In vivo kinematics of gait in posterior-stabilized and bicruciate-stabilized total knee arthroplasties using image-matching techniques
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This study aimed to evaluate the effects of two types of total knee arthroplasty (TKA) designs: posterior-stabilized (PS) and bicruciate-stabilized (BCS) on in vivo kinematics during gait.
Continuous X-ray images of the gait were taken using a flat panel detector for 23 PS and BCS TKAs. We analyzed the tibiofemoral implant flexion angle, anteroposterior (AP) translation, axial rotation, and anterior/posterior cam-post contact using image-matching techniques.
Double knee actions were demonstrated for the PS and BCS design (35 and 61%, respectively, p = 0.08). The tibiofemoral AP positions were significantly more posterior at peak extension (− 1.7 ± 2.2 and 1.0 ± 2.5 mm, respectively, p < 0.01) and anterior at peak flexion (1.3 ± 2.3 and − 0.8 ± 2.8 mm, respectively, p = 0.01) for the PS design than for the BCS design, with a significant difference in AP translation (3.0 ± 3.9 mm anterior and 1.7 ± 2.8 mm posterior, respectively, p < 0.01). Anterior/posterior tibial post contacts were found in 83/4% and 74/30% for the PS and BCS designs, respectively, with a significant difference in posterior contact (p = 0.72/0.04, respectively).
The knee flexion pattern, tibiofemoral AP translation, axial rotation, and cam-post contact during gait varied, depending on the type of implant, the PS and BCS designs.
KeywordsTotal knee arthroplasty Posterior-stabilized design Bicruciate-stabilized design Gait Image-matching technique Kinematics
This work was supported by a grant from the Kaibara Morikazu Medical Science Promotion Foundation. The authors thank Junji Kishimoto, a statistician from the Digital Medicine Initiative at Kyushu University, for his valuable comments and suggestions regarding the statistical analyses.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study protocol was approved by Institutional Review Board of Kyushu University (IRB number 24-166). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Weiss JM, Noble PC, Conditt MA, Kohl HW (2002) What functional activities are important to patients with knee replacements? Clin Orthop Relat Res 404:172–188. https://doi.org/10.1097/01.blo.0000036536.46246.d9. CrossRefGoogle Scholar
- 13.Steinbrück A, Schröder C, Woiczinski M, Fottner A, Pinskerova V, Müller PE et al (2016) Femorotibial kinematics and load patterns after total knee arthroplasty: an in vitro comparison of posterior-stabilized versus medial-stabilized design. Clin Biomech (Bristol, Avon) 33:42–48. https://doi.org/10.1016/j.clinbiomech.2016.02.002 CrossRefGoogle Scholar
- 14.Hamai S, Okazaki K, Shimoto T, Nakahara H, Higaki H, Iwamoto Y (2015) Continuous sagittal radiological evaluation of stair-climbing in cruciate-retaining and posterior-stabilized total knee arthroplasties using image-matching techniques. J Arthroplast 30:864–869. https://doi.org/10.1016/j.arth.2014.12.027 CrossRefGoogle Scholar
- 16.Belvedere C, Leardini A, Catani F, Pianigiani S, Innocenti B (2016) In vivo kinematics of knee replacement during daily living activities: condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses. J Orthop Res:1–8. https://doi.org/10.1002/jor.23405. CrossRefGoogle Scholar
- 18.Kuwashima U, Hamai S, Okazaki K, Ikebe S, Higaki H, Mizu-uchi H et al (2016) Contact stress analysis of the anterior tibial post in bi-cruciate stabilized and mobile-bearing posterior stabilized total knee arthroplasty designs. J Mech Behav Biomed Mater 60:460–467. https://doi.org/10.1016/j.jmbbm.2016.03.003 CrossRefPubMedGoogle Scholar
- 19.Kawahara S, Matsuda S, Okazaki K, Tashiro Y, Mitsuyasu H, Nakahara H et al (2012) Relationship between the tibial anteroposterior axis and the surgical epicondylar axis in varus and valgus knees. Knee Surg Sports Traumatol Arthrosc 20:2077–2081. https://doi.org/10.1007/s00167-011-1826-0 CrossRefPubMedGoogle Scholar
- 23.Murakami K, Hamai S, Okazaki K, Ikebe S, Nakahara H, Higaki H et al (2017) Kinematic analysis of stair climbing in rotating platform cruciate-retaining and posterior-stabilized mobile-bearing total knee arthroplasties. Arch Orthop Trauma Surg 137:701–711. https://doi.org/10.1007/s00402-017-2662-6 CrossRefPubMedGoogle Scholar
- 29.Koh YG, Son J, Kwon SK, Kim HJ, Kwon OR, Kang KT (2017) Preservation of kinematics with posterior cruciate-, bicruciate- and patient-specific bicruciate-retaining prostheses in total knee arthroplasty by using computational simulation with normal knee model. Bone Joint Res 6:557–565. https://doi.org/10.1302/2046-3758.69.BJR-2016-0250.R1 CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Okamoto S, Mizu-uchi H, Okazaki K, Hamai S, Nakahara H, Iwamoto Y (2015) Effect of tibial posterior slope on knee kinematics, quadriceps force, and patellofemoral contact force after posterior-stabilized total knee arthroplasty. J Arthroplast 30:1439–1343. https://doi.org/10.1016/j.arth.2015.02.042 CrossRefGoogle Scholar