Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Abstract

Purpose To investigate if postoperative clinical outcomes correlate with specific kinematic patterns after total knee arthroplasty (TKA) surgery. The hypothesis was that the group of patients with higher clinical outcomes would have shown postoperative medial pivot kinematics, while the group of patients with lower clinical outcomes would have not. Methods 52 patients undergoing TKA surgery were prospectively evaluated at least a year of follow-up (13.5 ± 6.8 months) through clinical and functional Knee Society Score (KSS), and kinematically through dynamic radiostereometric analysis (RSA) during a sit-to-stand motor task. Patients received posterior-stabilized TKA design. Based on the result of the KSS, patients were divided into two groups: “KSS > 70 group”, patients with a good-to-excellent score (93.1 ± 6.8 points, n = 44); “KSS < 70 group”, patients with a fair-to-poor score (53.3 ± 18.3 points, n = 8). The anteroposterior (AP) low point (lowest femorotibial contact points) translation of medial and lateral femoral compartments was compared through Student’s t test (p < 0.05). Results Low point AP translation of the medial compartment was significantly lower (p < 0.05) than the lateral one in both the KSS > 70 (6.1 mm ± 4.4 mm vs 10.7 mm ± 4.6 mm) and the KSS < 70 groups (2.7 mm ± 3.5 mm vs 11.0 mm ± 5.6 mm). Furthermore, the AP translation of the lateral femoral compartment was not significantly different (p > 0.05) between the two groups, while the AP translation of the medial femoral compartment was significantly higher for the KSS > 70 group (p = 0.0442). Conclusion In the group of patients with a postoperative KSS < 70, the medial compartment translation was almost one-fourth of the lateral one. Surgeons should be aware that an over-constrained kinematic of the medial compartment might lead to lower clinical outcomes. Level of evidence II.

In vivo kinematic comparison between an ultra-congruent and a posterior-stabilized total knee arthroplasty design by RSA

“…The absence of pre-operative investigation was required by our IRB with the speciic aim of reducing overall X-ray exposure per patient. Moreover, although 9 months can be considered a short-term follow-up, it is in line with literature on the irst post-operative TKA kinematical analysis [9,10]. The motor task investigated was not standardized in terms of velocity and starting knee lexion angle to allow patients moving naturally and investigate daily life kinematics as much as possible.…”

“…2 and 3). Pizza et al recently demonstrated that a tighter medial compartment is associated with lower clinical score [10]. This might imply that, if correctly balanced, the congruence of the UC insert can control the movement of the condyles, but at the expense of non‐physiological kinematics, as also demonstrated by Daniilidis et al [6].…”

“…The inclusion criteria were consistent along with the patient's recruitment and were: (1) age (50-85 years old), (2) severe radiographic primary osteoarthritis (Kellgren-Lawrence grade 3 and grade 4), (3) patients scheduled for a primary TKA. The exclusion criteria were: (1) previous corrective osteotomy on the afected lower limb, (2) post-traumatic arthritis, (3) severe preoperative varus-valgus deformity (hip knee ankle angle > 10°); body mass index > 40 kg/m 2 , (4) rheumatoid arthritis; (5) chronic inlammatory joint diseases, (6) patients with a pre-pathological abnormal gait (amputated, neuromuscular disorders, poliomyelitis, developmental dysplasia of the hip), (7) severe ankle osteoarthritis (Kellgren-Lawrence grade 3 and grade 4), (8) severe hip osteoarthritis (Kellgren-Lawrence grade 3 and grade 4), (9) previous total hip or ankle replacement, (10) unwillingness to take part in this study and providing Health Insurance Portability and Accountability Act (HIPAA) authorization.…”

Dynamic Radiostereometry Evaluation of 2 Different Anterior Cruciate Ligament Reconstruction Techniques During a Single-Leg Squat

“…The 6 degrees of freedom kinematic quantitative data were calculated using the Grood and Suntay decomposition in dedicated software in MATLAB (R2016a; MathWorks Inc) using a validated workflow with submillimetric accuracy (0.22 ± 0.46 mm and 0.26° ± 0.2° for the model position and orientation, respectively). 1 , 10 The test-retest reliability was assessed using a set of repeated tests under different image noise conditions, 27 , 41 and the average error 8 was <0.48 mm (95% CI, 0.15-0.80 mm). The RSA operator was blinded to the surgical technique.…”

Femoral Rollback at High-Flexion During Squatting is Related to the Improvement of Sports Activities After Bicruciate-Stabilized Total Knee Arthroplasty: An Observational Study

“…Several studies have demonstrated that the postoperative knee kinematics was related to the patientreported outcome measures (PROMs) [12][13][14]. Van Onsem et al reported that the high PROM group had more pronounced posterior translation laterally from 60° to 90° of exion than the low PROM group [15].…”