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J Knee Surg 2022; 35(12): 1342-1348
DOI: 10.1055/s-0041-1723763
Original Article

The Association between In Vivo Knee Kinematics and Patient-Reported Outcomes during Squatting in Bicruciate-Stabilized Total Knee Arthroplasty

Tomofumi Kage
1   Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
,
Hiroshi Inui
1   Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
,
Tetsuya Tomita 
2   Department of Orthopaedic Biomaterial Science, Graduate School of Medicine, Osaka University, Osaka, Japan
,
Takaharu Yamazaki
3   Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, Fukaya, Saitama, Japan
,
Shuji Taketomi
1   Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
,
Ryota Yamagami 
1   Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
,
Kenichi Kono
1   Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
,
Kohei Kawaguchi
1   Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
,
Kentaro Takagi
1   Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
,
Shin Sameshima
1   Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
,
Sakae Tanaka
1   Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
› Author Affiliations Funding None.
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Abstract

Bicruciate-stabilized total knee arthroplasty (BCS TKA) has been developed to improve TKA kinematic performance. However, the relationship between in vivo kinematics and patient-reported outcomes (PROs) has not been well described. This study was performed to clarify the relationship between in vivo kinematics and PROs in a cohort of patients undergoing BCS TKA. Forty knees were evaluated using a two-dimensional to three-dimensional registration technique obtained from sagittal plane fluoroscopy. In vivo kinematics including anteroposterior (AP) translation and tibiofemoral rotation were evaluated. Knee Society scores (KSSs) and Knee injury and Osteoarthritis Outcome Scores (KOOSs) were assessed before and after surgery. Relationships between tibiofemoral kinematics assessed with the knee in different positions of knee flexion and PROs were evaluated using Spearman's correlation analysis. The study demonstrated a significant negative correlation (r =  − 0.33) between medial AP translation from minimum flexion to 30 degrees flexion and postoperative KOOS activities of daily living subscale. A significant positive correlation (r = 0.51) was found between the femoral external rotation from minimum flexion to 30 degrees flexion and improvement of the KOOS pain subscale. No correlation was found between the lateral AP translation and PROs. Achieving medial AP and femoral external rotation stability in early flexion may be important in optimizing postoperative PROs.

Keywords

total knee arthroplasty - bicruciate stabilized - in vivo kinematics - patient-reported outcomes


Publication History

Received: 29 May 2020

Accepted: 17 December 2020

Article published online:
05 February 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Scott CE, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 2010; 92 (09) 1253-1258
    CrossrefPubMedGoogle Scholar
  • 2 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
    CrossrefPubMedGoogle Scholar
  • 3 Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 2017; 32 (12) 3854-3860
    Google Scholar
  • 4 Nam D, Nunley RM, Barrack RL. Patient dissatisfaction following total knee replacement: a growing concern?. Bone Joint J 2014; 96-b (11 supple A): 96-100
    CrossrefPubMedGoogle Scholar
  • 5 Grieco TF, Sharma A, Dessinger GM, Cates HE, Komistek RD. In vivo kinematic comparison of a bicruciate stabilized total knee arthroplasty and the normal knee using fluoroscopy. J Arthroplasty 2018; 33 (02) 565-571
    CrossrefPubMedGoogle Scholar
  • 6 Arbuthnot JE, Brink RB. Assessment of the antero-posterior and rotational stability of the anterior cruciate ligament analogue in a guided motion bi-cruciate stabilized total knee arthroplasty. J Med Eng Technol 2009; 33 (08) 610-615
    CrossrefPubMedGoogle Scholar
  • 7 Halewood C, Risebury M, Thomas NP, Amis AA. Kinematic behaviour and soft tissue management in guided motion total knee replacement. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 3074-3082
    CrossrefPubMedGoogle Scholar
  • 8 Victor J, Bellemans J. Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop Relat Res 2006; 452 (452) 53-58
    CrossrefPubMedGoogle Scholar
  • 9 Luyckx L, Luyckx T, Bellemans J, Victor J. Iliotibial band traction syndrome in guided motion TKA. A new clinical entity after TKA. Acta Orthop Belg 2010; 76 (04) 507-512
    PubMedGoogle Scholar
  • 10 Kono K, Inui H, Tomita T. et al. Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities. Knee Surg Sports Traumatol Arthrosc 2019; 27 (07) 2096-2103
    CrossrefPubMedGoogle Scholar
  • 11 Christen B, Kopjar B. Second-generation bi-cruciate stabilized total knee system has a lower reoperation and revision rate than its predecessor. Arch Orthop Trauma Surg 2018; 138 (11) 1591-1599
    CrossrefPubMedGoogle Scholar
  • 12 Hino K, Kutsuna T, Watamori K. et al. Bi-cruciate substituting total knee arthroplasty provides varus-valgus stability throughout the midflexion range. Knee 2018; 25 (05) 897-902
    CrossrefPubMedGoogle Scholar
  • 13 Kaneko T, Kono N, Mochizuki Y, Hada M, Toyoda S, Musha Y. Bi-cruciate substituting total knee arthroplasty improved medio-lateral instability in mid-flexion range. J Orthop 2017; 14 (01) 201-206
    CrossrefPubMedGoogle Scholar
  • 14 Mugnai R, Digennaro V, Ensini A, Leardini A, Catani F. Can TKA design affect the clinical outcome? Comparison between two guided-motion systems. Knee Surg Sports Traumatol Arthrosc 2014; 22 (03) 581-589
    CrossrefPubMedGoogle Scholar
  • 15 Inui H, Taketomi S, Yamagami R, Shirakawa N, Kawaguchi K, Tanaka S. The relationship between soft-tissue balance and intraoperative kinematics of guided motion total knee arthroplasty. J Knee Surg 2019; 32 (01) 91-96
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Minoda Y, Watanabe K, Iwaki H, Takahashi S, Fukui M, Nakamura H. Theoretical risk of anterior femoral cortex notching in total knee arthroplasty using a navigation system. J Arthroplasty 2013; 28 (09) 1533-1537
    CrossrefPubMedGoogle Scholar
  • 17 Eckhoff DG, Metzger RG, Vandewalle MV. Malrotation associated with implant alignment technique in total knee arthroplasty. Clin Orthop Relat Res 1995; (321) 28-31
    PubMedGoogle Scholar
  • 18 Shimizu N, Tomita T, Yamazaki T, Yoshikawa H, Sugamoto K. The effect of weight-bearing condition on kinematics of a high-flexion, posterior-stabilized knee prosthesis. J Arthroplasty 2011; 26 (07) 1031-1037
    CrossrefPubMedGoogle Scholar
  • 19 Yamazaki T, Watanabe T, Nakajima Y. et al. Visualization of femorotibial contact in total knee arthroplasty using X-ray fluoroscopy. Eur J Radiol 2005; 53 (01) 84-89
    CrossrefPubMedGoogle Scholar
  • 20 Yamazaki T, Watanabe T, Nakajima Y. et al. Improvement of depth position in 2-D/3-D registration of knee implants using single-plane fluoroscopy. IEEE Trans Med Imaging 2004; 23 (05) 602-612
    CrossrefPubMedGoogle Scholar
  • 21 Zuffi S, Leardini A, Catani F, Fantozzi S, Cappello A. A model-based method for the reconstruction of total knee replacement kinematics. IEEE Trans Med Imaging 1999; 18 (10) 981-991
    CrossrefPubMedGoogle Scholar
  • 22 Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 1983; 105 (02) 136-144
    CrossrefPubMedGoogle Scholar
  • 23 Scuderi GR, Sikorskii A, Bourne RB, Lonner JH, Benjamin JB, Noble PC. The Knee Society Short Form reduces respondent burden in the assessment of patient-reported outcomes. Clin Orthop Relat Res 2016; 474 (01) 134-142
    CrossrefPubMedGoogle Scholar
  • 24 Nakamura N, Takeuchi R, Sawaguchi T, Ishikawa H, Saito T, Goldhahn S. Cross-cultural adaptation and validation of the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS). J Orthop Sci 2011; 16 (05) 516-523
    CrossrefPubMedGoogle Scholar
  • 25 Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1: 64
    CrossrefPubMedGoogle Scholar
  • 26 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28 (02) 88-96
    CrossrefPubMedGoogle Scholar
  • 27 Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39 (02) 175-191
    Google Scholar
  • 28 Nishio Y, Onodera T, Kasahara Y, Takahashi D, Iwasaki N, Majima T. Intraoperative medial pivot affects deep knee flexion angle and patient-reported outcomes after total knee arthroplasty. J Arthroplasty 2014; 29 (04) 702-706
    CrossrefPubMedGoogle Scholar
  • 29 Van Onsem S, Verstraete M, Van Eenoo W, Van Der Straeten C, Victor J. Are TKA kinematics during closed kinetic chain exercises associated with patient-reported outcomes? A preliminary analysis. Clin Orthop Relat Res 2020; 478 (02) 255-263
    CrossrefPubMedGoogle Scholar
  • 30 Nagai K, Muratsu H, Kanda Y. et al. Intraoperative soft tissue balance using novel medial preserving gap technique in posterior-stabilized total knee arthroplasty: comparison to measured resection technique. Knee Surg Sports Traumatol Arthrosc 2018; 26 (11) 3474-3481
    CrossrefPubMedGoogle Scholar
  • 31 Tsubosaka M, Muratsu H, Takayama K, Miya H, Kuroda R, Matsumoto T. Comparison of intraoperative soft tissue balance between cruciate-retaining and posterior-stabilized total knee arthroplasty performed by a newly developed medial preserving gap technique. J Arthroplasty 2018; 33 (03) 729-734
    CrossrefPubMedGoogle Scholar
  • 32 Blankevoort L, Huiskes R, de Lange A. The envelope of passive knee joint motion. J Biomech 1988; 21 (09) 705-720
    CrossrefPubMedGoogle Scholar
  • 33 Hallén LG, Lindahl O. The “screw-home” movement in the knee-joint. Acta Orthop Scand 1966; 37 (01) 97-106
    CrossrefPubMedGoogle Scholar
  • 34 Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee--the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am 1976; 58 (05) 583-594
    CrossrefPubMedGoogle Scholar
  • 35 Moglo KE, Shirazi-Adl A. Cruciate coupling and screw-home mechanism in passive knee joint during extension--flexion. J Biomech 2005; 38 (05) 1075-1083
    CrossrefPubMedGoogle Scholar
  • 36 Trent PS, Walker PS, Wolf B. Ligament length patterns, strength, and rotational axes of the knee joint. Clin Orthop Relat Res 1976; (117) 263-270
    PubMedGoogle Scholar
  • 37 Kim HY, Kim KJ, Yang DS, Jeung SW, Choi HG, Choy WS. Screw-home movement of the tibiofemoral joint during normal gait: three-dimensional analysis. Clin Orthop Surg 2015; 7 (03) 303-309
    CrossrefPubMedGoogle Scholar
  • 38 Fuss FK. Principles and mechanisms of automatic rotation during terminal extension in the human knee joint. J Anat 1992; 180 (Pt 2): 297-304
    PubMedGoogle Scholar
  • 39 Kono K, Tomita T, Futai K. et al. In vivo three-dimensional kinematics of normal knees during different high-flexion activities. Bone Joint J 2018; 100-b (01) 50-55
    CrossrefPubMedGoogle Scholar
  • 40 Horiuchi H, Akizuki S, Tomita T, Sugamoto K, Yamazaki T, Shimizu N. In vivo kinematic analysis of cruciate-retaining total knee arthroplasty during weight-bearing and non-weight-bearing deep knee bending. J Arthroplasty 2012; 27 (06) 1196-1202
    CrossrefPubMedGoogle Scholar
  • 41 Kurita M, Tomita T, Yamazaki T. et al. In vivo kinematics of high-flex mobile-bearing total knee arthroplasty, with a new post-cam design, in deep knee bending motion. Int Orthop 2012; 36 (12) 2465-2471
    CrossrefPubMedGoogle Scholar
  • 42 Scott G, Imam MA, Eifert A. et al. Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised? A pulsed fluoroscopic investigation. Bone Joint Res 2016; 5 (03) 80-86
    CrossrefPubMedGoogle Scholar
  • 43 Planckaert C, Larose G, Ranger P, Lacelle M, Fuentes A, Hagemeister N. Total knee arthroplasty with unexplained pain: new insights from kinematics. Arch Orthop Trauma Surg 2018; 138 (04) 553-561
    CrossrefPubMedGoogle Scholar