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Bicruciate-retaining total knee arthroplasty reproduces in vivo kinematics of normal knees to a lower extent than unicompartmental knee arthroplasty

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to clarify the natural knee kinematics provided by bicruciate-retaining total knee arthroplasty (BCR-TKA) compared with those of unicompartmental knee arthroplasty (UKA) and normal knees.

Methods

Volunteers and patients who had undergone UKA and BCR-TKA with anatomical articular surface performed squatting motion under fluoroscopy. To estimate the knee’s spatial position and orientation, a two-dimensional/three-dimensional registration technique was used. The rotation angle and anteroposterior translation of the medial and lateral sides of the femur relative to the tibia in each flexion angle were directly evaluated using the same local coordinate system and their differences amongst the three groups were analysed using two-way analysis of variance and Bonferroni post hoc pairwise comparison.

Results

From 0° to 10° of flexion, the femoral external rotation angle of BCR-TKA knees was significantly greater than that of normal and UKA knees and the medial side of BCR-TKA knees was significantly more anteriorly located than that of normal and UKA knees. From 40° to 50° of flexion, the medial side of UKA knees was significantly more posteriorly located than that of normal and BCR-TKA knees. From 30° to 120° of flexion, the lateral side of BCR-TKA knees was significantly more anteriorly located than that of normal and UKA knees.

Conclusion

The in vivo kinematics of BCR-TKA knees reproduces those of normal knees to a lower extent than those of UKA knees. Thus, BCR-TKA with anatomical articular surface reproduces in vivo kinematics of normal knees to a lower extent than UKA.

Level of evidence

III.

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Abbreviations

KSS 2011:

2011 Knee Society Score

2D:

Two-dimensional

3D:

Three-dimensional

ACL:

Anterior cruciate ligament

ANOVA:

Analysis of variance

AP:

Anteroposterior

BCR-TKA:

Bicruciate-retaining total knee arthroplasty

CAD:

Computer-aided design

CR:

Cruciate-retaining

CR-TKA:

Cruciate-retaining total knee arthroplasty

CT:

Computed tomography

DKB:

Deep knee bend

FB:

Fixed bearing

HKA:

Hip-knee-ankle

KSS:

Knee Society Score

LCS:

Local coordinate system

MB:

Mobile-bearing

OA:

Osteoarthritis

PCL:

Posterior cruciate ligament

PRO:

Patient-reported outcome

PS:

Posterior-stabilised

PS-TKA:

Posterior-stabilised total knee arthroplasty

SD:

Standard deviation

TKA:

Total knee arthroplasty

UKA:

Unicompartmental knee arthroplasty

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Acknowledgements

We are grateful to Dr. Ryota Yamagami, Dr. Kohei Kawaguchi, Dr. Tomofumi Kage, Dr. Teruya Ishibashi and Dr. Shoji Konda for their cooperation in this research. We also thank our colleagues for their constructive comments. This research did not receive any specific grant from any funding agencies in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Kenichi Kono, Hiroshi Inui, Shuji Taketomi & Sakae Tanaka

  2. Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Osaka, Japan

    Tetsuya Tomita

  3. Department of Information Systems, Faculty of Engineering, Saitama Institute of Technology, Saitama, Japan

    Takaharu Yamazaki

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  1. Kenichi Kono
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  2. Hiroshi Inui
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  4. Takaharu Yamazaki
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Correspondence to Hiroshi Inui.

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Fluoroscopic analysis. Under fluoroscopy, each participant performed a squatting motion at a natural pace (WMV 5569 kb)

Two-dimensional/three-dimensional (2D/3D) registration of bicruciate-retaining total knee arthroplasty knee during squatting motion. The 2D/3D registration of the femoral and tibial implants was performed initially, followed by the 2D/3D registration of the femoral and tibial bone models (WMV 5541 kb)

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Kono, K., Inui, H., Tomita, T. et al. Bicruciate-retaining total knee arthroplasty reproduces in vivo kinematics of normal knees to a lower extent than unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 28, 3007–3015 (2020). https://doi.org/10.1007/s00167-019-05754-2

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