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Kinematics of mobile-bearing unicompartmental knee arthroplasty compared to native: results from an in vitro study

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Fixed-bearing unicompartmental knee arthroplasty (UKA) closely replicates native knee kinematics. As few studies have assessed kinematics following mobile-bearing (MB) UKA, the current study aimed to investigate whether MB UKA preserves natural knee kinematics.

Materials and methods

Seven fresh-frozen full-leg cadaver specimens were prepared and mounted in a kinematic rig that allowed all degrees of freedom at the knee. Three motion patterns, passive flexion–extension (0°–110° flexion), open-chain extension (5°–70° flexion) and squatting (30°–100° flexion), were performed pre- and post-implantation of a medial MB UKA and compared in terms of rotational and translational knee joint kinematics in the different anatomical planes, respectively.

Results

In terms of frontal plane rotational kinematics, MB UKA specimens were in a more valgus orientation for all motion patterns. In the axial plane, internal rotation of the tibia before and after UKA was consistent, regardless of motion task, with no significant differences. In terms of frontal plane, i.e., inferior–superior, translations, the FMCC was significantly higher in UKA knees in all flexion angles and motor tasks, except in early flexion during passive motion. In terms of axial plane, i.e., anteroposterior (AP), translations, during open-chain activities, the femoral medial condyle center (FMCC) tended to be more posterior following UKA relative to the native knee in mid-flexion and above. AP excursions of the FMCC were small in all tested motions, however. There was substantial AP translation of the femoral lateral condyle center during passive motion before and after UKA, which was significantly different for flexion angles > 38°.

Conclusions

Our study data demonstrate that the kinematics of the unloaded knee following MB UKA closely resemble those of the native knee while relative medial overstuffing with UKA will result in the joint being more valgus. However, replacing the conforming and rigidly fixed medial meniscus with a mobile inlay may successfully prevent aberrant posterior translation of the medial femoral compartment during passive motion and squatting motion.

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References

  1. Liddle AD, Pandit H, Judge A, Murray DW (2015) Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales. Bone Jt J 97-B(6):793–801

    Article  CAS  Google Scholar 

  2. Wiik AV, Aqil A, Tankard S, Amis AA, Cobb JP (2015) Downhill walking gait pattern discriminates between types of knee arthroplasty: improved physiological knee functionality in UKA versus TKA. Knee Surg Sports Traumatol Arthrosc 23(6):1748–1755

    Article  PubMed  Google Scholar 

  3. Catani F, Benedetti M, Bianchi L, Marchionni V, Giannini S, Leardini A (2012) Muscle activity around the knee and gait performance in unicompartmental knee arthroplasty patients: a comparative study on fixed- and mobile-bearing designs. Knee Surg Sports Traumatol Arthrosc 20(6):1042–1048

    Article  PubMed  Google Scholar 

  4. Becker R, Mauer C, Starke C, Brosz M, Zantop T, Lohmann CH, Schulze M (2013) Anteroposterior and rotational stability in fixed and mobile bearing unicondylar knee arthroplasty: a cadaveric study using the robotic force sensor system. Knee Surg Sports Traumatol Arthrosc 21(11):2427–2432

    Article  PubMed  Google Scholar 

  5. Heyse TJ, El-Zayat BF, De Corte R, Chevalier Y, Scheys L, Innocenti B, Fuchs-Winkelmann S, Labey L (2014) UKA closely preserves natural knee kinematics in vitro. Knee Surg Sports Traumatol Arthrosc 22(8):1902–1910

    Article  PubMed  Google Scholar 

  6. Mochizuki T, Sato T, Blaha JD, Tanifuji O, Kobayashi K, Yamagiwa H, Watanabe S, Matsueda M, Koga Y, Omori G, Endo N (2014) Kinematics of the knee after unicompartmental arthroplasty is not the same as normal and is similar to the kinematics of the knee with osteoarthritis. Knee Surg Sports Traumatol Arthrosc 22(8):1911–1917

    Article  PubMed  Google Scholar 

  7. Mochizuki T, Sato T, Tanifuji O, Kobayashi K, Koga Y, Yamagiwa H, Omori G, Endo N (2013) In vivo pre- and postoperative three-dimensional knee kinematics in unicompartmental knee arthroplasty. J Orthop Sci 18(1):54–60

    Article  PubMed  Google Scholar 

  8. Emerson RJ, Hansborough T, Reitman R, Rosenfeldt W, Higgins L (2002) Comparison of a mobile with a fixed-bearing unicompartmental knee implant. Clin Orthop Relat Res 404:62–70

    Article  Google Scholar 

  9. Smith T, Hing C, Davies L, Donell S (2009) Fixed versus mobile bearing unicompartmental knee replacement: a meta-analysis. Orthop Traumatol Surg Res 95(8):599–605

    Article  CAS  PubMed  Google Scholar 

  10. Ettinger M, Zoch JM, Becher C, Hurschler C, Stukenborg-Colsman C, Claassen L, Ostermeier S, Calliess T (2015) In vitro kinematics of fixed versus mobile bearing in unicondylar knee arthroplasty. Arch Orthop Trauma Surg 135(6):871–877

    Article  PubMed  Google Scholar 

  11. Walker T, Heinemann P, Bruckner T, Streit MR, Kinkel S, Gotterbarm T (2017) The influence of different sets of surgical instrumentation in Oxford UKA on bearing size and component position. Arch Orthop Trauma Surg 137(7):895–902

    Article  PubMed  Google Scholar 

  12. Gleeson R, Evans R, Ackroyd C, Webb J, Newman J (2004) Fixed or mobile bearing unicompartmental knee replacement? A comparative cohort study. Knee 11(5):379–384

    Article  CAS  PubMed  Google Scholar 

  13. Li M, Yao F, Joss B, Ioppolo J, Nivbrant B, Wood D (2006) Mobile vs. fixed bearing unicondylar knee arthroplasty: a randomized study on short term clinical outcomes and knee kinematics. Knee 13(5):365–370

    Article  PubMed  Google Scholar 

  14. Suzuki T, Ryu K, Kojima K, Iriuchishima T, Saito S, Nagaoka M, Tokuhashi Y (2015) Evaluation of spacer block technique using tensor device in unicompartmental knee arthroplasty. Arch Orthop Trauma Surg 135(7):1011–1016

    Article  PubMed  Google Scholar 

  15. Victor J, Van Glabbeek F, Vander Sloten J, Parizel PM, Somville J, Bellemans J (2009) An experimental model for kinematic analysis of the knee. J Bone Jt Surg Am 91(Suppl 6):150–163

    Article  Google Scholar 

  16. Brimacombe JM, Wilson DR, Hodgson AJ, Ho KC, Anglin C (2009) Effect of calibration method on Tekscan sensor accuracy. J Biomech Eng 131(3):034503

    Article  PubMed  Google Scholar 

  17. Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105(2):136–144

    Article  CAS  PubMed  Google Scholar 

  18. LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L (2007) The anatomy of the medial part of the knee. J Bone Jt Surg Am 89(9):2000–2010

    Google Scholar 

  19. Heyse TJ, El-Zayat BF, De Corte R, Scheys L, Chevalier Y, Fuchs-Winkelmann S, Labey L (2014) Biomechanics of medial unicondylar in combination with patellofemoral knee arthroplasty. Knee 21(Suppl 1):S3–S9

    Article  PubMed  Google Scholar 

  20. Heyse TJ, El-Zayat BF, De Corte R, Scheys L, Chevalier Y, Fuchs-Winkelmann S, Labey L (2016) Balancing UKA: overstuffing leads to high medial collateral ligament strains. Knee Surg Sports Traumatol Arthrosc 24(10):3218–3228

    Article  PubMed  Google Scholar 

  21. Heyse TJ, Tucker SM, Rajak Y, Kia M, Lipman JD, Imhauser CW, Westrich GH (2015) Frontal plane stability following UKA in a biomechanical study. Arch Orthop Trauma Surg 135(6):857–865

    Article  PubMed  Google Scholar 

  22. Mundermann A, Dyrby CO, D’Lima DD, Colwell CW Jr, Andriacchi TP (2008) In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement. J Orthop Res 26(9):1167–1172

    Article  PubMed  Google Scholar 

  23. Victor J (2009) A comparative study on the biomechanics of the native human knee joint and total knee arthroplasty. Katholieke Universiteit, Leuven

    Google Scholar 

  24. Navacchia A, Rullkoetter PJ, Schutz P, List RB, Fitzpatrick CK, Shelburne KB (2016) Subject-specific modeling of muscle force and knee contact in total knee arthroplasty. J Orthop Res 34(9):1576–1587

    Article  PubMed  PubMed Central  Google Scholar 

  25. Patil S, Colwell CW Jr, Ezzet KA, D’Lima DD (2005) Can normal knee kinematics be restored with unicompartmental knee replacement? J Bone Jt Surg Am 87(2):332–338

    Article  Google Scholar 

  26. Jeong JH, Kang H, Ha YC, Jang EC (2012) Incarceration of a dislocated mobile bearing to the popliteal fossa after unicompartmental knee arthroplasty. J Arthroplast 27(2):323.e325–323.e327

    Article  Google Scholar 

  27. Singh VK, Apsingi S, Balakrishnan S, Manjure S (2012) Posterior dislocation of meniscal bearing insert in mobile bearing unicompartmental knee arthroplasty mimicking a Baker cyst. J Arthroplasty 27(3):494.e413–494.e496

    Article  Google Scholar 

  28. Lee SY, Bae JH, Kim JG, Jang KM, Shon WY, Kim KW, Lim HC (2014) The influence of surgical factors on dislocation of the meniscal bearing after Oxford medial unicompartmental knee replacement: a case–control study. Bone Jt J 96(7):914–922

    Article  Google Scholar 

  29. Argenson J, Komistek R, Aubaniac J, Dennis D, Northcut E, Anderson D, Agostini S (2002) In vivo determination of knee kinematics for subjects implanted with a unicompartmental arthroplasty. J Arthroplast 17(8):1049–1054

    Article  Google Scholar 

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Acknowledgements

The study was funded by a German Knee Society Grant (Deutsche Kniegesellschaft) and a research Grant of the Rhön-Klinikum AG (Innovations- und Förderpool). The implants were donated by Zimmer Biomet, Europe.

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Authors and Affiliations

  1. Institute for Orthopaedic Research and Training, KU Leuven, Campus Pellenberg, Louvain, Belgium

    Geert Peersman, Josh Slane & Lennart Scheys

  2. Department of Orthopaedic Surgery, Ziekenhuis Netwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium

    Geert Peersman & Philippe Vuylsteke

  3. Center of Orthopedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany

    Susanne Fuchs-Winkelmann, Philipp Dworschak & Thomas Heyse

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  1. Geert Peersman
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  2. Josh Slane
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Correspondence to Geert Peersman.

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Peersman, G., Slane, J., Vuylsteke, P. et al. Kinematics of mobile-bearing unicompartmental knee arthroplasty compared to native: results from an in vitro study. Arch Orthop Trauma Surg 137, 1557–1563 (2017). https://doi.org/10.1007/s00402-017-2794-8

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  • DOI: https://doi.org/10.1007/s00402-017-2794-8

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