Abstract
Purpose
Total knee arthroplasty (TKA) is a very successful surgical procedure. However, implant failures and patient dissatisfaction still persist. Sometimes surgeons are not able to understand and explain these negative performances because the patient’s medical images “look good”, but the patient “feels bad”. Apart from radiograph imaging and clinical outcome scores, conventionally used follow-up methods are mainly based on the analysis of knee kinematics. However, even if kinematics remains close to the “normal” range of motion, the patient may still complain about pain and functional limitations. To provide more insight into this paradox, a better quantitative understanding of TKA mechanics must be developed. For this purpose, improved techniques for clinical follow-up, combining kinetics and kinematics analysis, should be introduced to help surgeons to assess and understand TKA performance.
Methods
An analysis on four TKA designs was performed, and the changes in kinematics and in kinetics induced by several implant configurations (simulating implant malalignment and different knee anatomy) were compared. More specifically, analysed tibio-femoral and patello-femoral contact forces and tibio-femoral kinematics were analysed during a squat task up to 120°.
Results
The results from this study show that contact forces (with changes up to 67 %) are more heavily affected by malconfigurations than kinematics, for which maximum deviations are of the order of 5 mm or 5°, similar to the simulated surgical errors. The results present a similar trend for the different designs.
Conclusions
The results confirm the hypothesis that kinematics is not the only and also not the most relevant parameter to predict or explain knee function after TKA. In the future, techniques to analyse knee kinetics should be integrated in the clinical follow-up.
Similar content being viewed by others
References
Acker S, Lia R, Murray H, John PS, Banks S, Mu S, Wyss U, Deluzio K (2011) Accuracy of single-plane fluoroscopy in determining relative position and orientation of total knee replacement components. J Biomech 44:784–787
Baker R (2006) Gait analysis methods in rehabilitation. J NeuroEng Rehabil 3:4
Banks SA (2005) Understanding and interpreting in vivo kinematics study. In: Bellemans J, Ries MD, Victor J (eds) Total knee arthroplasty: a guide to get better performance. Springer, Heidelberg, pp 115–120
Benoit DL, Ramsey DK, Lamontagne M, Xu L, Wretemberg P, Restrom P (2005) Effects of skin movement artifact on knee kinematics during gait and cutting motions measured in vivo. Gait Posture 24:58–70
Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59:241–242
Bozic KJ (2005) Failures with bearings. In: Bellemans J, Ries MD, Victor J (eds) Total knee arthroplasty: a guide to get better performance. Springer, Heidelberg, pp 51–56
Broström EW, Esbjörnsson A, von Heideken J, Iversen M (2012) Gait deviations in individuals with inflammatory joint diseases and osteoarthritis and the usage of three dimensional gait analysis. Best Pract Res Clin Rheumatol 26:409–422
Bryant BJ, Tilan JU, McGarry MH, Takenaka N, Kim WC, Lee TQ (2014) The biomechanical effect of increased valgus on total knee arthroplasty: a cadaveric study. J Arthroplasty 29:722–726
Catani F, Innocenti B, Belvedere C, Labey L, Ensini A, Leardini A (2010) The Mark Coventry Award Articular: contact estimation in TKA using in vivo kinematics and finite element analysis. Clin Orthop Relat Res 468:19–28
Daniilidis K, Tibesku CO (2013) Frontal plane alignment after total knee arthroplasty using patient-specific instruments. Int Orthop 37:45–50
Delport H, Labey L, De Corte R, Innocenti B, Vander Sloten J, Bellemans J (2013) Collateral ligament strains during knee joint laxity evaluation before and after TKA. Clin Biomech 28:777–782
Didden K, Luyckx T, Bellemans J, Labey L, Innocenti B, Vandenneucker H (2010) The effect of anteroposterior tibial component positioning on patello-femoral contact mechanics in total knee arthroplasty. J Bone Joint Surg Br 92:1466–1470
Eckhoff DG, Dwyer TF, Bach JM, Spitzer VM, Reinig KD (2001) Three-dimensional morphology and kinematics of the distal part the femur viewed in virtual reality, part I. J Bone Joint Surg Am 83:43–50
Eckhoff DG, Spitzer VM, Reinig KD, Bagur KD, Baldini TH, Rubinstein D, Humphries S (2008) Three-dimensional morphology and kinematics of the distal part the femur viewed in virtual reality, part II. J Bone Joint Surg Am 85:97–104
Figgie HE, Goldberg VM, Heiple KG, Moller HS, Gordon NH (1998) The influence of tibial-patello femoral location on function of the knee in patients with the posterior stabilized condylar knee prosthesis. J Bone Joint Surg Am 68:1035–1040
Grelsamer RP, Weinstein CH, Gould J, Dubey A (2008) Patellar tilt: the physical examination correlates with MR imaging. Knee 15:3–8
Hetaimish BM, Khan MM, Simunovic N, Al-Harbi HH, Bhandari M, Zalzal PK (2012) Meta-analysis of navigation vs conventional total knee arthroplasty. J Arthroplasty 27:1177–1182
Henriksen M, Aaboe J, Bliddal H (2012) The relationship between pain and dynamic knee joint loading in knee osteoarthritis varies with radiographic disease severity. A cross sectional study. Knee 19:392–398
Hodges PW (2011) Pain and motor control: from the laboratory to rehabilitation. J Electromyogr Kinesiol 21:220–228
Hungerford DS, Krackow KA, Kenna RV (1984) Total knee arthroplasty: a comprehensive approach. Williams & Wilkins, Baltimore
Hurwitz DE, Ryalsa AB, Block JA, Andriacchi TP (2002) The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. J Orthop Res 20:101–107
Innocenti B, Labey L, Kamali A, Pascale W, Pianigiani S (2014) Development and validation of a wear model to predict polyethylene wear in a total knee arthroplasty: a finite element analysis. Lubricants 2(4):193–205
Innocenti B, Bilgen ÖF, Labey L, van Lenthe GH, Vander Sloten J, Catani F (2014) Load sharing and ligament strains in balanced, overstuffed and understuffed uka. A validated finite element analysis. J Arthroplasty 29:1491–1498
Innocenti B, Pianigiani S, Labey L, Victor J, Bellemans J (2011) Contact forces in several TKA designs during squatting: a numerical sensitivity analysis. J Biomech 44:1573–1581
Johanson NA, Kleinbart FA, Cerynik DL, Brey JM, Ong KL, Kurtz SM (2011) Temporal relationship between knee arthroscopy and arthroplasty. A quality measure for joint care? J Arthroplasty 26:187–191
Karbowski A, Schwitalle M, Eckardt A, Heine J (1999) Periprosthetic bone remodeling after total knee arthroplasty: early assessment by dual energy X-ray absortiometry. Arch Orthop Trauma Surg 119:324–326
Kutzner I, Heinlein B, Graichen F, Bender A, Rohlmann A, Halder A, Beier A, Bergmann G (2010) Loading of the knee joint during activities of daily living measured in vivo in five subjects. J Biomech 43:2167–2173
Lloyd DG, Besier TF (2003) An EMG-driven musculoskeletal model to estimate muscle forces and knee joint moments in vivo. J Biomech 36:765–776
Lustig J, Scholes C, Oussedik SI, Kinzel V, Coolican MRJ, Parker DA (2013) Unsatisfactory accuracy as determined by computer navigation of VISIONAIRE patient-specific instrumentation for total knee arthroplasty. J Arthroplasty 28:469–473
Luyckx T, Didden K, Vandenneucker H, Labey L, Innocenti B, Bellemans J (2009) Is there a biomechanical explanation for anterior knee pain in patients with patella alta? Influence of patellar height on patellofemoral contact force, contact area and contact pressure. J Bone Joint Surg Br 91:344–350
Mason DJ, Whatling G, Kotwal RS, Brakspear K, Roberts H, Wilson C, Williams R, Sultan J, Holt C (2010) Can joint realignment surgery reveal mechanically regulated signals that influence pain and pathology in humans? J Biomech 43:S51
Moewis P, Wolterbeek G, Valstar E, Heller MO, Taylor WR (2012) The quality of bone surfaces may govern the use of model based fluoroscopy in the determination of joint laxity. Med Eng Phy 34:1427–1432
Oh SE, Choi A, Mun JH (2013) Prediction of ground reaction forces during gait based on kinematics and a neural network model. J Biomech 46:2372–2380
Ostermeier S, Schlomach C, Hurschler C, Windhagen H, Stukenborg-Colsman C (2006) Dynamic in vitro measurement of posterior cruciate ligament load and tibiofemoral stress after TKA independence on tibiofemoral slope. Clin Biomech 21:525–532
Pang HN, Yeo SJ, Chong HC, Chin PL, Ong J, Lo NN (2011) Computer-assisted gap balancing technique improves outcome in total knee arthroplasty, compared with conventional measured resection technique. Knee Surg Sports Traumatol Arthrosc 19:1496–1503
Papadopoulos K, Noyes J, Jones JG, Thom JM, Stasinopoulos D (2014) Clinical tests for differentiating between patients with and without patellofemoral pain syndrome. Hong Kong Physiother J 32:35–43
Pianigiani S, Chevalier Y, Labey L, Pascale V, Innocenti B (2012) Tibio-femoral kinematics in different total knee arthroplasty designs during a loaded squat: a numerical sensitivity study. J Biomech 45:2315–2323
Ramakrishnan HK, Kadaeat MP (1991) On the estimation of joint kinematics during gait. J Biomech Clin Orthop Relat Res 4:969–997
Ramappa AJ, Apreleva M, Harrold FR, Fitzgibbons PG, Wilson DR, Gill TJ (2006) The effects of medicalization and anteromedialization of the tibial tubercle on patellofemoral mechanics and kinematics. Am J Sports Am 34:749–756
Shirazi-Adl A, Mesfar W (2007) Effect of tibial tubercle elevation on biomechanics of the entire knee joint under muscle loads. Clin Biomech 22:344–351
Singerman R, White C, Davy DT (1995) Reduction of patellofemoral contact forces following anterior displacement of the tibial tubercle. J Orthop Res 13:279–285
Soenen M, Baracchi M, De Corte R, Labey L, Innocenti B (2013) Stemmed TKA in a femur with a total hip arthroplasty : Is there a safe distance between the stem tips? J Arthroplasty 28:1437–1445
van Jonbergen HPW, Innocenti B, Gervasi GL, Labey L, Verdonschot N (2012) Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study. J Orthop Surg Res 7:28
Vince KG, Bozic V (2005) Management of extra-articular deformities in total knee arthroplasty. In: Bellemans J, Ries MD, Victor J (eds) Total knee arthroplasty: a guide to get better performance. Springer, Heidelberg, pp 205–211
Walker PS, Meere PA, Bell CP (2014) Effects of surgical variables in balancing of total knee replacements using and instrumented tibial trial. Knee 21:156–619
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pianigiani, S., Labey, L., Pascale, W. et al. Knee kinetics and kinematics: What are the effects of TKA malconfigurations?. Knee Surg Sports Traumatol Arthrosc 24, 2415–2421 (2016). https://doi.org/10.1007/s00167-015-3514-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-015-3514-y