The effect of surgical alignment and soft tissue conditions on the kinematics and wear of a fixed bearing total knee replacement

Johnston, Helena; Abdelgaied, Abdellatif; Pandit, Hemant; Fisher, John; Jennings, Louise

doi:10.1016/j.jmbbm.2019.103386

Cited by 21 publications

(15 citation statements)

References 58 publications

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“…This was found to be particularly important for metal-on-metal hard contacts [347,348]. The importance of adverse testing in the knee implant was addressed for various alignments and soft tissue conditions [349]. While the majority of wear studies were conducted experimentally, computational wear prediction for the hip was reviewed in Ref.…”

Section: Joint Tribologymentioning

confidence: 99%

A review of recent advances in tribology

et al. 2020

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The reach of tribology has expanded in diverse fields and tribology related research activities have seen immense growth during the last decade. This review takes stock of the recent advances in research pertaining to different aspects of tribology within the last 2 to 3 years. Different aspects of tribology that have been reviewed including lubrication, wear and surface engineering, biotribology, high temperature tribology, and computational tribology. This review attempts to highlight recent research and also presents future outlook pertaining to these aspects. It may however be noted that there are limitations of this review. One of the most important of these is that tribology being a highly multidisciplinary field, the research results are widely spread across various disciplines and there can be omissions because of this. Secondly, the topics dealt with in the field of tribology include only some of the salient topics (such as lubrication, wear, surface engineering, biotribology, high temperature tribology, and computational tribology) but there are many more aspects of tribology that have not been covered in this review. Despite these limitations it is hoped that such a review will bring the most recent salient research in focus and will be beneficial for the growing community of tribology researchers.

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Section: Joint Tribologymentioning

confidence: 99%

A review of recent advances in tribology

et al. 2020

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“…Aseptic loosening (31.2%) and instability (18.7%) are the two commonest modes of failure of TKA [ 5 ]. Alignment and soft tissue balance during surgery can influence both of these factors [ 1 , 6 , 7 ]. The number of TKAs performed globally is rising.…”

Section: Introductionmentioning

confidence: 99%

After 25 years of computer-navigated total knee arthroplasty, where do we stand today?

Shah

2021

Arthroplasty

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Background Limb and implant alignment along with soft tissue balance plays a vital role in the outcomes after total knee arthroplasty (TKA). Computer navigation for TKA was first introduced in 1997 with the aim of implanting the prosthetic components with accuracy and precision. This review discusses the technique, current status, and scientific evidence pertaining to computer-navigated TKA. Body The adoption of navigated TKA has slowly but steadily increased across the globe since its inception 25 years ago. It has been more rapid in some countries like Australia than others, like the UK. Contemporary, large console-based navigation systems help control almost every aspect of TKA, including the depth and orientation of femoral and tibial resections, soft-tissue release, and customization of femoral and tibial implant positions in order to obtain desired alignment and balance. Navigated TKA results in better limb and implant alignment and reduces outliers as compared to conventional TKA. However, controversy still exists over whether improved alignment provides superior function and longevity. Surgeons may also be hesitant to adopt this technology due to the associated learning curve, slightly increased surgical time, fear of pin site complications, and the initial set-up cost. Furthermore, the recent advent of robotic-assisted TKA which provides benefits like precision in bone resections and avoiding soft-tissue damage due to uncontrolled sawing, in addition to those of computer navigation, might be responsible for the latter technology taking a backseat. Conclusion This review summarizes the current state of computer-navigated TKA. The superiority of computer navigation to conventional TKA in improving accuracy is well established. Robotic-assisted TKA provides enhanced functionality as compared to computer navigation but is significantly more expensive. Whether robotic-assisted TKA offers any substantive advantages over navigation is yet to be conclusively proven. Irrespective of the form, the use of computer-assisted TKA is on the rise worldwide and is here to stay.

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“…Soft tissue constraints have been shown to significantly affect the kinematics of knees in experimental simulations [9][10][11][12]. Springs have been widely used to simulate soft tissue functions in both computational [13][14][15] and experimental studies [10,11,[16][17][18][19]. Historically, physical spring constraints were initially used in artificial knee simulators to replicate the soft tissue or ligament function in AP translation and tibial rotation of the natural human knee [16][17][18]20].…”

Section: Introductionmentioning

confidence: 99%

“…They also have limited options of spring stiffnesses and gaps, and a limited ability to simulate nonlinear force-displacement characteristics of soft tissue. These reasons have motivated the development of virtual spring constraint systems in experimental knee simulations [ 10 , 11 , 19 ]. These virtual spring constraints in the knee simulator can be programmed to simulate different levels of soft tissue constraint more accurately, and the adjustment of load/torque-displacement/rotation curves are much simpler and time-efficient than the adjustment of physical springs.…”

Section: Introductionmentioning

confidence: 99%

Development of a specimen-specific in vitro pre-clinical simulation model of the human cadaveric knee with appropriate soft tissue constraints

et al. 2020

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A human cadaveric specimen-specific knee model with appropriate soft tissue constraints was developed to appropriately simulate the biomechanical environment in the human knee, in order to pre-clinically evaluate the biomechanical and tribological performance of soft tissue interventions. Four human cadaveric knees were studied in a natural knee simulator under force control conditions in the anterior posterior (AP) and tibial rotation (TR) axes, using virtual springs to replicate the function of soft tissues. The most appropriate spring constraints for each knee were determined by comparing the kinematic outputs in terms of AP displacement and TR angle of the human knee with all the soft tissues intact, to the same knee with all the soft tissues resected and replaced with virtual spring constraints (spring rate and free length/degree). The virtual spring conditions that showed the least difference in the AP displacement and TR angle outputs compared to the intact knee were considered to be the most appropriate spring conditions for each knee. The resulting AP displacement and TR angle profiles under the appropriate virtual spring conditions all showed similar shapes to the individual intact knee for each donor. This indicated that the application of the combination of virtual AP and TR springs with appropriate free lengths/ degrees was successful in simulating the natural human knee soft tissue function. Each human knee joint had different kinematics as a result of variations in anatomy and soft tissue laxity. The most appropriate AP spring rate for the four human knees varied from 20 to 55 N/ mm and the TR spring rate varied from 0.3 to 1.0 Nm/˚. Consequently, the most appropriate spring condition for each knee was unique and required specific combinations of spring rate and free length/degree in each of the two axes.

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The effect of surgical alignment and soft tissue conditions on the kinematics and wear of a fixed bearing total knee replacement

Cited by 21 publications

References 58 publications

A review of recent advances in tribology

A review of recent advances in tribology

After 25 years of computer-navigated total knee arthroplasty, where do we stand today?

Development of a specimen-specific in vitro pre-clinical simulation model of the human cadaveric knee with appropriate soft tissue constraints

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