Kinematics of mobile-bearing unicompartmental knee arthroplasty compared to native: results from an in vitro study

Peersman, Geert; Slane, Joshua; Vuylsteke, Philippe; Fuchs-Winkelmann, Susanne; Dworschak, Philipp; Heyse, Thomas J.; Scheys, Lennart

doi:10.1007/s00402-017-2794-8

Cited by 30 publications

(24 citation statements)

References 28 publications

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“…Also, the presence of a mobile insert is likely to be beneficial during passive and squatting motion by preventing abnormal posterior translation of the medial femoral compartment. 22 In another cadaveric study, Heyse et al 21 underlined the importance of optimal balancing. They recommended against over-stuffing the joint as this led to larger kinematic changes compared to the native condition and caused excess strain in the superficial medial collateral ligament.…”

Section: Discussionmentioning

confidence: 99%

Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty

Tapasvi¹,

Shekhar²,

Patil

et al. 2020

Bone & Joint Research

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Aims The mobile bearing Oxford unicompartmental knee arthroplasty (OUKA) is recommended to be performed with the leg in the hanging leg (HL) position, and the thigh placed in a stirrup. This comparative cadaveric study assesses implant positioning and intraoperative kinematics of OUKA implanted either in the HL position or in the supine leg (SL) position. Methods A total of 16 fresh-frozen knees in eight human cadavers, without macroscopic anatomical defects, were selected. The knees from each cadaver were randomized to have the OUKA implanted in the HL or SL position. Results Tibial base plate rotation was significantly more variable in the SL group with 75% of tibiae mal-rotated. Multivariate analysis of navigation data found no difference based on all kinematic parameters across the range of motion (ROM). However, area under the curve analysis showed that knees placed in the HL position had much smaller differences between the pre- and post-surgery conditions for kinematics mean values across the entire ROM. Conclusion The sagittal tibia cut, not dependent on standard instrumentation, determines the tibial component rotation. The HL position improves accuracy of this step compared to the SL position, probably due to better visuospatial orientation of the hip and knee to the surgeon. The HL position is better for replicating native kinematics of the knee as shown by the area under the curve analysis. In the supine knee position, care must be taken during the sagittal tibia cut, while checking flexion balance and when sizing the tibial component.

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Section: Discussionmentioning

confidence: 99%

Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty

Tapasvi¹,

Shekhar²,

Patil

et al. 2020

Bone & Joint Research

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“…Several reports describe the difference in knee kinematics between fixed-bearing UKA and mobile-bearing UKA. 46 It is possible that other types of prosthesis could produce different results. Second, the original bone model in the current study had a neutral limb alignment with a 7° posterior slope, and only one bone model was used.…”

Section: Discussionmentioning

confidence: 99%

Effect of tibial component alignment on knee kinematics and ligament tension in medial unicompartmental knee arthroplasty

Sekiguchi

Nakamura

Kuriyama

et al. 2019

Bone & Joint Research

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Objectives Unicompartmental knee arthroplasty (UKA) is one surgical option for treating symptomatic medial osteoarthritis. Clinical studies have shown the functional beneﬁts of UKA; however, the optimal alignment of the tibial component is still debated. The purpose of this study was to evaluate the effects of tibial coronal and sagittal plane alignment in UKA on knee kinematics and cruciate ligament tension, using a musculoskeletal computer simulation. Methods The tibial component was first aligned perpendicular to the mechanical axis of the tibia, with a 7° posterior slope (basic model). Subsequently, coronal and sagittal plane alignments were changed in a simulation programme. Kinematics and cruciate ligament tensions were simulated during weight-bearing deep knee bend and gait motions. Translation was defined as the distance between the most medial and the most lateral femoral positions throughout the cycle. Results The femur was positioned more medially relative to the tibia, with increasing varus alignment of the tibial component. Medial/lateral (ML) translation was smallest in the 2° varus model. A greater posterior slope posteriorized the medial condyle and increased anterior cruciate ligament (ACL) tension. ML translation was increased in the > 7° posterior slope model and the 0° model. Conclusion The current study suggests that the preferred tibial component alignment is between neutral and 2° varus in the coronal plane, and between 3° and 7° posterior slope in the sagittal plane. Varus > 4° or valgus alignment and excessive posterior slope caused excessive ML translation, which could be related to feelings of instability and could potentially have negative effects on clinical outcomes and implant durability. Cite this article : K. Sekiguchi, S. Nakamura, S. Kuriyama, K. Nishitani, H. Ito, Y. Tanaka, M. Watanabe, S. Matsuda. Bone Joint Res 2019;8:126–135. DOI: 10.1302/2046-3758.83.BJR-2018-0208.R2.

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“…Consequently, surgeons tend to keep the medial joint space of the knee tight so that bearing does not slip out. Furthermore, the surgeons tend to perfom valgus overcorrection to offload the medial compartment and further decreasing the probability of bearing dislocation and aseptic loosening [105]. Failure to do so meticulously may lead to undesirable complications of accelerated progressive lateral compartment osteoarthritis.…”

Section: Choice Of Bearing Design: Mobile or Fixed Bearing?mentioning

confidence: 99%

Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA

Mittal¹,

Meshram²,

Kim³

et al. 2020

J Orthop Traumatol

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Unicompartmental knee arthroplasty (UKA) is a bone-and ligament-sparing alternative to total knee arthroplasty in the patients with end-stage single-compartment degeneration of the knee. Despite being a successful procedure, the multiple advantages of UKA do not correlate with its usage, most likely due to the concerns regarding prosthesis survivability, patient selection, ideal bearing design, and judicious use of advanced technology among many others. Therefore, the purpose of this study is to review and summarize the debated literature and discuss the controversies as "Ten Enigmas of UKA. "

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Kinematics of mobile-bearing unicompartmental knee arthroplasty compared to native: results from an in vitro study

Cited by 30 publications

References 28 publications

Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty

Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty

Effect of tibial component alignment on knee kinematics and ligament tension in medial unicompartmental knee arthroplasty

Unicompartmental knee arthroplasty, an enigma, and the ten enigmas of medial UKA

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