Three-dimensional determination of femoral-tibial contact positions under in vivo conditions using fluoroscopy

Hoff, William; Komistek, Richard D.; Dennis, Douglas A.; Gabriel, Stefan; Walker, Scott A.

doi:10.1016/s0268-0033(98)00009-6

Cited by 163 publications

(130 citation statements)

References 20 publications

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“…Malrotation of the femoral component has been associated with numerous undesirable conditions including patellofemoral and tibiofemoral instability, arthrofibrosis, knee pain, and disturbed knee kinematics [1,3,4,11,19,21]. The best method to determine correct femoral component rotation and subsequent coronal plane stability is debated.…”

Section: Discussionmentioning

confidence: 99%

“…Fluoroscopic images were captured and then downloaded to a workstation computer for analysis. Three-dimensional kinematics for each knee were recovered from the 2-D fluoroscopic images using a previously described automated model-fitting technique that determined the in vivo orientation of the femoral component relative to the tibial component [7,11]. Error analyses of this 3-D model-fitting technique have shown a 3-D error of less than 0.5 mm in translation, less than 0.5°in rotation, and less than 0.75 mm in determining femoral condylar lift-off [17].…”

Section: Methodsmentioning

confidence: 99%

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Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty

Dennis

Komistek

Kim³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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239

197

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Multiple differing surgical techniques are currently utilized to perform total knee arthroplasty (TKA). We compared knee arthroplasties performed using either a measured resection or gap balancing technique to determine if either operative technique provides superior coronal plane stability as measured by assessment of the incidence and magnitude of femoral condylar lift-off. We performed 40 TKA using a measured resection technique (20 PCLretaining and 20 PCL-substituting) and 20 PCL-substituting TKA were implanted using gap balancing. All subjects were analyzed fluoroscopically while performing a deep knee bend. The incidence of coronal instability (femoral condylar lift-off) was then determined using a 3-D model fitting technique. The incidence of lift-off greater than 0.75 mm was 80% (maximum, 2.9 mm) and 70% (maximum, 2.5 mm) for the PCL-retaining and substituting TKA groups performed using measured resection versus 35% (maximum, 0.88 mm) for the gap-balanced group. Lift-off greater than 1 mm occurred in 60% and 45% of the PCL-retaining and -substituting TKA using measured resection versus none in the gap-balanced group. Rotation of the femoral component using a gap balancing technique resulted in better coronal stability which we suggest will improve functional performance and reduce polyethylene wear.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty

Dennis

Komistek

Kim³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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239

197

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“…Axial femorotibial rotation during flexion of the healthy knee has been seen in numerous previous in vitro and in vivo kinematic analyses [5,8,10,16]. With knee flexion, the tibia typically internally rotates relative to the femur, and conversely, externally rotates with knee extension (i.e.…”

Section: Introductionmentioning

confidence: 93%

Comparison of tibial rotation in fixed and mobile bearing total knee arthroplasty using computer navigation

Stiehl

2008

International Orthopaedics (SICOT)

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Tibial rotation is an important aspect of knee function and can be altered after total knee arthroplasty (TKA). These alterations include decreased internal rotation with knee flexion as compared to the normal state and paradoxical external rotation with flexion. Mobile bearing total knee prostheses may allow greater unconstrained tibial rotation. I compared tibial rotation after fixed bearing or mobile bearing total knee arthroplasty in 82 patients who underwent TKA with the tibia cut first technique to ascertain any differences. Using intraoperative imageless computer navigation, measurements included the determination of tibial rotation from extension to 90°flexion before and after prosthetic implantation with non-weight-bearing range of motion. I found that tibial rotation was significantly reduced after fixed bearing total knee replacement as compared to mobile bearing. In addition, the tibial position compared to the distal femur in extension was more external in fixed bearings compared to mobile bearings. Placing the fixed tibial tray with increased internal rotation could explain this difference.Résumé La rotation du tibia est un élément important sur le plan fonctionnel. Elle peut être altérée après une prothèse totale du genou. Ces altérations de la rotation portent sur une diminution de la rotation interne et paradoxalement une augmentation de la rotation externe en flexion. Une prothèse totale du genou à plateau mobile permet une libération plus importante de la rotation tibiale. Nous avons comparé cette rotation à partir de prothèses à la plateau fixe et à plateau mobile sur une série de 82 patients ayant bénéficie de cette arthroplastie avec une coupe première du tibia. Nous avons utilisé pour cela un système de navigation per opératoire. Nous avons trouvé à l'issue de cette étude que les rotations tibiales étaient significativement réduites après prothèse totale à plateau fixe versus prothèses à plateau mobile. Par ailleurs, la position du tibia en extension est en rotation externe par rapport au fémur distal. Cette rotation est plus importante dans les prothèses à plateau fixe que dans les prothèses à plateau mobile. Le positionnement du plateau tibial en rotation interne lors de l'intervention peut expliquer cette différence.

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“…Using a threedimensional (3-D) to two-dimensional (2-D) image registration approach, the relative 3-D poses of the femoral and tibial knee implant components were determined using the fluoroscopy image in the sagittal plane and registration of the component computer-aided design models in 3-D space [4,14,19]. The process involved two stages.…”

Section: Methodsmentioning

confidence: 99%

“…Initially, the 3-D orientations of the femoral and tibial components were positioned manually by an operator in an approximate position corresponding to the respective silhouettes in the digitized fluoroscopic image. Then, an automated global optimization algorithm, based on a weighted measure of edge intensity, used intensity-based matching to finalize the best orientation of the models [4,14]. The 3-D orientation of the radiolucent PE bearing then was determined by matching the beads embedded in the PE insert with their observed fluoroscopic silhouettes.…”

Section: Methodsmentioning

confidence: 99%

Confirmation of Long-term In Vivo Bearing Mobility in Eight Rotating-platform TKAs

LaCour

Sharma

Carr

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Posterior-stabilized rotating-platform prostheses for TKAs were designed to improve contact mechanics at the femoral-polyethylene (PE) interface. Short-term followup studies have shown that the PE bearings rotate with respect to the tibia but might not necessarily track with the femur. It is important to know how kinematics in these designs change owing to longterm in vivo use.Questions/purposes We asked whether there is a significant change in the in vivo kinematic performance of a posterior-stabilized rotating-platform prosthesis at as much as 10 years postoperative. We specifically examined (1) relative femoral component-PE bearing and relative PE bearing-tibial tray motion; (2) relative AP motion of the femoral condyles with respect to the tibial tray; and (3) relative femorotibial condylar translations. Methods In vivo three-dimensional kinematics were evaluated for eight patients at 3 months, 15 months, 5 years, and 10 years after TKA with primary implantation of a posterior-stabilized rotating-platform prosthesis. Each patient performed deep knee bend activity, and threedimensional kinematics were reconstructed from multiple fluoroscopic images using a three-dimensional to twodimensional registration technique. Once complete, relative component axial rotation patterns, medial and lateral condyle motions throughout flexion, and the presence of femoral condylar lift-off were analyzed. Results Overall, tibial bearing rotation was maintained at 10 years postoperatively. There was no statistical difference between postoperative periods for any kinematic parameter except for femoral component-PE bearing axial rotation, which was reduced at the 10-year evaluation versus other assessment periods (p = 0.0006). The lack of statistical difference between postoperative evaluation

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Three-dimensional determination of femoral-tibial contact positions under in vivo conditions using fluoroscopy

Cited by 163 publications

References 20 publications

Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty

Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty

Comparison of tibial rotation in fixed and mobile bearing total knee arthroplasty using computer navigation

Confirmation of Long-term In Vivo Bearing Mobility in Eight Rotating-platform TKAs

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