Influence of Component Rotation in Total Knee Arthroplasty on Tibiofemoral Kinematics—A Cadaveric Investigation

Maderbacher, Günther; Keshmiri, Armin; Springorum, Hans-Robert; Maderbacher, Hermann; Grifka, Joachim; Baier, Christel

doi:10.1016/j.arth.2017.03.055

Cited by 18 publications

(27 citation statements)

References 57 publications

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“…In other words, our HiL setup is capable of predicting the typical kinematics patterns 34,51 of the knee joint under reproducible conditions. Additionally, several clinical phenomena have been observed, e.g., a loss of the physiological screw-home mechanism in agreement with the findings reported by other research groups 26,30,34 . This can be explained by the loss of menisci and anterior cruciate ligament.…”

Section: Discussionsupporting

confidence: 90%

“…Although computational studies have shown great potential in clinical decision-making 11,12,17,18,21,38,45,48,53,54 , they are associated with uncertainties regarding the prediction of realistic contact conditions. On the other hand, experimental studies 16,24,26,34,36,55 lack the consideration of the complex soft tissue structures acting at the lower extremity. Moreover, human cadaver specimens do not allow reproducible and comparable evaluations of different parameters due to the limited acquisition of samples and their decay.…”

Section: Discussionmentioning

confidence: 99%

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Effect of surgical parameters on the biomechanical behaviour of bicondylar total knee endoprostheses – A robot-assisted test method based on a musculoskeletal model

Kebbach

Grawe

Geier

et al. 2019

Sci Rep

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The complicated interplay of total knee replacement (TKR) positioning and patient-specific soft tissue conditions still causes a considerable number of unsatisfactory outcomes. Therefore, we deployed a robot-assisted test method, in which a six-axis robot moved and loaded a bicondylar cruciate-retaining (CR)-TKR in a virtual lower extremity emulated by a musculoskeletal multibody model. This enabled us to systematically analyse the impact of the posterior cruciate ligament (PCL), tibial slope, and tibial component rotation on TKR function while considering the physical implant components and physiological-like conditions during dynamic motions. The PCL resection yielded a decrease of femoral rollback by 4.5 mm and a reduction of tibiofemoral contact force by 50 N. A reduced tibial slope led to an increase of tibiofemoral contact force by about 170 N and a decrease of femoral rollback up to 1.7 mm. Although a higher tibial slope reduced the contact force, excessive tibial slopes should be avoided to prevent joint instability. Contrary to an external rotation of the tibial component, an internal rotation clearly increased the contact force and lateral femoral rollback. Our data contribute to improved understanding the biomechanics of TKRs and show the capabilities of the robot-assisted test method based on a musculoskeletal multibody model as a preoperative planning tool.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Effect of surgical parameters on the biomechanical behaviour of bicondylar total knee endoprostheses – A robot-assisted test method based on a musculoskeletal model

Kebbach

Grawe

Geier

et al. 2019

Sci Rep

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“…In this context, numerous kinematic concepts are currently being used and put up for discussion [ 9 , 12 , 14 ]. Thereby, the positioning of the components and especially the femoral component, play an important role [ 2 , 11 , 21 ]. Conventional implantation concepts (MA, AA, MR) compete with newer and currently popular approaches (KA, RKA, GBA) but the results are controversial.…”

Section: Discussionmentioning

confidence: 99%

“…The values determined in the laboratory utilizing tests on cadaver knees can, therefore, only be transferred to a specific knee joint to a limited extent and are not suitable for comparing simultaneously the results before and after the operation. Moreover, the possible pain due to the resulted implantation can not be evaluated [ 21 , 39 ].…”

Section: Introductionmentioning

confidence: 99%

A patient-specific 3D model of the knee to compare the femoral rollback before and after total knee arthroplasty (TKA)

et al. 2021

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Purpose Total knee arthroplasty (TKA) is nowadays performed as a standard procedure on a large number of patients suffering from arthrosis. Replacing the knee joint causes changes in the geometry and kinematics of the knee, which are unique to each individual. This research focuses on the method to detect these changes after TKA and on the impact on the knee movement. This approach could reduce complications in patients with post-operative pain and reduce the number of revisions. Methods A 3D model of a patient’s knee was made by measuring the movement with a medically certified infrared stereo camera. This measurement was combined with the 3D model of the patient’s bones, previously segmented from the CT scan. This model is printed in 3D, one part being the mechanism that follows the movement of the patient, and the other part being the 3D copy of the femur and tibia bones. The knee replacement operation is performed directly on the model and the resulting rollback is being measured before and after TKA. Results We observe a difference in the rollback before and after TKA on the 3D printed model. The variation in size and shape of the femoral implant compared to the natural femur condyles is one of the reasons for the changes in the rollback effect. The rollback is half as large after the prosthesis insertion, which confirms the fact that the femoral prosthesis geometry influences the knee kinematics. Conclusions In this study, a first 3D model combining the patient-specific kinematic and the geometry of his bones has been constructed. This model allows the surgeon to validate the plan of the operation, but also to understand the problems and consequences generated by the prosthesis insertion. The rollback is one of the most important motion of the knee joint and this behavior could be quantified, providing comparative analysis of the knee joint before and after the operation. As a future study, the model could be used to analyse more parameters of the TKA such as the impact of different implantation methods.

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“…Accurate rotational alignment of the components is an important prognostic factor in TKA. Component malrotation can cause patellar maltracking and altered tibiofemoral kinematics, which contributes to post-operative pain and abnormal loading [4][5][6][7][8][9][10][11][12][13][14], predisposing to early implant failure and revision surgery.…”

Section: Introductionmentioning

confidence: 99%

The accuracy of femoral component rotational measurements using computed tomography—a cadaveric study

et al. 2020

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Background CT scans can be used to assess the rotational alignment of the femoral component following total knee arthroplasty (TKA). This is done by calculating the posterior condylar angle (PCA). However, the methods used may not account for the biomechanical functionality of the TKA components. This cadaveric study aimed to determine whether the axis of scanning (mechanical or anatomical) alters the results of PCA calculations. Methods CT scans of 12 cadaveric adult femora were performed along the anatomical axis and the mechanical axis. The PCA was determined on each CT scan by measuring the relationship of the prosthetic posterior condyles to the surgical epicondylar axis of the femur. The mechanical and anatomical axis groups were further subdivided into best-fit and multi-slice subgroups. As a control, the posterior condylar angle was also calculated on photographic images of each femur. Bland-Altman plots were used to determine the correlation between the PCA values obtained from the different scanning axes and measurement techniques. Results There was no significant difference between the PCA measurements derived from anatomical and mechanical axis CT scans. The Pearson correlation co-efficient also indicated good correlation between the two scanning axes. Conclusion The axis of scanning does not significantly affect the PCA measurements. Therefore, the measurements may be reliably used for clinical decision-making, regardless of the axis of CT scanning.

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Influence of Component Rotation in Total Knee Arthroplasty on Tibiofemoral Kinematics—A Cadaveric Investigation

Cited by 18 publications

References 57 publications

Effect of surgical parameters on the biomechanical behaviour of bicondylar total knee endoprostheses – A robot-assisted test method based on a musculoskeletal model

Effect of surgical parameters on the biomechanical behaviour of bicondylar total knee endoprostheses – A robot-assisted test method based on a musculoskeletal model

A patient-specific 3D model of the knee to compare the femoral rollback before and after total knee arthroplasty (TKA)

The accuracy of femoral component rotational measurements using computed tomography—a cadaveric study

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