The role of patient, surgical, and implant design variation in total knee replacement performance

Fitzpatrick, Clare K.; Clary, Chadd W.; Rullkoetter, Paul J.

doi:10.1016/j.jbiomech.2012.05.035

Cited by 68 publications

(39 citation statements)

References 36 publications

(36 reference statements)

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“…The wide range in six of the eight limits also necessitates a patient‐specific approach when creating computational models of the tibiofemoral joint to study the behavior of the soft tissue restraints. This finding supports the recent push in the computational modeling field for a more patient‐specific approach because a generic computational model of the tibiofemoral joint does not take into account the wide variability in the population and hence is inherently limited. These patient‐specific computational models may be useful to both the surgeon and orthopedic companies for preoperative planning .…”

Section: Discussionsupporting

confidence: 78%

The limits of passive motion are variable between and unrelated within normal tibiofemoral joints

Roth

Hull

Howell

2015

Journal Orthopaedic Research

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Patient-to-patient differences should be accounted for in both clinical evaluations and computational models of knee laxity. Accordingly, the objectives were to determine how variable the laxities are between knees by determining the range of the internal-external (I-E), varus-valgus (V-V), anterior-posterior (A-P), and compression-distraction (C-D) limits of passive motion, and how related the laxities are within a knee by determining whether these limits are correlated with one another. The limits in I-E (AE 3 Nm), V-V (AE 5 Nm), A-P (AE 45 N), and C-D (AE 100 N) were measured in 10 normal human cadaveric knees at 0˚to 120˚flexion in 15i ncrements using a six degree-of-freedom load application system. The ranges from 15˚to 120˚flexion of the I-E limits were greater than 3.6˚, of the A-P limits were greater than 1.8 mm, and of the varus limits were greater than 1.4˚. The ranges from 30˚to 120f exion of the distraction limits were greater than 2.0 mm. Twenty-four of the 28 pair-wise comparisons between the limits had a correlation coefficient less than 0.65. These results demonstrate that a patient-specific approach, including all degrees of freedom of interest, is necessary during clinical evaluations of laxity and when creating and validating computational models of the tibiofemoral joint. Keywords: limits of passive motion; patient-specific modeling; laxity; knee It is important to characterize the patient-to-patient differences in the laxities of the tibiofemoral joint of the normal human knee in various degrees of freedom. The laxities of the normal human knee are often used both as a benchmark by orthopedic surgeons when evaluating laxities before, during, and after surgical interventions (e.g., total knee arthroplasty) 1 and as a gold standard by researchers when validating computational models of the tibiofemoral joint.2,3 Passive kinematics of the tibiofemoral joint are guided by the interaction between the soft tissue restraints and the articular geometry. However, the restraints from both the soft tissues and articular geometry are different between individuals. 4 Because the laxities are a measure of the function of the soft tissue restraints and the articular geometry, abnormal laxities indicate abnormal function. Therefore, it is critical to characterize the patientto-patient differences in the laxities so they may be accounted for during clinical evaluations of laxity and when creating computational models of the knee to study the behavior of the soft tissue restraints.There are two types of patient-to-patient differences that are of interest with regards to the laxities of the tibiofemoral joint. The first is the variability of the laxities between knees. If there is a wide variability as characterized by a wide range of the laxities, then a patient-specific approach would be necessary both during clinical evaluations of laxity and when creating computational models of the knee to study the behavior of the soft tissue restraints. The second is the relationship between the laxity in one ...

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Section: Discussionsupporting

confidence: 78%

The limits of passive motion are variable between and unrelated within normal tibiofemoral joints

Roth

Hull

Howell

2015

Journal Orthopaedic Research

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“…Second, according to many previous studies, joint kinematics and kinetics did not exhibit significant alterations between the pre‐ and post‐operative evaluations, and patients may still retain the pre‐surgery gait pattern. Furthermore, all previous musculoskeletal models, FEA models and experimental studies on the effect of component mal‐alignments in TKA on biomechanics have assumed the same input conditions at the neutral position. Therefore, in the present study, small changes in the component alignments were assumed to not affect the motion patterns at the hip or the foot, and the same gait trail was assumed to be used throughout all simulated mal‐aligned cases.…”

Section: Discussionmentioning

confidence: 99%

Effect of component mal‐rotation on knee loading in total knee arthroplasty using multi‐body dynamics modeling under a simulated walking gait

Chen

Wang

Liu

et al. 2015

Journal Orthopaedic Research

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Mal-rotation of the components in total knee arthorplasty (TKA) is a major cause of postoperative complications, with an increased propensity for implant loosening or wear leading to revision. A musculoskeletal multi-body dynamics model was used to perform a parametric study of the effects of the rotational mal-alignments in TKA on the knee loading under a simulated walking gait. The knee contact forces were found to be more sensitive to variations in the varus-valgus rotation of both the tibial and the femoral components and the internal-external rotation of the femoral component in TKA. The varus-valgus mal-rotation of the tibial or femoral component and the internal-external mal-rotation of the femoral component with a 5˚variation were found to affect the peak medial contact force by 17.8-53.1%, the peak lateral contact force by 35.0-88.4% and the peak total contact force by 5.2-18.7%. Our findings support the clinical observations that a greater than 3˚internal mal-rotation of the femoral component may lead to unsatisfactory pain levels and a greater than 3˚varus mal-rotation of the tibial component may lead to medial bone collapse. These findings determined the quantitative effects of the mal-rotation of the components in TKA on the contact load. The effect of such malrotation of the components of TKA on the kinematics would be further addressed in future studies. Keywords: total knee arthroplasty; mal-rotation; multi-body dynamics; musculoskeletal model; contact forceThe fundamental objectives of total knee arthroplasty (TKA) are to restore normal knee joint function and to relieve pain. However, the failure in TKA resulting from clinical error and mal-alignment of the components limits the long-term survivorship of such prostheses. Dalury et al. 1 retrospectively identified 820 consecutive revision TKAs and found that malposition/mal-alignment was the seventh highest reason for revision. However, mal-position/mal-alignment also affects joint loading, component loosening and wear so that it may have a much larger effect on revision. For example, mal-rotation of the components in TKA may result in overload in the medial or lateral condyle, bone damage and bone cement crack initiation, severe wear of the polyethylene component, component loosening, and ultimately revision surgery. 2,3 In contrast, good alignment measured against the neutral position (referenced to the mechanical axis to within 2˚) after TKA leads to faster rehabilitation and better function. 4 In previous clinical studies, 5 the issue of malrotation was the most frequently discussed complication in TKA. Mal-rotation of a measurable degree has been found in approximately 10-30% of patients with TKA, depending on the surgical technique and the anatomical landmarks used. 5 Even in the hands of experienced surgeons, overall coronal mal-alignment (> AE 3˚from neutral) existed in approximately 28% of the patients. 6 Despite the improvements in surgical instruments and techniques as well as implant designs, a large percentage of the cause...

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“…Computer simulations can apply large loads and duplicate weight-bearing activities using musculoskeletal models that can diminish the limitations of clinical and cadaveric experimental studies. Several previous papers used simulations to predict postoperative flexion angle, knee kinematics, joint load, and damage to the insert [18][19][20][21]. These results were validated by clinical data [20] and implant retrieval findings [21].…”

mentioning

confidence: 81%

Effect of Tibial Posterior Slope on Knee Kinematics, Quadriceps Force, and Patellofemoral Contact Force After Posterior-Stabilized Total Knee Arthroplasty

Okamoto

Mizu-uchi

Okazaki

et al. 2015

The Journal of Arthroplasty

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The role of patient, surgical, and implant design variation in total knee replacement performance

Cited by 68 publications

References 36 publications

The limits of passive motion are variable between and unrelated within normal tibiofemoral joints

The limits of passive motion are variable between and unrelated within normal tibiofemoral joints

Effect of component mal‐rotation on knee loading in total knee arthroplasty using multi‐body dynamics modeling under a simulated walking gait

Effect of Tibial Posterior Slope on Knee Kinematics, Quadriceps Force, and Patellofemoral Contact Force After Posterior-Stabilized Total Knee Arthroplasty

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