Lateral subvastus lateralis versus medial parapatellar approach for total knee arthroplasty: A cadaveric biomechanical study

Sidhu, Sahil Prabhnoor; Moslemian, Alireza; Yamomo, Geofrey; Vakili, Samira; Kelly, Paul B.; Willing, Ryan; Lanting, Brent A.

doi:10.1016/j.knee.2020.09.022

Cited by 7 publications

(8 citation statements)

References 10 publications

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“…Each frozen knee was CT scanned prior to the study and thawed for 24 hours at room temperature. Triathlon TKA components (Stryker Corp., Mahwah, NJ) were implanted into the knee joint by an orthopedic surgeon, in mechanical alignment using conventional surgical tools [32]. The joints were sized and balanced for cruciate-retaining ultra-high molecular weight polyethylene (UHMWPE) bearings.…”

Section: Methodsmentioning

confidence: 99%

Development of Multi-Bundle Virtual Ligaments to Simulate Knee Mechanics after Total Knee Arthroplasty

Vakili

Lanting

Getgood

et al. 2022

Preprint

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Preclinical evaluation of total knee arthroplasty (TKA) components is essential to understanding their mechanical behavior and developing strategies for improving joint stability. While preclinical testing of TKA components has been useful in quantifying their effectiveness, such testing can be criticized for lacking clinical relevance, as the important contributions of surrounding soft tissues are either neglected or greatly simplified. The purpose of our study was to develop and determine if subject-specific virtual ligaments reproduce the same kinematics as native ligaments surrounding TKA joints. Five TKA knees were mounted to a motion simulator. Each was subjected to tests of anterior-posterior (AP), internal-external (IE), and varus-valgus (VV) laxity. The forces transmitted through major ligaments were measured using a sequential resection technique. By tuning the measured ligament forces and elongations to a generic non-linear elastic ligament model, virtual ligaments were designed and used to simulate the soft tissue envelope around isolated TKA components. The average root mean square error (RMSE) between the laxity results of TKA joints with native versus virtual ligaments was 2.9 mm during AP translation, 6.5 degrees during IE rotations, and 2.0 degrees during VV rotations, and there was no statistically significant difference between the results of both methods. Interclass correlation coefficients (ICCs) indicated a good level of reliability for AP and IE laxity (0.85 and 0.84). To conclude, a virtual ligament envelope around TKA joints can mimic natural knee behavior and is an effective method for the preclinical testing of TKA components. Keywords: Total knee arthroplasty; Prosthesis components; Joint motion simulator; Virtual ligaments; Stability

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Section: Methodsmentioning

confidence: 99%

Development of Multi-Bundle Virtual Ligaments to Simulate Knee Mechanics after Total Knee Arthroplasty

Vakili

Lanting

Getgood

et al. 2022

Preprint

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“…These specimens were then potted and aligned to be secured to the actuators of the VIVO joint motion simulator (Advanced Mechanical Technology, Inc, Watertown, MA) as previously described and validated. 6 , 7 This involved skeletonizing the proximal 75 mm of the femur and cementing it into a polyvinyl chloride pipe using dental model stone (Modern Materials Golden Denstone Labstone; Modern Materials, Kulzer GmbH, Hanau, Germany). The femur was then mounted in place to the upper actuator control arm.…”

Section: Methodsmentioning

confidence: 99%

“…Two previously described loading scenarios which simulate passive flexion/extension and laxity testing performed during TKA surgery were used to reduce the joints. 6 , 7 These involved either a 200 N compressive force applied along the long axis of the tibia, or 100 N simulated muscle forces consisting of 50 N of tension on the extensor mechanism (via a pneumatic actuator) and two 25 N hamstring forces generated using the virtual spring force capabilities of the VIVO. Knees were taken through flexion and extension cycles while all remaining degrees of freedom (DoF) were unconstrained (0 N/0 Nm load applied), and the resulting six-DoF kinematics represented the neutral paths of motion of the joints during compression and simulated muscle loading.…”

Section: Methodsmentioning

confidence: 99%

Trial Tibial Inserts May Result in Different Knee Kinematics from Final Poly Inserts in Total Knee Arthroplasty

Sidhu¹,

Lanting²,

Kelly³

et al. 2021

ORR

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Introduction Trialling is a key step in total knee arthroplasty (TKA) and helps the surgeon assess for adequate balancing, range of motion, and stability. Despite this, there are no studies investigating knee kinematics when using trial versus final polyethylene tibial inserts. Materials and Methods Fourteen fresh frozen cadaveric specimens were cycled in a VIVO joint motion simulator. Using both simple compression and simulated muscle loads, joints were tested after TKA with a trial insert or a final tibial poly insert. Anterior/posterior (AP), internal/external (IE), and varus/valgus (VV) kinematics and laxities were analyzed. Results Knees with trial poly inserts had significantly greater AP hysteresis (difference between flexion and extension motion) than those with final poly inserts (p=0.001). There was no significant difference in IE (p=0.563) or VV (p=0.580) hysteresis. There was no difference in AP, IE, or VV motion or laxities when considering the flexion path alone. Prosthetic joints followed different paths in flexion versus extension. Conclusion While trial tibial inserts impart valuable information, they may not accurately reproduce the same joint kinematics as final inserts. Balancing of the knee at specific degrees of flexion may depend on the path taken to get there.

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“…6 A cadaveric biomechanics study also showed no difference in TKA kinematics or laxity between the SLA and MPA. 7 In this study, we aimed to prospectively compare patient reported outcome measures (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Short Form 12 , Knee Society Score [KSS]) and joint kinematics (using quasi-static stereoradiography) between the standard MPA and SLA. We hypothesized that the SLA may theoretically lead to decreased postoperative pain scores as compared with the MPA, due to more anatomic kinematics of the knee as well as the nervous supply of the knee originating medially.…”

mentioning

confidence: 99%

“…6 A cadaveric biomechanics study also showed no difference in TKA kinematics or laxity between the SLA and MPA. 7…”

mentioning

confidence: 99%

Lateral Subvastus Lateralis versus Medial Parapatellar Approach for Total Knee Arthroplasty: Patient Outcomes and Kinematics Analysis

Sidhu,

Broberg,

Willing

et al. 2023

J Knee Surg

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The conventional approach for total knee arthroplasty (TKA) is a medial parapatellar approach (MPA). We aimed to study patient outcomes and kinematics with a quadriceps sparing lateral subvastus lateralis approach (SLA). Patients with neutral/varus alignment undergoing primary TKA were consented to undergo the SLA. At 1-year postoperative, patients underwent radiostereometric analysis. Patients were administered the Short Form 12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Society Score (KSS). Kinematics and outcome data were compared to a group undergoing TKA via conventional MPA. Fourteen patients underwent TKA via SLA with a mean age 71.5 ± 8.0 and mean body mass index (BMI) 31.0 ± 4.5. The MPA group had 13 patients with mean age 63.4 ± 5.5 (p = 0.006) and mean BMI 31.2 ± 4.6 (p = 0.95). The SLA resulted in a significantly more posterior medial contact point at 0 (p = 0.011), 20 (p = 0.020), and 40 (p = 0.039) degrees of flexion. There was no significant difference in medial contact point from 60 to 120 degrees, lateral contact point at any degree of flexion, or axial rotation. There was no difference in improvement in postoperative WOMAC, SF-12, KSS function, and total KSS knee scores between groups. The MPA group had a significantly greater improvement in KSS knee scores at 3 months (p < 0.001), 1 year (p = 0.003), and 2 years (p = 0.017). The SLA resulted in increased medial femoral rollback early in flexion. Although both approaches resulted in improved postoperative outcomes, the MPA group showed significantly greater improvements in KSS knee scores at 3 months, 1 year, and 2 years. Further studies are required to identify any benefits that the SLA may offer. Level of Evidence Therapeutic Level II

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Lateral subvastus lateralis versus medial parapatellar approach for total knee arthroplasty: A cadaveric biomechanical study

Cited by 7 publications

References 10 publications

Development of Multi-Bundle Virtual Ligaments to Simulate Knee Mechanics after Total Knee Arthroplasty

Development of Multi-Bundle Virtual Ligaments to Simulate Knee Mechanics after Total Knee Arthroplasty

Trial Tibial Inserts May Result in Different Knee Kinematics from Final Poly Inserts in Total Knee Arthroplasty

Lateral Subvastus Lateralis versus Medial Parapatellar Approach for Total Knee Arthroplasty: Patient Outcomes and Kinematics Analysis

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