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New design total knee arthroplasty shows medial pivoting movement under weight-bearing conditions

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess, using model-based dynamic radiostereometric analysis (RSA), the biomechanical behaviour of a new design posterior-stabilized (PS) fixed-bearing (FB) total knee arthroplasty (TKA) in vivo while patients performing two common motor tasks. The hypothesis was that model-based dynamic RSA is able to detect different behaviour of the implant under weight-bearing and non-weight-bearing conditions.

Methods

A cohort of 15 non-consecutive patients was evaluated by dynamic RSA 9 months after TKA implantation. The mean age of patients was 73.4 (65–72) years. The kinematic evaluations were performed using an RSA device (BI-STAND DRX 2) developed in our Institute. The patients were asked to perform two active motor tasks: sit-to-stand in weight-bearing condition; range of motion (ROM) while sitting on the chair. The motion parameters were evaluated using the Grood and Suntay decomposition and the low-point kinematics methods.

Results

The dynamic RSA evaluation showed a significant difference (p < 0.05) between the biomechanical behaviour of the prosthesis during the two motor tasks. When subjected to the patient weight (in the sit-to-stand) the low point of the medial compartment had a shorter motion (5.7 ± 0.2 mm) than the lateral (11.0 ± 0.2 mm). This realizes a medial pivot motion as in the normal knee. In the ROM task, where the patient had no weight on the prosthesis, this difference was not present: the medial compartment had a displacement of 12.7 ± 0.2 mm, while the lateral had 17.3 ± 0.2 mm.

Conclusions

Model-based RSA proved to be an effective tool for the evaluation of TKA biomechanics. In particular, it was able to determine that the fixed-bearing posterior-stabilized TKA design evaluated in this study showed a medial pivoting movement under weight-bearing conditions that was not present when load was not applied. Under loading conditions what drives the pattern of movement is the prosthetic design itself. By the systematic use of this study protocol future comparisons among different implants could be performed, thus contributing significantly to the improvement of TKA design.

Level of evidence

IV.

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Abbreviations

PS:

Posterior stabilized

CR:

Cruciate retaining

PCL:

Posterior cruciate ligament

AP:

Antero-posterior

RSA:

Roentgen stereophotogrammetric analysis

FB:

Fixed bearing

TKA:

Total knee arthroplasty

HIPAA:

Health Insurance Portability and Accountability Act

IRB:

Institutional Review Board

VAS:

Visual Analogue Scale

AKSS:

American Knee Society Score

KOOS:

Knee Injury and Osteoarthritis Outcome Score

FU:

Follow-up

AEC:

Automatic exposure control

ROM:

Range of motion

FPS:

Frame per second

MBRSA:

Model-based roentgen stereophotogrammetric analysis

VV:

Varus–valgus

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Acknowledgements

We acknowledge all the other people involved in this study: radiology technicians, undergraduates, trainees. Their help has been and continue to be of great importance during radiological follow-up and elaboration of RSA images. In alphabetical order: Stefano Durante, Claudia Lopes, Valentina Matti, Rosanna Presicci, Stefania Stramenga, etc.

Funding

The study was partially funded with a grant from the company De Puy Synthes, Johnson & Johnson, Raynham, MA, USA.

Author information

Authors and Affiliations

  1. II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Lab. di Biomeccanica via di Barbiano 1/10, 40136, Bologna, Italy

    Giulio Maria Marcheggiani Muccioli, Tommaso Roberti di Sarsina, Domenico Alesi, Maria Pia Neri & Stefano Zaffagnini

  2. University of Bologna, Bologna, Italy

    Laura Bragonzoni, Giulio Maria Marcheggiani Muccioli, Marco Bontempi & Umberto Cardinale

  3. Prosthetic Surgery and Articular Biological Reconstruction, Humanitas Clinical Institute, Milan, Italy

    Francesco Iacono

Authors
  1. Laura Bragonzoni
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  2. Giulio Maria Marcheggiani Muccioli
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  3. Marco Bontempi
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  4. Tommaso Roberti di Sarsina
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  5. Umberto Cardinale
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  6. Domenico Alesi
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  7. Francesco Iacono
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  8. Maria Pia Neri
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  9. Stefano Zaffagnini
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Contributions

All authors are involved in scientific development of dynamic RSA. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Giulio Maria Marcheggiani Muccioli.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study obtained the approval from Institutional Review Board (IRB) of Rizzoli Orthopedic Institute (ID: 0035595 October 22, 2015—Clinical Trial Gov ID: NCT02323386).

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Bragonzoni, L., Marcheggiani Muccioli, G., Bontempi, M. et al. New design total knee arthroplasty shows medial pivoting movement under weight-bearing conditions. Knee Surg Sports Traumatol Arthrosc 27, 1049–1056 (2019). https://doi.org/10.1007/s00167-018-5243-5

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  • DOI: https://doi.org/10.1007/s00167-018-5243-5

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