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J Knee Surg
DOI: 10.1055/a-2240-3336
Original Article

Intraoperative Kinematics in Posterior Cruciate Ligament Retaining Total Knee Arthroplasty Using Different Inserts

Yoshikazu Sumida
1   Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
,
Eisaku Fujimoto
1   Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
,
Yasuji Masuda
1   Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
,
Saori Ishibashi
1   Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
,
Yoshiaki Sasashige
1   Department of Orthopaedic Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
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Abstract

We analyzed the intraoperative kinematics of total knee arthroplasty (TKA) using a navigation system to investigate the influence of different inserts on kinematics. This was a retrospective observational study. The Vanguard individualized design (33 patients, 33 knees) XP and anterior-stabilized (AS) inserts were used in TKA for osteoarthritis. Kinematic data were intraoperatively recorded. The range of motion, tibiofemoral rotational angle, anteroposterior translation of the femur, and varus-valgus laxity were compared between the two inserts (XP vs. AS). There was no significant difference in the range of motion (extension: XP, 3.7° ± 3.3° vs. AS, 3.8° ± 3.3°, p = 0.84; flexion: XP, 138.1° ± 10.2° vs. AS, 139.0° ± 13.3°, p = 0.73). With the AS insert, the tibia was gradually internally rotated as the knee was flexed. At maximum extension, the internal rotation was smallest with AS (XP 6.5° ± 4.0° vs. AS 5.1° ± 3.4°, p = 0.022), which was also associated with smaller anterior femoral translation (maximum extension: XP, 14.1 ± 4.8 mm vs. AS, 11.3 ± 4.7 mm, p = 0.00036; 30°: XP, 23.7 ± 5.6 mm vs. AS, 20.7 ± 5.1 mm, p = 0.000033; 45°: XP, 24.4 ± 4.9 mm vs. AS, 23.2 ± 4.5 mm, p = 0.0038). The AS was associated with a lower varus-valgus laxity (30° XP 4.1° ± 3.4 vs. AS 3.3° ± 2.7°, p = 0.036; 60°: XP, 3.2° ± 3.0° vs. AS, 2.4° ± 3.3°, p = 0.0089). The AS insert facilitated sequential tibiofemoral rotation with varus-valgus stability in mid-flexion without restricting the range of motion.

Keywords

total knee arthroplasty - kinematics - insert


Publication History

Received: 09 April 2022

Accepted: 07 January 2024

Accepted Manuscript online:
08 January 2024

Article published online:
31 January 2024

© 2024. Thieme. All rights reserved.

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  • References

  • 1 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
  • 2 Heath EL, Ackerman IN, Cashman K, Lorimer M, Graves SE, Harris IA. Patient-reported outcomes after hip and knee arthroplasty : results from a large national registry. Bone Jt Open 2021; 2 (06) 422-432
    Google Scholar
  • 3 Rodriguez-Merchan EC. Patient satisfaction following primary total knee arthroplasty: contributing factors. Arch Bone Jt Surg 2021; 9 (04) 379-386
    Google Scholar
  • 4 Hofmann AA, Schaeffer JF. Patient satisfaction following total knee arthroplasty: is it an unrealistic goal?. Semin Arthroplasty 2014; 25 (03) 169-171
    Google Scholar
  • 5 Tsubosaka M, Ishida K, Kodato K. et al. Mid-flexion stability in the anteroposterior plane is achieved with a medial congruent insert in cruciate-retaining total knee arthroplasty for varus osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2021; 29 (02) 467-473
    Google Scholar
  • 6 Wada K, Hamada D, Takasago T. et al. The medial constrained insert restores native knee rotational kinematics after bicruciate-retaining total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27 (05) 1621-1627
    Google Scholar
  • 7 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16 (04) 494-502
    Google Scholar
  • 8 Akagi M, Oh M, Nonaka T, Tsujimoto H, Asano T, Hamanishi C. An anteroposterior axis of the tibia for total knee arthroplasty. Clin Orthop Relat Res 2004; (420) 213-219
    Google Scholar
  • 9 Kono K, Dorthe EW, Tomita T, Tanaka S, Angibaud L, D'Lima DD. Intraoperative knee kinematics measured by computer-assisted navigation and intraoperative ligament balance have the potential to predict postoperative knee kinematics. J Orthop Res 2022; 40 (07) 1538-1546
    Google Scholar
  • 10 Ritter MA, Harty LD, Davis KE, Meding JB, Berend ME. Predicting range of motion after total knee arthroplasty. Clustering, log-linear regression, and regression tree analysis. J Bone Joint Surg Am 2003; 85 (07) 1278-1285
    Google Scholar
  • 11 Ahmed I, Gray AC, van der Linden M, Nutton R. Range of flexion after primary TKA: the effect of soft tissue release and implant design. Orthopedics 2009; 32 (11) 811
    Google Scholar
  • 12 Freeman MA, Pinskerova V. The movement of the normal tibio-femoral joint. J Biomech 2005; 38 (02) 197-208
    Google Scholar
  • 13 Iwaki H, Pinskerova V, Freeman MA. Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br 2000; 82 (08) 1189-1195
    Google Scholar
  • 14 Nakagawa S, Kadoya Y, Todo S. et al. Tibiofemoral movement 3: full flexion in the living knee studied by MRI. J Bone Joint Surg Br 2000; 82 (08) 1199-1200
    Google Scholar
  • 15 Banks SA, Hodge WA. 2003 Hap Paul Award Paper of the International Society for Technology in Arthroplasty. Design and activity dependence of kinematics in fixed and mobile-bearing knee arthroplasties. J Arthroplasty 2004; 19 (07) 809-816
    Google Scholar
  • 16 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
    Google Scholar
  • 17 Hallén LG, Lindahl O. The “screw-home” movement in the knee-joint. Acta Orthop Scand 1966; 37 (01) 97-106
    Google Scholar
  • 18 Yue B, Varadarajan KM, Moynihan AL, Liu F, Rubash HE, Li G. Kinematics of medial osteoarthritic knees before and after posterior cruciate ligament retaining total knee arthroplasty. J Orthop Res 2011; 29 (01) 40-46
    Google Scholar
  • 19 Nakamura S, Kuriyama S, Ito H. et al. Kinematic comparison between asymmetrical and symmetrical polyethylene inserts during deep knee bend activity. J Orthop Sci 2022; 27 (04) 810-814
    Google Scholar
  • 20 Dennis DA, Komistek RD, Colwell Jr CE. et al. In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 1998; (356) 47-57
    Google Scholar
  • 21 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
    Google Scholar
  • 22 Vajapey SP, Pettit RJ, Li M, Chen AF, Spitzer AI, Glassman AH. Risk factors for mid-flexion instability after total knee arthroplasty: a systematic review. J Arthroplasty 2020; 35 (10) 3046-3054
    Google Scholar
  • 23 Hino K, Ishimaru M, Iseki Y, Watanabe S, Onishi Y, Miura H. Mid-flexion laxity is greater after posterior-stabilised total knee replacement than with cruciate-retaining procedures: a computer navigation study. Bone Joint J 2013; 95-B (04) 493-497
    Google Scholar
  • 24 Matsuzaki T, Matsumoto T, Muratsu H. et al. Kinematic factors affecting postoperative knee flexion after cruciate-retaining total knee arthroplasty. Int Orthop 2013; 37 (05) 803-808
    Google Scholar
  • 25 Alesi D, Marcheggiani Muccioli GM, Roberti di Sarsina T. et al. In vivo femorotibial kinematics of medial-stabilized total knee arthroplasty correlates to post-operative clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2021; 29 (02) 491-497
    Google Scholar
  • 26 Samy DA, Wolfstadt JI, Vaidee I, Backstein DJ. A retrospective comparison of a medial pivot and posterior-stabilized total knee arthroplasty with respect to patient-reported and radiographic outcomes. J Arthroplasty 2018; 33 (05) 1379-1383
    Google Scholar
  • 27 Warth LC, Ishmael MK, Deckard ER, Ziemba-Davis M, Meneghini RM. Do medial pivot kinematics correlate with patient-reported outcomes after total knee arthroplasty?. J Arthroplasty 2017; 32 (08) 2411-2416
    Google Scholar