Less femorotibial rotation and AP translation in deep-dished total knee arthroplasty. An intraoperative kinematic study using navigation

Massin, P.; Boyer, Patrick; Sabourin, M.

doi:10.1007/s00167-011-1740-5

Cited by 44 publications

(47 citation statements)

References 28 publications

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“…reported slight mid-flexion instability in CR compared with PS TKA [4], and Massin et al. detected paradoxical displacements in hyper congruent prostheses [5]. Thus, intra- and postoperative kinematics of TKA vary depending on the model and type of prosthesis, and all TKA procedures do not give similar knee kinematics to those of normal knees [6], [7].…”

Section: Introductionmentioning

confidence: 98%

Case series report of navigation-based in vivo knee kinematics in total knee arthroplasty with a gradually reducing femoral radius design

Takagi

Asai

Sato

et al. 2017

Annals of Medicine &Amp; Surgery

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BackgroundSimulations show that paradoxical anterior femoral slide in conventional dual radius total knee arthroplasty (TKA) is initiated by sudden reduction of the femoral radius from distal to posterior. Therefore, we hypothesized that a new TKA prosthesis design with a gradually reducing femoral radius may minimize the anterior slide in navigation-based in vivo knee kinematics. The purpose of this study was to compare the kinematics of TKA in vivo using a prosthesis with a gradually reducing radius, in comparison with the conventional dual radius design.MethodsA retrospective case series report was performed for 12 knees with osteoarthritis using a CT-free navigation system. Six knees received TKA using a prosthesis with a gradually reducing femoral radius (Attune CR) and the other 6 knees underwent TKA using a conventional dual radius design (PFCΣ CR). Anterior-posterior (AP) displacement of the medial and lateral femoral condyles relative to the tibia, and kinematic patterns of the femur throughout the range of motion were compared between the groups.ResultsThe average AP displacement in the Attune CR group indicated no paradoxical anterior movement of both condyles, and kinematic data showed a medial pivot pattern. In contrast, AP displacement in the PFCΣ CR group indicated that both condyles showed paradoxical anterior movement, and kinematically both condyles moved in the same manner, showing a parallel motion pattern.ConclusionTKA using a prosthesis with a gradually reducing radius minimized paradoxical anterior slide in navigation-based in vivo knee kinematics.

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Section: Introductionmentioning

confidence: 98%

Case series report of navigation-based in vivo knee kinematics in total knee arthroplasty with a gradually reducing femoral radius design

Takagi

Asai

Sato

et al. 2017

Annals of Medicine &Amp; Surgery

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show abstract

“…Preoperative and postoperative knee kinematics of osteoarthritic knees have shown a wide variety of results, such as mostly paradoxical forward slide of the femur during flexion [6,8,9], whereas normal knee kinematics describe an asymmetrical femoral roll-back mechanism during flexion, predominantly of the lateral femoral condyle [10,12]. Using a magnetic resonance imaging (MRI) technique in cadaver and living knees, Hill [11] described a pattern of no anteroposterior movement medially, but a lateral roll-back combined with sliding laterally during flexion.…”

Section: Introductionmentioning

confidence: 99%

Comparing navigation-based in vivo knee kinematics pre- and postoperatively between a cruciate-retaining and a cruciate-substituting implant

Baier

Springorum

Götz

et al. 2013

International Orthopaedics (SICOT)

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Purpose Individual physiological knee kinematics are highly variable in normal knees and are altered following cruciatesubstituting (PS) and cruciate-retaining (CR) total knee arthroplasty (TKA). We wanted to know whether knee kinematics are different choosing two different knee designs, CR and PS TKA, during surgery using computer navigation. Methods For this purpose, 60 consecutive TKA were randomised, receiving either CR (37 patients) or PS TKA (23 patients). All patients underwent computer navigation, and kinematics were assessed prior to making any cuts or releases and after implantation. Outcome measures were relative rotation between femur and tibia, measured medial and lateral gaps and medial and lateral condylar lift-off. Results We were not able to demonstrate a significant difference in femoral external rotation between either group prior to implantation (7.9°CR vs. 7.4°PS) or after implantation (9.0°C R vs. 11.3°PS), both groups showed femoral roll-back. It significantly increased pre-to postoperatively in PS TKA. In the CR group both gaps increased, the change of the medial gap was significantly attributable to medial release. In the PS group both gaps increased and the change of the medial and of the lateral gap was significant. Condylar lift-off was observed in the CR group during 20°and 60°of flexion. Conclusion This study did not reveal significant differences in navigation-based knee kinematics between CR and PS implants. Femoral roll-back was observed in both implant designs, but significantly increased pre-to postoperatively in PS TKA. A slight midflexion instability was observed in CR TKA. Intra-operative computer navigation can measure knee kinematics during surgery before and after TKR implantation and may assist surgeons to optimise knee kinematics or identify abnormal knee kinematics that could be corrected with ligament releases to improve the functional result of a TKR, whether it is a CR or PS design. Our intraoperative finding needs to be confirmed using fluoroscopic or radiographic 3D matching after complete recovery from surgery.

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“…Few studies have focussed on knee kinematics, which, however, might be one reason for improving postoperative problems with the operated joint. Pre-and postoperative knee kinematics show a wide variety of results, including mostly paradoxical forward slide of the femur during flexion [6,25,32], whereas normal knee kinematics describe a predominantly lateral femoral rollback during flexion [17,18,21].…”

Section: Introductionmentioning

confidence: 99%

Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique

Baier

Fitz

Craiovan

et al. 2013

International Orthopaedics (SICOT)

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Purpose Navigation-based total knee arthroplasty (TKA) has proven its value for restoration of the limb axis. However, patient-orientated results after TKA show a wide variation from the correct implantation technique. Nonphysiological kinematics without posterior femoral rollback and tibial internal rotation in flexion could be one reason for this. We postulated that a modified gap-balancing technique with navigation of the tibia alone, in comparison to a conventional navigated technique, would: (1) obtain lateral femoral rollback, (2) alter condylar liftoff without midflexion instability, (3) significantly differ in femoral and tibial cuts, (4) not be inferior in leg-axis restoration and (5) be comparable in clinical short-term scores. Methods In this prospective study, we compared in vivo navigation-based kinematics pre-and postoperatively of 40 consecutive TKA comprising 21 conventional navigationbased TKA and 19 TKA with the modified gap-balancing technique and a reduced navigation workflow. All cuts were double checked and compared with cuts proposed by the navigation system. Clinical results were assessed preoperatively and six months postoperatively. Results The modified gap-balancing technique resulted in significantly increased lateral femoral rollback (mean 16.3 mm) and lateral condylar liftoff (mean 1.3 mm) compared to the conventional group. The modified technique comprised an average of 2.1 mm less distal femoral resection and an average of 4°less external rotation and 3.5°more flexion of the femoral component compared with the control group. Average tibial resection height was 1.1 mm greater and average tibial slope was 0.5°elevated compared to the control group. A neutral leg axis was achieved in all cases. Results showed no significant differences in clinical scores between groups. Conclusion A partial navigation solely of the tibial cut can securely restore the leg axis. Modification of the surgical technique can possibly reproduce more physiological knee kinematics with higher lateral femoral rollback in flexion without midflexion instability. This might help reduce postoperative problems with the new implant and thus reduce the amount of unsatisfactory results. Despite equal short-term results, mid-to long-term results are needed to prove whether or not this correlates with better clinical results and at least equal implant longevity.

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Less femorotibial rotation and AP translation in deep-dished total knee arthroplasty. An intraoperative kinematic study using navigation

Abstract: Diagnostic study, Level II.

Cited by 44 publications

References 28 publications

Case series report of navigation-based in vivo knee kinematics in total knee arthroplasty with a gradually reducing femoral radius design

Case series report of navigation-based in vivo knee kinematics in total knee arthroplasty with a gradually reducing femoral radius design

Comparing navigation-based in vivo knee kinematics pre- and postoperatively between a cruciate-retaining and a cruciate-substituting implant

Improved kinematics of total knee replacement following partially navigated modified gap-balancing technique

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