Tibiofemoral force following total knee arthroplasty: Comparison of four prosthesis designs in vitro

Nicholls, Rochelle; Schirm, Andreas; Jeffcote, Benjamin O.; Kuster, Markus S.

doi:10.1002/jor.20438

Cited by 27 publications

(15 citation statements)

References 42 publications

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“…However, determination of in vivo tibiofemoral contact forces has been a challenging issue in biomechanics. Instrumented tibial implants have been used to measure tibiofemoral forces in-vitro (Kaufman, et al, 1996, Nicholls, et al, 2007. Computational models using inverse dynamic optimization have also been used to estimate joint reaction forces (Crowninshield and Brand, 1981, Li, et al, 1999, Taylor, et al, 2004.…”

Section: Introductionmentioning

confidence: 99%

In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities

Varadarajan

Moynihan

D’Lima

et al. 2008

Journal of Biomechanics

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Analysis of polyethylene component wear and implant loosening in total knee arthroplasty (TKA) requires precise knowledge of in vivo articular motion and loading conditions. This study presents a simultaneous, in vivo measurement of tibiofemoral articular contact forces and contact kinematics in three TKA patients. These measurements were accomplished via a dual fluoroscopic imaging system and instrumented tibial implants during dynamic single leg lunge and chair risingsitting. The measured forces and contact locations were also used to determine mediolateral distribution of axial contact forces. Contact kinematics data showed a medial pivot during flexion of the knee, for all patients in the study. Average axial forces were higher for lunge compared to chair rising-sitting (224% body weight vs. 187% body weight). In this study we measured peak anteroposterior and mediolateral forces averaging 13.3% BW, during lunge and 18.5% BW during chair rising-sitting. Mediolateral distributions of axial contact force were both patient and activity specific. All patients showed equitable medial-lateral loading during lunge but greater loads at the lateral compartment during chair rising-sitting. The results of this study may enable more accurate reproduction of in vivo loads and articular motion patterns in wear simulators and finite element models. This in turn may help advance our understanding of factors limiting longevity of TKA implants, such as aseptic loosening and polyethylene component wear, and enable improved TKA designs.

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Section: Introductionmentioning

confidence: 99%

In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities

Varadarajan

Moynihan

D’Lima

et al. 2008

Journal of Biomechanics

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“…1,4--6 During knee motion, tensions in the ligaments, capsule, and extensor envelope may restrict flexion and affect implant wear. 6,7 Awareness of the role of the extensor retinaculum in patellofemoral kinematics is increasing. 8 While studies to date have focused on its role in patellar instability, [8][9][10][11] the influence of TKR is unknown.…”

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confidence: 99%

Length change patterns of the extensor retinaculum and the effect of total knee replacement

Ghosh

Merican

Iranpour-Boroujeni

et al. 2009

Journal Orthopaedic Research

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Patellofemoral dysfunction following total knee replacement (TKR) is a significant clinical problem, but little information exists on the mechanics of the patellofemoral retinacula or the effects of TKR on these structures. We hypothesized that TKR would cause significant elongation of the retinacula. Retinacular length changes were measured by threading sutures along the retinacula, fixing the sutures to the patella and the iliotibial band (ITB), and attaching the femoral ends to displacement transducers. The intact knee was flexed-extended while the quadriceps and ITB were tensed and the retinacular length change patterns were recorded. The measurements were repeated post-TKR. The medial patellofemoral ligament (MPFL) was close to isometric, stretching 2 mm in terminal knee extension, whereas the lateral retinaculum slackened 8 mm from 1108 to 08 flexion. TKR did not cause significant elongation of either of the retinacula, the largest change being 3 mm elongation of the MPFL around 408, which stretched the MPFL by 1.4 mm above its maximum natural length. Thus, this work did not support the hypothesis that TKR causes significant elongation of the retinacula sufficient to affect knee function. Keywords: knee; patellofemoral; retinaculum; TKR; length change patterns Demand is increasing for improved knee function after surgery. Despite continuing evolution in prosthesis design and surgical methods, stiffness after total knee replacement (TKR) remains a disabling complication. The prevalence appears to be relatively low, but has not been clearly defined, primarily due to ambiguity in the literature concerning its definition. The prevalence of knee stiffness was recently reported as 1.3%-3.7%, 1,2 though higher levels (8%-12%) were reported in older literature. 3Stiffness after TKR may be caused by limited preoperative motion, biological predisposition, intraoperative technical problems, poor patient motivation, and inadequate postoperative rehabilitation.1,4--6 During knee motion, tensions in the ligaments, capsule, and extensor envelope may restrict flexion and affect implant wear.6,7 Awareness of the role of the extensor retinaculum in patellofemoral kinematics is increasing.8 While studies to date have focused on its role in patellar instability, [8][9][10][11] the influence of TKR is unknown. The positioning and thickness of TKR components may cause the surrounding soft tissues to be stretched. Abnormal soft tissue tensions post-arthroplasty may alter patellofemoral kinematics and stability; the literature shows that these mechanical factors can lead to clinical problems such as pain, stiffness, and excessive wear. Our aims were: to measure the length change patterns of the medial and lateral retinacula during knee extension; and to test the hypothesis that insertion of a TKR would cause significant elongations of the retinacula. MATERIALS AND METHODS Specimen PreparationEight right knees aged 69 years (range, 57-87 years) and including 20 cm of femur and 15 cm of tibia were obtained from a tissue b...

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“…In an in-vitro study, Nicholls et al 30 compared the compressive tibiofemoral forces during passive flexion for four different TKA designs: a fixed bearing CRTKA (PFC, Depuy J and J) before and after resection of the PCL, a mobile bearing PSTKA (LCS), a cruciate-substituting mobile bearing TKA (PFC Sigma PS) and a high-flex design (PFC Sigma PS-RPF). All designs showed the same low force during the range of 0-1058.…”

Section: High-flex Total Knee Arthroplastiesmentioning

confidence: 99%

Results of cruciate retaining total knee arthroplasty

Gundle

Pandit

2008

Current Orthopaedic Practice

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Tibiofemoral force following total knee arthroplasty: Comparison of four prosthesis designs in vitro

Cited by 27 publications

References 42 publications

In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities

In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities

Length change patterns of the extensor retinaculum and the effect of total knee replacement

Results of cruciate retaining total knee arthroplasty

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