In vivo weight-bearing kinematics with medial rotation knee arthroplasty

Moonot, Pradeep; Mu, Shang; Railton, G. T.; Field, Richard E.; Banks, Scott A.

doi:10.1016/j.knee.2009.06.009

Cited by 25 publications

(16 citation statements)

References 32 publications

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“…The static postures were maximum flexion kneeling and lunging. 15 - 19 Dynamic activities were stepping up and down on a 22 cm step without swing-through of the contralateral limb, and pivoting about a fixed foot placement with the weight-bearing knee near extension. 9 , 17 , 18 The pivoting activity required the patient to plant their foot with the toes pointed outward, and then pivot from a position of femoral internal rotation to femoral external rotation in one smooth fully weight-bearing action.…”

Section: Methodsmentioning

confidence: 99%

“…Descriptive statistics were compiled to permit comparison of measured knee motions with previous reports. 6 , 9 , 16 - 19 Comparisons of pre- and post-operative clinical scores, and knee kinematics between lunging and kneeling activities were performed using paired t -tests with significance set at a p-value < 0.05. Linear correlation was used to examine the relationship between longitudinal rotation of the knee and AP translation of the lateral femoral condyle.…”

Section: Methodsmentioning

confidence: 99%

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Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised?

Scott

Imam

Eifert

et al. 2016

Bone & Joint Research

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ObjectivesThroughout the 20th Century, it has been postulated that the knee moves on the basis of a four-bar link mechanism composed of the cruciate ligaments, the femur and the tibia. As a consequence, the femur has been thought to roll back with flexion, and total knee arthroplasty (TKA) prostheses have been designed on this basis. Recent work, however, has proposed that at a position of between 0° and 120° the medial femoral condyle does not move anteroposteriorly whereas the lateral femoral condyle tends, but is not obliged, to roll back – a combination of movements which equates to tibial internal/ femoral external rotation with flexion. The aim of this paper was to assess if the articular geometry of the GMK Sphere TKA could recreate the natural knee movements in situ/in vivo.MethodsThe pattern of knee movement was studied in 15 patients (six male: nine female; one male with bilateral TKAs) with 16 GMK Sphere implants, at a mean age of 66 years (53 to 76) with a mean BMI of 30 kg/m2 (20 to 35). The motions of all 16 knees were observed using pulsed fluoroscopy during a number of weight-bearing and non-weight-bearing static and dynamic activities.ResultsDuring maximally flexed kneeling and lunging activities, the mean tibial internal rotation was 8° (standard deviation (sd) 6). At a mean 112° flexion (sd 16) during lunging, the medial and lateral condyles were a mean of 2 mm (sd 3) and 8 mm (sd 4) posterior to a transverse line passing through the centre of the medial tibial concavity. With a mean flexion of 117° (sd 14) during kneeling, the medial and lateral condyles were a mean of 1 mm (sd 4) anterior and 6 mm (sd 4) posterior to the same line. During dynamic stair and pivoting activities, there was a mean anteroposterior translation of 0 mm to 2 mm of the medial femoral condyle. Backward lateral condylar translation occurred and was linearly related to tibial rotation.ConclusionThe GMK Sphere TKA in our study group shows movements similar in pattern, although reduced in magnitude, to those in recent reports relating to normal knees during several activities. Specifically, little or no translation of the medial femoral condyle was observed during flexion, but there was posterior roll-back of the lateral femoral condyle, equating to tibiofemoral rotation. We conclude that the GMK Sphere is anteroposteriorly stable medially and permits rotation about the medial compartment.Cite this article: Professor G. Scott. Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised?: A pulsed fluoroscopic investigation. Bone Joint Res 2016;5:80–86. DOI: 10.1302/2046-3758.53.2000621.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised?

Scott

Imam

Eifert

et al. 2016

Bone & Joint Research

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“…Moonot et al showed for a range of activities, the MRK design controlled the medial femoral condyle to remain within a few millimeters of the tibial insert sulcus, while the lateral condyle translated both anteriorly and posteriorly as coupled to tibial internalexternal rotation. 24,25 Shimmin et al reported kinematics of the Saiph TKA (MatOrtho, Surrey, UK), a design evolved from the MRK with a dished rather than cylindric lateral compartment, and showed there was slightly more tibial rotation and lateral translation, while the medial condyle remained within a few millimeters of the sulcus over the activities observed. 26 Scott et al reported in vivo kinematics of the GMK Sphere, a design with a sagittally flat lateral tibiofemoral articulation to allow free axial rotation about the medially spherical articulation.…”

Section: Medially Constrained Designsmentioning

confidence: 99%

Rationale and Results for Fixed-Bearing Pivoting Designs in Total Knee Arthroplasty

Banks

Deckard

Hodge³

et al. 2019

J Knee Surg

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Total knee arthroplasty (TKA) is a maturing technology, and the focus for improvement centers on optimizing patient satisfaction and further reducing revisions. It is commonly assumed that achieving closer-to-normal knee mechanics in a TKA will result in further improvement in outcomes and revision rates. Fixed-bearing TKA designs with asymmetric pivoting articulations are designed to provide more natural joint stability and kinematics. These designs have been used for more than 20 years and there is a substantial body of literature characterizing their performance. This article reviews the various design types of fixed-bearing pivoting TKA designs, and recounts their clinical, functional, and patient-preference performance from peer-reviewed studies. To date, the evidence suggests there is measurable benefit to providing closer-to-normal joint stability and kinematics, and that fixed-bearing, pivoting TKA designs may decrease instability-related revisions and improve patient satisfaction.

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“…However, none of the described TKA systems completely restore normal knee kinematics. Outcomes for the described implant categories have been good with survivorship reported as high as 90-95 % at 15-20 years [ 24 ]. Despite this, further research is ongoing to better replicate the normal knee and restore the stability and fl exion that both patients and orthopedic surgeons seek in a TKA.…”

Section: Discussionmentioning

confidence: 99%

Prosthetic Kinematics: Cruciate Retaining Versus Posterior Stabilized Versus Medial Pivot

Blevins

Cross

2015

Total Knee Arthroplasty

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In vivo weight-bearing kinematics with medial rotation knee arthroplasty

Cited by 25 publications

References 32 publications

Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised?

Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised?

Rationale and Results for Fixed-Bearing Pivoting Designs in Total Knee Arthroplasty

Prosthetic Kinematics: Cruciate Retaining Versus Posterior Stabilized Versus Medial Pivot

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