Pre-operative and post-operative kinematic analysis in total knee arthroplasty. A pilot study

Paolo Di Benedetto; Daniele Vidi; Andrea Colombo; Michele Mario Buttironi; Vanni Cainero; Araldo Causero

doi:10.23750/abm.v90i12-S.8984

Pre-operative and post-operative kinematic analysis in total knee arthroplasty. A pilot study

Authors

Paolo Di Benedetto Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy
Daniele Vidi University of Udine, Udine, Italy
Andrea Colombo Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy
Michele Mario Buttironi Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy
Vanni Cainero Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy
Araldo Causero Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy

DOI: https://doi.org/10.23750/abm.v90i12-S.8984

Keywords:

knee, arthroplasty, kinematic, muscles activation

Abstract

Introduction: Total knee replacement is the treatment of choice in knee osteoarthritis. Despite this, there is still a percentage of unsatisfied patients. Recently, prosthetic designs have been developed to improve the kinematics of the prosthetic knee. Materials and methods: Between June 2016 and November 2016 we enrolled 26 patients underwent to total knee arthroplasty divided in two groups (A and B) treated respectively with Journey 2 implant and the Attune impltant. Each patient was evaluated with functional scores (KOOS and KSS) and with kinematic analysis using the Bioval System. Results: In the group A, compared to the pre-operative, the flexion of the operated knees is significantly increased (31.27°±3.13° → 35.02°±2.1°) as well as that of the unoperated knee (34.34°±2.8° → 35.39°±3.5°). The pre/post-operative comparison of the muscles’ activation timing showed an improvement for the unoperated side, which is closed to the physiological pattern, while the operated side showed an incorrect activation of all the investigated muscles. Conclusions: The Journey 2 prosthesis seems to reach better results in rotational flexion, rotational freedom and muscles activation during free walking. Furthermore, it seems that with this prosthesis the patient can feel his “new prosthetic knee” more similar and closer to the physiological one. More studies are needed to confirm these results.

References

1. Khatod M et al., Knee replacement: epidemiology, outcomes, and trends in Southern California – 17,080 replacements from 1995 through 2004, Acta Orthopaedica, 2008; 79(6):812-819.
2. Lützner J et al., Computer-assisted and conventional total knee replacement – A comparative, prospective, randomised study with radiological and CT evaluation, J Bone Joint Surg Br, 2008; 90-B(8):1039-1044.
3. Hepinstall MS et al., Knee reconstruction: landmarks for optimizing component position in total knee arthroplasty, Current Orthopaedic Practice, 2008; 19(2):147-154.
4. Eckoff DG et al, Three-dimensional mechanics, kinematics, and morphology of the knee viewed in virtual reality, J Bone Joint Surg Am, 2005; 87(suppl 2); 71-80.
5. Rahman J,Tang Q, Monda M, Miles J, McCarthy I. Gait assessment as a functional outcome measure in total knee arthroplasty: a cross-sectional study. BMC Musculoskeletal Disorders (2015) 16:66
1. The role of pain and function in determining patient satisfaction after total knee replacement . Data from the National Joint Registry for England and Wales. Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. J Bone Joint Surg Br. 2007 Jul;89(7):893-900.
2. Lee. Biomechanics of Hyperflexion and Kneeling before and after Total Knee Arthroplasty Clinics in Orthopedic Surgery • Vol. 6, No. 2, 2014
3. Does TKA Improve Functional Outcome and Range of Motion in Patients with Stiff Knees? Young-Hoo Kim MD, Jun-Shik Kim MD. Clin Orthop Relat Res (2009) 467:1348–1354.
4. The influence of contemporary knee design on high flexion ii: a kinematic comparison with the normal knee. Edward A. Morra, Mircea Rosca, Jonathan F. I. Greenwald, A. Seth Greenwald, D.Phil.The journal of bone and joint surgery · december 2008
5. In Vivo Kinematics after a Cruciate-substituting TKA Jan Victor MD, John Kyle P. Mueller BS, Richard D. Komistek PhD, Adrija Sharma PhD, Matthew C. Nadaud MD, Johan Bellemans MD, PhD. Clin Orthop Relat Res (2010) 468:807–814
6. The Influence of Design on TKR Mechanics during Activities of Daily Living . Fitzpatrick CK; Clary CW; Rullkoetter PJ University of Denver. 37
7. Biomechanical changes in gait of subjects with medial knee osteoarthritis. Hésojy Gley Pereira Vital da Silva, Alberto Cliquet Junior, Alessandro Rozim Zorzi, and João Batista de Miranda. Acta Ortop Bras. 2012; 20(3): 150–156. 38
8. Straw R, Kulkarni S, Attfield S, Wilton TJ. Posterior cruciate ligament at total knee replacement. Essential, beneficial or a hindrance? J Bone Joint Surg Br 2003;85–5: 671–4. 39
9. Misra AN, Hussain MR, Fiddian NJ, Newton G. The role of the posterior cruciate ligament in total knee replacement. J Bone Joint Surg Br 2003;85–3:389–92.
10. Parsley BS, Conditt MA, Bertolusso R, Noble PC. Posterior cruciate ligament substitution is not essential for excellent postoperative outcomes in total knee arthroplasty. J Arthroplasty 2006;21–6(Suppl 2):127–31.
11. Gait analysis comparison of cruciate retaining and substituting TKA following PCL sacrifice Siddharth Joglekar , Terence J. Gioe , Patrick Yoon , Michael H. Schwartz, The Knee 19 (2012) 279–285
12. Straw R, Kulkarni S, Attfield S, Wilton TJ. Posterior cruciate ligament at total knee replacement. Essential, beneficial or a hindrance? J Bone Joint Surg Br 2003;85–5: 671–4.
13. Misra AN, Hussain MR, Fiddian NJ, Newton G. The role of the posterior cruciate ligament in total knee replacement. J Bone Joint Surg Br 2003;85–3:389–92.
14. Parsley BS, Conditt MA, Bertolusso R, Noble PC. Posterior cruciate ligament substitution is not essential for excellent postoperative outcomes in total knee arthroplasty. J Arthroplasty 2006;21–6(Suppl 2):127–31.

15. Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am May 2005;87(5):1047–53.
16. Silva M, Shepherd EF, Jackson WO, Pratt JA, McClung CD, Schmalzried TP. Knee strength after total knee arthroplasty. J Arthroplasty Aug 2003;18(5):605–11.
17. Judd DL, Eckhoff DG, Stevens-Lapsley JE. Muscle strength loss in the lower limb after total knee arthroplasty. Am J Phys Med Rehabil Mar 2012;91(3):220–6 quiz 227– 230.
18. Stevens-Lapsley JE, Balter JE, Kohrt WM, Eckhoff DG. Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty. Clin Orthop Relat Res Jan 2010.
19. Muscle activation and coactivation during five-time-sit-to-stand movement in patients undergoing total knee arthroplasty Bradley S. Davidson, Dana L. Judd, Abbey C. Thomas, Ryan L. Mizner, Donald G. Eckhoff, Jennifer E. Stevens-Lapsley Journal of Electromyography and Kinesiology 23 (2013) 1485–1493

20. Understanding the human knee and its relationship to total knee replacement Vaienti E, Scita G, Ceccarelli F, Pogliacomi F.
21. Design evolution in total knee replacement: which is the future? Review article Causero A, Di Benedetto P., Beltrame A., Gisonni R., Cainero V., Pagano M. - Acta Biomed (2014)