Gait and Knee Flexion In Vivo Kinematics of Asymmetric Tibial Polyethylene Geometry Cruciate Retaining Total Knee Arthroplasty

2020 ◽  
Author(s):  
Christian Klemt ◽  
John Drago ◽  
Ruben Oganesyan ◽  
Evan J. Smith ◽  
Ingwon Yeo ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Knee Biomechanics ◽  
Functional Activities ◽  
In Vivo Kinematics ◽  
Sit To Stand ◽  
Healthy Knee ◽  
Total Knee

AbstractThe preservation of the posterior cruciate ligament in cruciate retaining (CR) total knee arthroplasty (TKA) designs has the potential to restore healthy knee biomechanics; however, concerns related to kinematic asymmetries during functional activities still exist in unilateral TKA patients. As there is a limited data available regarding the ability of the contemporary CR TKA design with concave medial and convex lateral tibial polyethylene bearing components to restore healthy knee biomechanics, this study aimed to investigate in vivo three-dimensional knee kinematics in CR TKA patients during strenuous knee flexion activities and gait. Using a combined computer tomography and dual fluoroscopic imaging system approach, in vivo kinematics of 15 unilateral CR TKA patients (comparison of replaced and contralateral nonreplaced knee) were evaluated during sit-to-stand, step-ups, single-leg deep lunge, and level walking. The patient cohort was followed-up at an average of 24.5 months ( ± 12.6, range 13–42) from surgical procedure. Significantly smaller internal knee rotation angles were observed for the contemporary CR TKA design during step-ups (2.6 ± 5.8 vs. 6.3 ± 6.6 degrees, p < 0.05) and gait (0.6 ± 4.6 vs. 6.3 ± 6.8 degrees, p < 0.05). Significantly larger proximal and anterior femoral translations were measured during sit-to-stand (34.7 ± 4.5 vs. 29.9 ± 3.1 mm, p < 0.05; –2.5 ± 2.9 vs. –8.1 ± 4.4 mm, p < 0.05) and step-ups (34.1 ± 4.5 vs. 30.8 ± 2.9 mm, p < 0.05; 2.2 ± 3.2 vs. –3.5 ± 4.5 mm, p < 0.05). Significantly smaller ranges of varus/valgus and internal/external rotation range of motion were observed for CR TKA, when compared with the nonoperated nee, during strenuous activities and gait. The preservation of the posterior cruciate ligament in the contemporary asymmetric bearing geometry CR TKA design with concave medial and convex lateral tibial polyethylene bearing components has the potential to restore healthy knee biomechanics; however, the study findings demonstrate that native knee kinematics were not fully restored in patients with unilateral asymmetric tibial polyethylene bearing geometry CR TKA during functional activities.

scholarly journals In VivoHealthy Knee Kinematics during Dynamic Full Flexion

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Satoshi Hamai ◽  
Taka-aki Moro-oka ◽  
Nicholas J. Dunbar ◽  
Hiromasa Miura ◽  
Yukihide Iwamoto ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Knee Kinematics ◽  
The Other ◽  
Medial Compartment ◽  
Knee Flexion Angle ◽  
Knee Prostheses ◽  
Healthy Knee ◽  
Total Knee ◽  
Full Flexion ◽  
2D Model

Healthy knee kinematics during dynamic full flexion were evaluated using 3D-to-2D model registration techniques. Continuous knee motions were recorded during full flexion in a lunge from 85° to 150°. Medial and lateral tibiofemoral contacts and femoral internal-external and varus-valgus rotations were analyzed as a function of knee flexion angle. The medial tibiofemoral contact translated anteroposteriorly, but remained on the center of the medial compartment. On the other hand, the lateral tibiofemoral contact translated posteriorly to the edge of the tibial surface at 150° flexion. The femur exhibited external and valgus rotation relative to the tibia over the entire activity and reached 30° external and 5° valgus rotations at 150° flexion. Kinematics’ data during dynamic full flexion may provide important insight as to the designing of high-flexion total knee prostheses.

The in Vivo Kinematics of the Anteromedial and Posterolateral Bundles of the Anterior Cruciate Ligament during Weightbearing Knee Flexion

2007 ◽  
Vol 35 (4) ◽  
pp. 547-554 ◽  
Author(s):  
Susan S. Jordan ◽  
Louis E. DeFrate ◽  
Kyung Wook Nha ◽  
Ramprasad Papannagari ◽  
Thomas J. Gill ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
In Vivo Kinematics ◽  
Anterior Cruciate

The Effect of Joint Line Elevation on In Vivo Knee Kinematics in Bicruciate Retaining Total Knee Arthroplasty

2021 ◽  
Author(s):  
Christian Klemt ◽  
Anand Padmanabha ◽  
Venkatsaiakhil Tirumala ◽  
Evan J. Smith ◽  
Young-Min Kwon
Keyword(s):  
Negative Correlation ◽  
Knee Kinematics ◽  
Significant Negative Correlation ◽  
Significant Loss ◽  
Maximum Flexion ◽  
Sit To Stand ◽  
Total Knee ◽  
In Vivo Knee Kinematics ◽  
Bcr Tka

AbstractPrior studies have reported a negative effect on both clinical outcomes and patient-reported outcome measures (PROMS) following joint line elevation (JLE) in cruciate-retaining (CR) total knee arthroplasty (TKA) and posterior stabilized (PS) TKA designs. This experimental study was aimed to quantify the effect of JLE on in vivo knee kinematics in patients with bicruciate retaining (BCR) TKA during strenuous activities. Thirty unilateral BCR TKA patients were evaluated during single-leg deep lunge and sit-to-stand using a validated combined computer tomography and dual fluoroscopic imaging system. Correlation analysis was performed to quantify any correlations between JLE and in vivo kinematics, as well as PROMS. There was a significant negative correlation between JLE and maximum flexion angle during single-leg deep lunge (ρ = −0.34, p = 0.02), maximum varus joint angles during single-leg deep lunge (ρ = −0.37, p = 0.04), and sit-to-stand (ρ = −0.29, p = 0.05). There was a significant negative correlation between JLE and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score (ρ = −0.39, p = 0.01) and knee disability and osteoarthritis outcome score physical function (KOOS-PS; ρ = −0.33, p = 0.03). The JLE that yields a significant loss in PROMS and maximum flexion angles were 2.6 and 2.3 mm, respectively. There was a linear negative correlation of JLE with both in vivo knee kinematics and PROMS, with changes in JLE of greater than 2.6 and 2.3 mm, leading to a clinically significant loss in PROMS and maximum flexion angles, respectively, suggesting an increased need to improve surgical precision to optimize patient outcomes following BCR TKA.

Knee Kinematics During an In Vitro Simulated Deep Flexion Squat

2007 ◽  
Author(s):  
Chadd W. Clary ◽  
Amit M. Mane ◽  
Amber N. Reeve ◽  
Kevin A. Dodd ◽  
Lorin P. Maletsky
Keyword(s):  
Knee Flexion ◽  
Weight Bearing ◽  
Knee Kinematics ◽  
Knee Prostheses ◽  
Deep Flexion ◽  
Total Knee ◽  
Design Characteristics ◽  
Insight Into

Understanding the behavior of the natural knee in deep flexion can offer insight into the necessary design characteristics of a total knee implant. Andriacchi et al. [1] measured the in vivo characteristics of knee motion down to ∼150° knee flexion during a weight bearing squat. Likewise, Li et al. [2] investigated deep knee flexion in vitro using robotic technology during passive knee flexion. Both of these studies offer insight into the behavior of the knee in deep knee flexion; however, they have some limitations with regards to assessing physiological activities in a controlled manner. The purpose of this study was to measure the kinematics of the knee during a simulated in vitro deep knee squat so that in the future a dynamic, load-bearing, simulated deep knee squat could be used as a tool in the design of total knee prostheses.

In Vitro Kinematic Analysis of Single Axis Radius Posterior-Substituting Total Knee Arthroplasty

2020 ◽  
Author(s):  
Paul Arauz ◽  
Yun Peng ◽  
Tiffany Castillo ◽  
Christian Klemt ◽  
Young-Min Kwon
Keyword(s):  
Knee Flexion ◽  
Knee Kinematics ◽  
Lateral Collateral Ligament ◽  
Collateral Ligament ◽  
Flexion Extension ◽  
Healthy Knee ◽  
Joint Biomechanics ◽  
Total Knee ◽  
Intact Knee

AbstractThis is an experimental study. As current posterior-substituting (PS) total knee arthroplasties have been reported to incompletely restore intrinsic joint biomechanics of the healthy knee, the recently designed single axis radius PS knee system was introduced to increase posterior femoral translation and promote ligament isometry. As there is a paucity of data available regarding its ability to replicate healthy knee biomechanics, this study aimed to assess joint and articular contact kinematics as well as ligament isometry of the contemporary single axis radius PS knee system. Implant kinematics were measured from 11 cadaveric knees using an in vitro robotic testing system. In addition, medial collateral ligament (MCL) and lateral collateral ligament (LCL) forces were quantified under simulated functional loads during knee flexion for the contemporary PS knee system. Posterior femoral translation between the intact knee and the single axis radius PS knee system differed significantly (p < 0.05) at 60, 90, and 120 degrees of flexion. The LCL force at 60 degrees (9.06 ± 2.81 N) was significantly lower (p < 0.05) than those at 30, 90, and 120 degrees of flexion, while MCL forces did not differ significantly throughout the range of tested flexion angles. The results from this study suggest that although the contemporary single axis radius PS knee system has the potential to mimic the intact knee kinematics under muscle loading during flexion extension due to its design features, single axis radius PS knee system did not fully replicate posterior femoral translation and ligament isometry of the healthy knee during knee flexion.

In vivo kinematics of deep lunges and sit-to-stand activities in patients with bicruciate-retaining total knee arthroplasty

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 59-65
Author(s):  
Young-Min Kwon ◽  
Paul Arauz ◽  
Yun Peng ◽  
Christian Klemt
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Cruciate Ligaments ◽  
In Vivo Kinematics ◽  
Contralateral Knee ◽  
Sit To Stand ◽  
Flexion Extension ◽  
Total Knee ◽  
Bcr Tka

Aims The removal of the cruciate ligaments in total knee arthroplasty (TKA) has been suggested as a potential contributing factor to patient dissatisfaction, due to alteration of the in vivo biomechanics of the knee. Bicruciate retaining (BCR) TKA allows the preservation of the cruciate ligaments, thus offering the potential to reproduce healthy kinematics. The aim of this study was to compare in vivo kinematics between the operated and contralateral knee in patients who have undergone TKA with a contemporary BCR design. Methods A total of 29 patients who underwent unilateral BCR TKA were evaluated during single-leg deep lunges and sit-to-stand tests using a validated computer tomography and fluoroscopic imaging system. In vivo six-degrees of freedom (6DOF) kinematics were compared between the BCR TKA and the contralateral knee. Results During single-leg deep lunge, BCR TKAs showed significantly less mean posterior femoral translation (13 mm; standard deviation (SD) 4) during terminal flexion, compared with the contralateral knee (16.6 mm, SD 3.7; p = 0.001). Similarly, BCR TKAs showed significantly less mean femoral rollback (11.6 mm (SD 4.5) vs 14.4 mm (SD 4.6); p < 0.043) during sit-to-stand. BCR TKAs showed significantly reduced internal rotation during many parts of the strenuous flexion activities particularly during high-flexion lunge (4° (SD 5.6°) vs 6.5° (SD 6.1°); p = 0.051) and during sit-to-stand (4.5° (SD 6°) vs 6.9° (SD 6.3°); p = 0.048). Conclusion The contemporary design of BCR TKA showed asymmetrical flexion-extension and internal-external rotation, suggesting that the kinematics are not entirely reproduced during strenuous activities. Future studies are required to establish the importance of patient factors, component orientation and design, in optimizing kinematics in patients who undergo BCR TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):59–65.

Posterior Tibial Slope Increases Anterior Cruciate Ligament Stress in Bi-Cruciate Retaining Total Knee Arthroplasty: In Vivo Kinematic Analysis

2020 ◽  
Author(s):  
Christian Klemt ◽  
Georges Bounajem ◽  
Venkatsaiakhil Tirumala ◽  
Liang Xiong ◽  
Ruben Oganesyan ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Weight Bearing ◽  
Knee Kinematics ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
Total Knee ◽  
Anterior Cruciate ◽  
Pl Bundle ◽  
Bcr Tka

AbstractThe study design involved here is experimental in nature. The resection of the anterior cruciate ligament (ACL) during conventional total knee arthroplasty (TKA) has been considered a potential factor leading to abnormal in vivo knee kinematics. Bi-cruciate retaining (BCR) TKA designs allow the preservation of the ACL with the potential to restore native knee kinematics. This study aimed to investigate the effect of posterior tibial slope (PTS) on stress experienced by the ACL during weight bearing sit-to-stand (STS) and single-leg deep lunge. The ACL elongation patterns were measured in 30 unilateral BCR TKA patients during weight-bearing STS and single-leg deep lunge using a validated dual fluoroscopic tracking technique. The minimum normalized stress within the anteromedial (AM) and posterolateral (PL) bundle of the ACL during weight-bearing STS and single-leg deep lunge was found at a PTS of 3.7 degrees. The maximum AM and PL bundle stresses were observed at a PTS of 8.5 and 9.3 degrees, respectively during STS and at 8.4, and 9.1 degrees, respectively during single-leg deep lunge. There was a significant positive correlation between PTS and stress observed within the AM and PL bundle of the ACL during weight-bearing STS (R 2 = 0.37; p < 0.01; R2  = 0.36; p = 0.01) and single-leg deep lunge (R 2 = 0.42; p < 0.01; R 2 = 0.40; p < 0.01). The study demonstrates that PTS of operated BCR TKA knees has a significant impact on the stress experienced by the preserved ACL during weight-bearing STS and single-leg deep lunge. This suggests that avoiding excessive PTS may be one of the surgical implant alignment factors to consider during surgery to minimize increased loading of the preserved ACL.

scholarly journals Loss of Knee Flexion and Femoral Rollback of the Medial-Pivot and Posterior-Stabilized Total Knee Arthroplasty During Early-Stance of Walking in Chinese Patients

2021 ◽  
Vol 9 ◽  
Author(s):  
Jiaqi Tan ◽  
Diyang Zou ◽  
Xianlong Zhang ◽  
Nan Zheng ◽  
Yuqi Pan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Knee Flexion ◽  
Knee Kinematics ◽  
Chinese Patients ◽  
Posterior Stabilized ◽  
Medial Pivot ◽  
Total Knee ◽  
Femoral Rollback

Background The medial-pivot (MP) prosthesis was developed to produce more physiological postoperative knee kinematics and better patient satisfaction than traditional prostheses, but outcomes are inconsistent in different studies of Caucasian patients. This study aimed to investigate the postoperative patient satisfaction and in vivo knee kinematics of the MP and posterior-stabilized (PS) prosthesis during gait activity in Chinese patients.Methods A retrospective analysis of 12 patients was received for this study in each MP group and PS group. Patient-reported satisfaction level and Forgotten Joint Score (FJS) were evaluated with questionnaires. A dual fluoroscopic imaging system was used to investigate in vivo knee kinematics of MP and PS total knee arthroplasty (TKA) during treadmill walking at a speed of 0.4 m/s.Results Comparable promising patient satisfaction and overall FJS (MP 60.7 ± 15.35 vs. PS 51.3 ± 17.62, p = 0.174) were found between the MP and PS groups. Peak flexion appeared at around 70% of gait cycle with values of 52.4 ± 7.4° for MP and 50.1 ± 3.6° for PS groups (no difference). Both groups maintained a stable position at the stance phase and began to translated anteriorly at toe-off with an amount of 4.5 ± 2.3 mm in the MP and 6.6 ± 2.7 mm in the PS (p = 0.08) group until late swing. The range of this external rotation motion was 5.9 ± 4.8 and 6.2 ± 4.1° (p = 0.79) for the MP and PS, respectively.Conclusion A similar knee kinematics pattern characterized by a loss of early-stance knee flexion and femoral rollback during walking was observed in the MP and PS TKAs. Our study confirmed similar effectiveness of MP TKA compared to PS TKA in Chinese patients, while the change of knee kinematics of both implants during slow walking should be noted.

Physical examination and in vivo kinematics in two posterior cruciate ligament retaining total knee arthroplasty designs

The Knee ◽  
2010 ◽  
Vol 17 (3) ◽  
pp. 204-209 ◽  
Author(s):  
M.J.M. Ploegmakers ◽  
B. Ginsel ◽  
H.J. Meijerink ◽  
J.W. de Rooy ◽  
M.C. de Waal Malefijt ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Physical Examination ◽  
Posterior Cruciate Ligament ◽  
Knee Arthroplasty ◽  
Cruciate Ligament ◽  
In Vivo Kinematics ◽  
Posterior Cruciate Ligament Retaining ◽  
Total Knee
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