In vivo kinematic comparison between an ultra-congruent and a posterior-stabilized total knee arthroplasty design by RSA

Sarsina, Tommaso Roberti di; Alesi, Domenico; Paolo, Stefano Di; Zinno, Raffaele; Pizza, Nicola; Zaffagnini, Stefano; Bragonzoni, Laura

doi:10.1007/s00167-021-06629-1

Cited by 17 publications

(27 citation statements)

References 21 publications

(43 reference statements)

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“…The range of A-P translation in both groups studied here was comparable to previous studies during functional activities in good outcome TKAs with similar UC inlay geometries (28,42,43). The socalled 'paradoxical anterior translation' pattern that is commonly observed in tibiofemoral kinematics after TKA (44) was also observed in both groups during level walking and became even more evident during downhill walking and stair descent.…”

Section: Discussionsupporting

confidence: 87%

Comparable in vivo joint kinematics between self-reported stable and unstable knees after TKA can be explained by muscular adaptation strategies: a retrospective observational study

Rao

Horn

Meister

et al. 2022

Preprint

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Background:Postoperative knee instability is one of the major reasons accounting for unsatisfactory outcomes, as well as a major failure mechanism leading to total knee arthroplasty (TKA) revision. Nevertheless, subjective knee instability is not well defined clinically, plausibly because the relationships between instability and implant kinematics during functional activities of daily living remain unclear. Although muscles play a critical role in supporting the dynamic stability of the knee joint, the influence of joint instability on muscle synergy patterns is poorly understood. Therefore, this study aimed to understand the impact of self-reported joint instability on tibiofemoral kinematics and muscle synergy patterns after TKA during functional gait activities of daily living.Methods:Tibiofemoral kinematics and muscle synergy patterns were examined during level walking, downhill walking, and stair descent in eight self-reported unstable knees after TKA (3M:5F, 68.9±8.3 years, BMI 26.1±3.2 kg/m2, 31.9±20.4 months postoperatively), and compared against ten stable TKA knees (7M:3F, 62.6±6.8 years, 33.9±8.5 months postoperatively, BMI 29.4±4.8 kg/m2). For each knee joint, clinical assessments of postoperative outcome were performed, while joint kinematics were evaluated using moving video-fluoroscopy, and muscle synergy patterns were recorded using electromyography.Results:Our results reveal that average condylar A-P translations, rotations, as well as their ranges of motion were comparable between stable and unstable groups. However, the unstable group exhibited more heterogeneous muscle synergy patterns and prolonged activation of knee flexors compared to the stable group. In addition, subjects who reported instability events during measurement showed distinct, subject-specific tibiofemoral kinematic patterns in the early/mid-swing phase of gait.Conclusions:Our findings suggest that accurate movement analysis is sensitive for detecting acute instability events, but might be less robust in identifying general joint instability. Conversely, muscle synergy patterns seem to be able to identify muscular adaptation associated with underlying chronic knee instability.Funding:This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Section: Discussionsupporting

confidence: 87%

Comparable in vivo joint kinematics between self-reported stable and unstable knees after TKA can be explained by muscular adaptation strategies: a retrospective observational study

Rao

Horn

Meister

et al. 2022

Preprint

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“…Limited literature investigated the differences in AP translation among similar TKA design. A recent study by Roberti di Sarsina et al [ 14 ] found lower AP translation of a UC TKA design between 30° and 0° of knee flexion during a sit-to-stand motor task with respect to a PS TKA design. The authors concluded that UC design high congruence was the reason for a greater control of femoro-tibial translation throughout the ROM.…”

Section: Discussionmentioning

confidence: 99%

“…This study has several limitations: first, the small sample size, due to the strict inclusion criteria and the radiographic setup of the study. Acknowledging this limitation, the sample size is nevertheless in line with that used in studies of the same type, which involve a complicated setup and long data processing times [ 1 , 6 , 7 , 14 ]. Second, the postoperative knee ROM is usual affected by a variety of patient and surgical factors (e.g., soft tissue contracture).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the final analysis was conducted on 16 patients, eight in the MC group (mean age 77.6 ± 2.7 years, 6 males, 2 females, 6 right knees) and eight in the UC group (mean age 70.9 ± 9.0 years, 2 males, 6 females, 6 right knees). The UC group patients were investigated in a previous study by the same research group in comparison with a different TKA design [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…The UC group patients were investigated in a previous study by the same research group in comparison with a different TKA design [14].…”

Section: Methodsmentioning

confidence: 99%

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No kinematical difference between ultra-congruent and medial-congruent total knee arthroplasty when implanted with mechanical alignment: an in vivo dynamic RSA study

Alesi

Paolo

Bragonzoni

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To explore in vivo kinematical behavior of the same total knee arthroplasty (TKA) cruciate-retaining (CR) femoral design with either medial-congruent (MC) or ultra-congruent (UC) inlay using model-based dynamic radiostereometric analysis (RSA). The hypothesis was that there would be comparable kinematics between the two groups. Methods A cohort of 16 randomly selected patients (8 MC Persona Zimmer, 8 UC Persona Zimmer) was evaluated through dynamic radiostereometric analysis (RSA) at a minimum of 9 months after TKA, during the execution of a sit-to-stand. The antero-posterior (AP) translation of the femoral component and the AP translation of the low point of medial and lateral femoral compartments were compared through Student’s t test (p < 0.05). Results Both groups showed a medial pivot behavior, with a significantly greater anterior translation of the Low Point of the lateral compartment with respect to the medial compartment (MC medial range: 2.4 ± 2.4 mm; MC lateral range: 7.7 ± 3.0 mm; p < 0.001 – UC medial range: 3.3 ± 3.3 mm; UC lateral range: 8.0 ± 3.2 mm; p < 0.001). A statistically significant greater degree of flexion was clinically recorded at follow-up visit in the MC group respect to the UC group (126° vs 101°—p = 0.003). Conclusion The present study did not show difference in the medial pivot behavior between ultra-congruent and medial-congruent total knee arthroplasty when implanted with mechanical alignment; however, the MC group demonstrated a greater degree of flexion. The MC design examined is a valid alternative to the UC design, allowing to achieve a screw-home movement restoration combined with a high flexion. Level of evidence IV.

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Kinematic function of knee implant designs across a range of daily activities

Kour

Guan

Dowsey

et al. 2022

Journal Orthopaedic Research

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The aim of this randomized controlled trial was to measure and compare six‐degree‐of‐freedom (6‐DOF) knee joint motion of three total knee arthroplasty (TKA) implant designs across a range of daily activities. Seventy‐five TKA patients were recruited to this study and randomly assigned a posterior‐stabilized (PS), cruciate‐retaining (CR), or medial‐stabilized (MS) implant. Six months after surgery, patients performed five activities of daily living: level walking, step‐up, step‐down, sit‐to‐stand, and stand‐to‐sit. Mobile biplane X‐ray imaging was used to measure 6‐DOF knee kinematics and the center of rotation of the knee in the transverse plane for each activity. Mean 6‐DOF knee kinematics were consistently similar for PS and CR, whereas MS was more externally rotated and abducted, and lateral shift was lower across all activities. Peak‐to‐peak anterior drawer for MS was also significantly lower during walking, step‐up, and step‐down (p < 0.017). The center of rotation of the knee in the transverse plane was located on the medial side for MS, whereas PS and CR rotated about the lateral compartment or close to the tibial origin. The kinematic function of MS was more similar to that of the healthy knee than PS and CR based on reduced paradoxical anterior translation at low flexion angles and a transverse center of rotation located in the medial compartment. Overall, 6‐DOF knee joint motion for PS and CR were similar across all daily activities, whereas that measured for MS was appreciably different. The kinematic patterns observed for MS reflects a highly conforming medial articulation in the MS design.

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In vivo kinematic comparison between an ultra-congruent and a posterior-stabilized total knee arthroplasty design by RSA

Cited by 17 publications

References 21 publications

Comparable in vivo joint kinematics between self-reported stable and unstable knees after TKA can be explained by muscular adaptation strategies: a retrospective observational study

Comparable in vivo joint kinematics between self-reported stable and unstable knees after TKA can be explained by muscular adaptation strategies: a retrospective observational study

No kinematical difference between ultra-congruent and medial-congruent total knee arthroplasty when implanted with mechanical alignment: an in vivo dynamic RSA study

Kinematic function of knee implant designs across a range of daily activities

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