standard OTS prosthesis. The anteriorposterior translation and internal-external (IE) rotation in customized TKA were more similar to native knee joint behaviors compared with standard OTS TKA under gait loading conditions. The difference from normal knee kinematics was lower for femoral rollback and IE rotation in customized TKA than in standard OTS TKA in the deep-knee-bend condition. In general, customized prostheses achieve kinematics that are close to those of the native healthy knee joint and have better contact stresses than standard OTS prostheses in gait and deep-knee-bend loading conditions.

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“…Recent studies that focused on customized TKA are associated with good clinical reports, although most of them were limited to CR-TKA [ 18 – 20 , 22 ]. Previous studies did not focus on post-cam design in customized PS-TKA.…”

Section: Discussionmentioning

confidence: 99%

Effect of Post-Cam Design for Normal Knee Joint Kinematic, Ligament, and Quadriceps Force in Patient-Specific Posterior-Stabilized Total Knee Arthroplasty by Using Finite Element Analysis

Koh

Son

Kwon

et al. 2018

BioMed Research International

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The purpose of this study is to investigate post-cam design via finite element analysis to evaluate the most normal-like knee mechanics. We developed five different three-dimensional computational models of customized posterior-stabilized (PS) total knee arthroplasty (TKA) involving identical surfaces with the exception of the post-cam geometry. They include flat-and-flat, curve-and-curve (concave), curve-and-curve (concave and convex), helical, and asymmetrical post-cam designs. We compared the kinematics, collateral ligament force, and quadriceps force in the customized PS-TKA with five different post-cam designs and conventional PS-TKA to those of a normal knee under deep-knee-bend conditions. The results indicated that femoral rollback in curve-and-curve (concave) post-cam design exhibited the most normal-like knee kinematics, although the internal rotation was the closest to that of a normal knee in the helical post-cam design. The curve-and-curve (concave) post-cam design showed a femoral rollback of 4.4 mm less than the normal knee, and the helical post-cam design showed an internal rotation of 5.6° less than the normal knee. Lateral collateral ligament and quadriceps forces in curve-and-curve (concave) post-cam design, and medial collateral ligament forces in helical post-cam design were the closest to that of a normal knee. The curve-and-curve (concave) post-cam design showed 20% greater lateral collateral ligament force than normal knee, and helical post-cam design showed medial collateral ligament force 14% greater than normal knee. The results revealed the variation in each design that provided the most normal-like biomechanical effect. The present biomechanical data are expected to provide useful information to improve post-cam design to restore normal-like knee mechanics in customized PS-TKA.

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Gait analysis of patients with an off-the-shelf total knee replacement versus customized bi-compartmental knee replacement

Cited by 22 publications

References 21 publications

Unicompartmental vs. segmental bicompartmental vs. total knee replacement: comparison of clinical outcomes

Unicompartmental vs. segmental bicompartmental vs. total knee replacement: comparison of clinical outcomes

Computational analysis of customized cruciate retaining total knee arthroplasty restoration of native knee joint biomechanics

Effect of Post-Cam Design for Normal Knee Joint Kinematic, Ligament, and Quadriceps Force in Patient-Specific Posterior-Stabilized Total Knee Arthroplasty by Using Finite Element Analysis

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