<i>In vivo</i> kinematics of total knee arthroplasty: Flat compared with concave tibial joint surface

Journal of Orthopaedic Research - Tập 18 Số 6 - Trang 856-864 - 2000
Johan Uvehammer1, Johan Kärrholm1, Sveinbjörn Brandsson2, Peter Herberts1, Lars Carlsson1, Jón Karlsson2, Lars Regnér1
1Orthopaedic Department, Sahlgrenska University Hospital, Göteborg, Sweden
2East Hospital, Göteborg, Sweden.

Tóm tắt

AbstractThis study evaluated the influence of the geometric configuration of the tibial joint area on the kinematics of the knee. Twenty‐two patients with noninflammatory arthritis and minor preoperative deformity were studied. They each received an AMK total knee replacement with retention of the posterior cruciate ligament. Eleven patients without any knee abnormalities were used as controls. The patients were stratified to either the flat (terminology of the manufacturer: standard) or concave (terminology of the manufacturer: constrained) polyethylene insert (n = 11 in each group). Knee kinematics were assessed 1 year after the operation by having the patient ascend a platform corresponding to an extension of the knee from 50 to 70° of flexion. During this motion, two film‐exchangers simultaneously exposed six to 13 pairs of serial stereoradiographs. The concave geometric configuration of the tibial insert resulted paradoxically in increased anterior‐posterior translations compared with the flat insect but no significant change of rotations and translations in the other directions. Compared with normal knees, the most obvious abnormality was increased anterior‐posterior translations (p < 0.004). At 50° of flexion, the implants with the flat tibial polyethylene insert had displaced 2 times and the concave ones had displaced 2.5 times more posteriorly than the normal knees (p ⩽ 0.001). Less internal tibial rotation was also recorded in the flexed positions for both types of inserts compared with the normal knees (p < 0.02). Four knees in four patients, who reported symptoms of instability and abnormal knee function, showed significantly increased proximal displacement of the center of the tibial plateau in the flexed position. The findings suggest that current prosthetic designs and surgical technique do not restore normal knee kinematics and indicate that design improvements should rely on in vivo kinematic studies.

Từ khóa


Tài liệu tham khảo

10.1016/S0883-5403(88)80080-9

10.2106/00004623-198264090-00008

10.1016/S0883-5403(88)80003-2

Andriacchi TP, 1999, New insights into femoral rollback during stair climbing and posterior cruciate ligament function, Trans Orthop Res Soc, 45, 20

Banks SA, 1997, The mechanics of knee replacements during gait: in vivo fluoroscopic analysis of two designs, Am J Knee Surg, 10, 261

10.1016/S0883-5403(97)90024-3

10.1097/00003086-199610000-00015

Ewald FC, 1989, The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system, Clin Orthop, 248, 9, 10.1097/00003086-198911000-00003

Goodfellow J, 1978, The mechanics of the knee and prosthesis design, J Bone Joint Surg [Br], 60, 358, 10.1302/0301-620X.60B3.581081

10.1177/036354658901700613

10.1002/jor.1100120604

Kärrholm J, 1988, Active knee motion after cruciate ligament rupture: stereoradiography, Acta Orthop Scand, 59, 58

10.3109/17453678909149328

10.1007/BF01552655

Nilsson KG, 1990, Knee motion in total knee arthroplasty: a roentgen stereophotogrammetric analysis of the kinematics of the Tricon‐M knee prosthesis, Clin Orthop, 256, 147, 10.1097/00003086-199007000-00022

10.3109/17453679108996640

10.1002/jor.1100130308

Nilsson KG, 1997, In vivo kinematics in knee replacements with fixed or mobile polyethylene bearings, Trans Orthop Res Soc, 43, 261

10.1016/S0883-5403(99)90196-1

Pocock SJ, 1983, Clinical Trials: A Practical Approach

10.1097/00003086-197307000-00023

10.1016/S0883-5403(97)90156-X

10.1016/S0883-5403(86)80008-0

Stiehl JB, 1995, Fluoroscopic analysis of kinematics after posterior‐cruciateretaining knee arthroplasty, J Bone Joint Surg [Br], 77, 884, 10.1302/0301-620X.77B6.7593100

10.1097/00003086-199712000-00010

Wright TM, 1992, Wear of polyethylene in total joint replacements: observations from retrieved PCA knee implants, Clin Orthop, 276, 126, 10.1097/00003086-199203000-00016

Thông tin
Thông tin xuất bản

Journal of Orthopaedic Research

Tập 18 Số 6

856-864

Thông tin tác giả