Advertisement

Small differences in tibial contact locations following kinematically aligned TKA from the native contralateral knee

  • Stephanie Nicolet-Petersen
  • Augustine Saiz
  • Trevor Shelton
  • Stephen M. Howell
  • Maury L. HullEmail author
KNEE

Abstract

Purpose

Kinematically aligned (KA) TKA strives to restore native limb and knee alignments without ligament release with the premise that knee function likewise will be closely restored to native to the extent enabled by the components used. This study determined differences in anterior–posterior (AP) tibial contact locations of a KA TKA performed with asymmetric, fixed bearing, posterior cruciate-retaining (PCR) components from those of the native contralateral knee and also determined the incidence of posterior rim contact of the tibial insert during a deep knee bend and a step-up.

Methods

Both knees were imaged using single-plane fluoroscopy for 25 patients with a calipered KA TKA and a native knee in the contralateral limb. AP tibial contact locations in each compartment were determined following 3D model-to-2D image registration. Differences in mean AP tibial contact locations in each compartment between the KA TKA knees and the native contralateral knees were analysed. Contact locations either on or beyond the most posterior point of the tibial insert determined the occurrence of posterior rim contact.

Results

Mean AP tibial contact locations for both native and KA TKA knees remained relatively centred in the medial compartment but moved posterior in the lateral compartment during flexion. In both the medial and lateral compartments, differences in mean AP tibial contact locations between the KA TKA knees and the native contralateral knees were more posterior and greatest at 0° flexion for both activities (4 mm, p = 0.0009 and 7 mm, p < 0.0001 for deep knee bend and 6 mm, p < 0.0001 and 8 mm, p < 0.0001 for step-up in the medial and lateral compartments, respectively). The incidence of posterior rim contact of the tibial insert was 16% (4 of 25 patients) but the lowest Oxford Knee Score was 43 for these patients. The median Oxford Knee Score for all patients was 46 (out of 48).

Conclusions

Calipered KA TKA with asymmetric, fixed bearing, PCR components resulted in mean AP tibial contact locations which were relatively centred in the compartments and differed at most from those of the native contralateral knee by approximately 15% of the AP dimension of a mid-sized tibial baseplate. Although posterior rim contact occurred in some patients, all such patients had high patient-reported outcome scores.

Level of evidence

Therapeutic, Level III.

Keywords

Total knee replacement Total knee arthroplasty Contact kinematics Kinematic alignment Posterior edge loading Deep knee bend Step-up Activities of daily living Tibiofemoral joint 

Notes

Acknowledgements

The authors would like to thank the individuals who participated in this study for their contribution to the advancement of education and research. Lastly, the authors would like to thank Savannah Axume Gamero, Anya Guzman, Yash Taneja, and Caitlyn Munch for assistance with segmentation and image processing.

Funding

This study was funded by Zimmer-Biomet, Award number IRU2016-101K:Knees.

Compliance with ethical standards

Conflict of interest

S. M. Howell is a paid consultant for THINK Surgical and Medacta, Inc. M. L. Hull receives research support from Zimmer-Biomet and Medacta, Inc. Remaining authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the University of California Davis Institutional Review Board (IRB#954288).

References

  1. 1.
    Banks SA, Hodge WA (1996) Accurate measurement of three-dimensional knee replacement kinematics using single-plane fluoroscopy. IEEE Trans Biomed Eng 43(6):638–649CrossRefGoogle Scholar
  2. 2.
    Banks SA, Hodge WA (2004) Design and activity dependence of kinematics in fixed and mobile-bearing knee arthroplasties. J Arthroplast 19(7):809–816CrossRefGoogle Scholar
  3. 3.
    Bartlett JW, Frost C (2008) Reliability, repeatability and reproducibility: analysis of measurement errors in continuous variables. Ultrasound Obstet Gynecol 31(4):466–475CrossRefGoogle Scholar
  4. 4.
    Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M (2017) PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 25(6):1743–1748CrossRefGoogle Scholar
  5. 5.
    Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, Lapp MA (1998) In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res 356:47–57CrossRefGoogle Scholar
  6. 6.
    Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG (2014) A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results. Bone Jt J 96-B(7):907–913CrossRefGoogle Scholar
  7. 7.
    Fregly BJ, Rahman HA, Banks SA (2005) Theoretical accuracy of model-based shape matching for measuring natural knee kinematics with single-plane fluoroscopy. J Biomech Eng 127(4):692–699CrossRefGoogle Scholar
  8. 8.
    Grieco TF, Sharma A, Komistek RD, Cates HE (2016) Single versus multiple-radii cruciate-retaining total knee arthroplasty: an in vivo mobile fluoroscopy study. J Arthroplast 31(3):694–701CrossRefGoogle Scholar
  9. 9.
    Harman MK, Banks SA, Hodge WA (2001) Polyethylene damage and knee kinematics after total knee arthroplasty. Clin Orthop Relat Res 393:383–393CrossRefGoogle Scholar
  10. 10.
    Hess S, Moser LB, Amsler F, Behrend H, Hirschmann MT (2019) Highly variable coronal tibial and femoral alignment in osteoarthritic knees: a systematic review. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-00019-05506-00162 Google Scholar
  11. 11.
    Hirschmann MT, Moser LB, Amsler F, Behrend H, Leclerq V, Hess S (2019) Functional knee phenotypes: a novel classification for phenotyping the coronal lower limb alignment based on the native alignment in young non-osteoarthritic patients. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-00019-05509-z Google Scholar
  12. 12.
    Howell SM, Hodapp EE, Vernace JV, Hull ML, Meade TD (2013) Are undesirable contact kinematics minimized after kinematically aligned total knee arthroplasty? An intersurgeon analysis of consecutive patients. Knee Surg Sports Traumatol Arthrosc 21(10):2281–2287CrossRefGoogle Scholar
  13. 13.
    Howell SM, Papadopoulos S, Kuznik KT, Hull ML (2013) Accurate alignment and high function after kinematically aligned TKA performed with generic instruments. Knee Surg Sports Traumatol Arthrosc 21(10):2271–2280CrossRefGoogle Scholar
  14. 14.
    Howell SM, Shelton TJ, Hull ML (2018) Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplast.  https://doi.org/10.1016/j.arth.2018.07.020 Google Scholar
  15. 15.
    Indrayan A (2013) Methods of clinical epidemiology. Springer series on epidemiology and public health, Chap 2. Springer, Berlin.  https://doi.org/10.1007/978-3-642-37131-8_2 Google Scholar
  16. 16.
    Li C, Hosseini A, Tsai TY, Kwon YM, Li G (2015) Articular contact kinematics of the knee before and after a cruciate retaining total knee arthroplasty. J Orthop Res 33(3):349–358CrossRefGoogle Scholar
  17. 17.
    Mahfouz MR, Hoff WA, Komistek RD, Dennis DA (2003) A robust method for registration of three-dimensional knee implant models to two-dimensional fluoroscopy images. IEEE Trans Med Imaging 22(12):1561–1574CrossRefGoogle Scholar
  18. 18.
    Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R (2017) Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Jt J 99-B(5):640–646CrossRefGoogle Scholar
  19. 19.
    Moglo KE, Shirazi-Adl A (2005) Cruciate coupling and screw-home mechanism in passive knee joint during extension–flexion. J Biomech 38(5):1075–1083CrossRefGoogle Scholar
  20. 20.
    Moro-oka TA, Hamai S, Miura H, Shimoto T, Higaki H, Fregly BJ, Iwamoto Y, Banks SA (2008) Dynamic activity dependence of in vivo normal knee kinematics. J Orthop Res 26(4):428–434CrossRefGoogle Scholar
  21. 21.
    Moro-oka T, Hamai S, Miura H, Shimoto T, Higaki H, Fregly BJ, Iwamoto Y, Banks SA (2007) Can magnetic resonance imaging–derived bone models be used for accurate motion measurement with single-plane three-dimensional shape registration? J Orthop Res 25(7):867–872CrossRefGoogle Scholar
  22. 22.
    Moser LB, Hess S, Amsler F, Behrend H, Hirschmann MT (2019) Native non-osteoarthritic knees have a highly variable coronal alignment: a systematic review. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-00019-05417-00162 Google Scholar
  23. 23.
    Nedopil AJ, Howell SM, Hull ML (2016) Does malrotation of the tibial and femoral components compromise function in kinematically aligned total knee arthroplasty? Orthop Clin N Am 47(1):41–50CrossRefGoogle Scholar
  24. 24.
    Nedopil AJ, Singh AK, Howell SM, Hull ML (2018) Does calipered kinematically aligned TKA restore native left to right symmetry of the lower limb and improve function? J Arthroplast 33(2):398–406CrossRefGoogle Scholar
  25. 25.
    Okamoto N, Breslauer L, Hedley AK, Mizuta H, Banks SA (2011) In vivo knee kinematics in patients with bilateral total knee arthroplasty of 2 designs. J Arthroplast 26(6):914–918CrossRefGoogle Scholar
  26. 26.
    Paschos NK, Howell SM, Johnson JM, Mahfouz MR (2017) Can kinematic tibial templates assist the surgeon locating the flexion and extension plane of the knee? Knee 24(5):1006–1015CrossRefGoogle Scholar
  27. 27.
    Prins AH, Kaptein BL, Stoel BC, Reiber JHC, Valstar ER (2010) Detecting femur–insert collisions to improve precision of fluoroscopic knee arthroplasty analysis. J Biomech 43(4):694–700CrossRefGoogle Scholar
  28. 28.
    Rathnayaka K, Momot KI, Noser H, Volp A, Schuetz MA, Sahama T, Schmutz B (2012) Quantification of the accuracy of MRI generated 3D models of long bones compared to CT generated 3D models. Med Eng Phys 34(3):357–363CrossRefGoogle Scholar
  29. 29.
    Ross DS, Howell SM, Hull ML (2017) Errors in calculating anterior–posterior tibial contact locations in total knee arthroplasty using three-dimensional model to two-dimensional image registration in radiographs: an in vitro study of two methods. J Biomech Eng 139(12):121003.121001–121003.121010CrossRefGoogle Scholar
  30. 30.
    Roth JD, Howell SM, Hull ML (2015) Native knee laxities at 0, 45, and 90 of flexion and their relationship to the goal of the gap-balancing alignment method of total knee arthroplasty. J Bone Jt Surg 97-A(20):1678–1684CrossRefGoogle Scholar
  31. 31.
    Roth JD, Howell SM, Hull ML (2018) Kinematically aligned total knee arthroplasty limits high tibial forces, differences in tibial forces between compartments, and abnormal tibial contact kinematics during passive flexion. Knee Surg Sports Traumatol Arthrosc 26(6):1589–1601CrossRefGoogle Scholar
  32. 32.
    Roth JD, Howell SM, Hull ML (2019) Analysis of differences in laxities and neutral positions from native after kinematically aligned TKA using cruciate retaining implants. J Orthop Res 37(2):358–369CrossRefGoogle Scholar
  33. 33.
    Victor J, Banks S, Bellemans J (2005) Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomized outcome study. J Bone Jt Surg 87-B(5):646–655CrossRefGoogle Scholar
  34. 34.
    Watanabe T, Ishizuki M, Muneta T, Banks SA (2013) Knee kinematics in anterior cruciate ligament-substituting arthroplasty with or without the posterior cruciate ligament. J Arthroplast 28(4):548–552CrossRefGoogle Scholar
  35. 35.
    Yamaguchi S, Gamada K, Sasho T, Kato H, Sonoda M, Banks SA (2009) In vivo kinematics of anterior cruciate ligament deficient knees during pivot and squat activities. Clin Biomech 24(1):71–76CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Biomedical EngineeringUniversity of California DavisDavisUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of California Davis Medical CenterSacramentoUSA
  3. 3.Department of Mechanical EngineeringUniversity of California DavisDavisUSA

Personalised recommendations