Retention of Posterior Cruciate Ligament Alone May Not Achieve Physiological Knee Joint Kinematics After Total Knee Arthroplasty: A Retrospective Study.
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee
/ adverse effects
Biomechanical Phenomena
Female
Humans
Knee Injuries
/ physiopathology
Knee Joint
/ physiopathology
Knee Prosthesis
/ adverse effects
Male
Middle Aged
Osteoarthritis, Knee
/ physiopathology
Posterior Cruciate Ligament
/ surgery
Randomized Controlled Trials as Topic
Retrospective Studies
Journal
The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
Titre abrégé: J Bone Joint Surg Am
Pays: United States
ID NLM: 0014030
Informations de publication
Date de publication:
20 Jan 2021
20 Jan 2021
Historique:
pubmed:
17
10
2020
medline:
11
5
2021
entrez:
16
10
2020
Statut:
ppublish
Résumé
The apparently physiological kinematics of the bicruciate-stabilized total knee arthroplasty (BCS TKA) systems have been attributed to the anterior and posterior post-cam mechanism. Although comparisons between TKA designs with either a retained or a sacrificed cruciate ligament have been conducted, we are not aware of any analyses of 2 implants with identical bearing geometry but different cruciate-ligament strategies under equal loading conditions. Knowledge about the kinematic effect of the different cruciate ligament strategies would potentially be valuable to facilitate preoperative planning and decision-making with regard to selecting the most appropriate implant for a patient. This retrospective study included 20 patients: 10 treated with a BCS and 10 treated with a cruciate retaining (CR) TKA. Fluoroscopic analyses during high-flexion activities (unloaded flexion-extension and loaded lunge) were conducted at 24 months postsurgery. All patients completed the Knee Society Score, Forgotten Joint Score, and High-Flexion Knee Score questionnaires preoperatively and postoperatively. The BCS cohort showed greater femoral lateral rollback as well as a medial pivot in both activities. In contrast, the CR cohort showed a significant increase in anterior translation on the medial compartment as well as almost absent femoral lateral rollback. Higher clinical scores were observed in the BCS cohort. At 24 months postsurgery, despite equal bearing geometry, retention of the posterior cruciate ligament in the CR cohort apparently was insufficient to reduce anterior shift. The BCS cohort showed expected knee joint kinematics; however, the kinematics in this cohort could eventually benefit from a smooth transition between the interchanging surfaces. Further investigation should be focused on the surgical technique and its interaction with the TKA design. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Sections du résumé
BACKGROUND
BACKGROUND
The apparently physiological kinematics of the bicruciate-stabilized total knee arthroplasty (BCS TKA) systems have been attributed to the anterior and posterior post-cam mechanism. Although comparisons between TKA designs with either a retained or a sacrificed cruciate ligament have been conducted, we are not aware of any analyses of 2 implants with identical bearing geometry but different cruciate-ligament strategies under equal loading conditions. Knowledge about the kinematic effect of the different cruciate ligament strategies would potentially be valuable to facilitate preoperative planning and decision-making with regard to selecting the most appropriate implant for a patient.
METHODS
METHODS
This retrospective study included 20 patients: 10 treated with a BCS and 10 treated with a cruciate retaining (CR) TKA. Fluoroscopic analyses during high-flexion activities (unloaded flexion-extension and loaded lunge) were conducted at 24 months postsurgery. All patients completed the Knee Society Score, Forgotten Joint Score, and High-Flexion Knee Score questionnaires preoperatively and postoperatively.
RESULTS
RESULTS
The BCS cohort showed greater femoral lateral rollback as well as a medial pivot in both activities. In contrast, the CR cohort showed a significant increase in anterior translation on the medial compartment as well as almost absent femoral lateral rollback. Higher clinical scores were observed in the BCS cohort.
CONCLUSIONS
CONCLUSIONS
At 24 months postsurgery, despite equal bearing geometry, retention of the posterior cruciate ligament in the CR cohort apparently was insufficient to reduce anterior shift. The BCS cohort showed expected knee joint kinematics; however, the kinematics in this cohort could eventually benefit from a smooth transition between the interchanging surfaces. Further investigation should be focused on the surgical technique and its interaction with the TKA design.
LEVEL OF EVIDENCE
METHODS
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Identifiants
pubmed: 33060427
pii: 00004623-202101200-00007
doi: 10.2106/JBJS.20.00024
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
146-154Informations de copyright
Copyright © 2020 by The Journal of Bone and Joint Surgery, Incorporated.
Déclaration de conflit d'intérêts
Disclosure: This work was supported by Smith & Nephew GmbH (the manufacturer of the implants and employer of one of the authors), EFRE (16409608, OrthoLoadLab), the German Research Foundation (DFG) (TR 1657/1-1), the Bundesministerium für Bildung und Forschung (BMBF), and theOrthoLoadClub. The funding sources played no role in the investigation. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (including relationships with Smith & Nephew GmbH) (http://links.lww.com/JBJS/G161).
Références
Bonnin MP, Basiglini L, Archbold HA. What are the factors of residual pain after uncomplicated TKA? Knee Surg Sports Traumatol Arthrosc. 2011 Sep;19(9):1411-7. Epub 2011 May 20.
Maratt JD, Lee YY, Lyman S, Westrich GH. Predictors of satisfaction following total knee arthroplasty. J Arthroplasty. 2015 Jul;30(7):1142-5. Epub 2015 Jan 30.
Noble PC, Fuller-Lafreniere S, Meftah M, Dwyer MK. Challenges in outcome measurement: discrepancies between patient and provider definitions of success. Clin Orthop Relat Res. 2013 Nov;471(11):3437-45.
Moewis P, Hommel H, Trepczynski A, Krahl L, von Roth P, Duda GN. Weight bearing activities change the pivot position after total knee arthroplasty. Sci Rep. 2019 Jun 24;9(1):9148.
Komistek RD, Scott RD, Dennis DA, Yasgur D, Anderson DT, Hajner ME. In vivo comparison of femorotibial contact positions for press-fit posterior stabilized and posterior cruciate-retaining total knee arthroplasties. J Arthroplasty. 2002 Feb;17(2):209-16.
Saffarini M, Demey G, Nover L, Dejour D. Evolution of trochlear compartment geometry in total knee arthroplasty. Ann Transl Med. 2016 Jan;4(1):7.
Pinskerova V, Samuelson KM, Stammers J, Maruthainar K, Sosna A, Freeman MA. The knee in full flexion: an anatomical study. J Bone Joint Surg Br. 2009 Jun;91(6):830-4.
Bailey O, Ferguson K, Crawfurd E, James P, May PA, Brown S, Blyth M, Leach WJ. No clinical difference between fixed- and mobile-bearing cruciate-retaining total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc. 2015 Jun;23(6):1653-9. Epub 2014 Feb 9.
Jiang C, Liu Z, Wang Y, Bian Y, Feng B, Weng X. Posterior cruciate ligament retention versus posterior stabilization for total knee arthroplasty: a meta-analysis. PLoS One. 2016 Jan 29;11(1):e0147865.
Moskal JT, Capps SG. Rotating-platform TKA no different from fixed-bearing TKA regarding survivorship or performance: a meta-analysis. Clin Orthop Relat Res. 2014 Jul;472(7):2185-93. Epub 2014 Mar 4.
Zingde SM, Slamin J. Biomechanics of the knee joint, as they relate to arthroplasty. Orthop Trauma. 2017 Feb;31(1):1-7.
Pfitzner T, Moewis P, Stein P, Boeth H, Trepczynski A, von Roth P, Duda GN. Modifications of femoral component design in multi-radius total knee arthroplasty lead to higher lateral posterior femoro-tibial translation. Knee Surg Sports Traumatol Arthrosc. 2018 Jun;26(6):1645-55. Epub 2017 Jun 27.
Banks SA, Harman MK, Bellemans J, Hodge WA. Making sense of knee arthroplasty kinematics: news you can use. J Bone Joint Surg Am. 2003;85-A(Suppl 4):64-72.
Hamai S, Miura H, Higaki H, Shimoto T, Matsuda S, Iwamoto Y. Evaluation of impingement of the anterior tibial post during gait in a posteriorly-stabilised total knee replacement. J Bone Joint Surg Br. 2008 Sep;90(9):1180-5.
Hanson GR, Suggs JF, Kwon YM, Freiberg AA, Li G. In vivo anterior tibial post contact after posterior stabilizing total knee arthroplasty. J Orthop Res. 2007 Nov;25(11):1447-53.
Li G, Papannagari R, Most E, Park SE, Johnson T, Tanamal L, Rubash HE. Anterior tibial post impingement in a posterior stabilized total knee arthroplasty. J Orthop Res. 2005 May;23(3):536-41.
Murakami K, Hamai S, Okazaki K, Wang Y, Ikebe S, Higaki H, Shimoto T, Mizu-Uchi H, Akasaki Y, Nakashima Y. In vivo kinematics of gait in posterior-stabilized and bicruciate-stabilized total knee arthroplasties using image-matching techniques. Int Orthop. 2018 Nov;42(11):2573-81. Epub 2018 Apr 5.
Hamai S, Okazaki K, Shimoto T, Nakahara H, Higaki H, Iwamoto Y. Continuous sagittal radiological evaluation of stair-climbing in cruciate-retaining and posterior-stabilized total knee arthroplasties using image-matching techniques. J Arthroplasty. 2015 May;30(5):864-9. Epub 2015 Jan 10.
Banks SA, Hodge WA. Implant design affects knee arthroplasty kinematics during stair-stepping. Clin Orthop Relat Res. 2004 Sep;426:187-93.
Banks SA, Hodge WA. 2003 Hap Paul Award Paper of the International Society for Technology in Arthroplasty. Design and activity dependence of kinematics in fixed and mobile-bearing knee arthroplasties. J Arthroplasty. 2004 Oct;19(7):809-16.
Harman MK, Bonin SJ, Leslie CJ, Banks SA, Hodge WA. Total knee arthroplasty designed to accommodate the presence or absence of the posterior cruciate ligament. Adv Orthop. 2014;2014:178156. Epub 2014 Oct 8.
Arbuthnot JE, Brink RB. Assessment of the antero-posterior and rotational stability of the anterior cruciate ligament analogue in a guided motion bi-cruciate stabilized total knee arthroplasty. J Med Eng Technol. 2009;33(8):610-5.
Kono K, Inui H, Tomita T, Yamazaki T, Taketomi S, Sugamoto K, Tanaka S. Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities. Knee Surg Sports Traumatol Arthrosc. 2019 Jul;27(7):2096-103. Epub 2019 Apr 10.
Victor J, Bellemans J. Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop Relat Res. 2006 Nov;452:53-8.
Grieco TF, Sharma A, Dessinger GM, Cates HE, Komistek RD. In vivo kinematic comparison of a bicruciate stabilized total knee arthroplasty and the normal knee using fluoroscopy. J Arthroplasty. 2018 Feb;33(2):565-71. Epub 2017 Sep 25.
Iriuchishima T, Ryu K. A comparison of rollback ratio between bicruciate substituting total knee arthroplasty and Oxford unicompartmental knee arthroplasty. J Knee Surg. 2018 Jul;31(6):568-72. Epub 2017 Jul 25.
Iriuchishima T, Ryu K. Bicruciate substituting total knee arthroplasty improves stair climbing ability when compared with cruciate-retain or posterior stabilizing total knee arthroplasty. Indian J Orthop. 2019 Sep-Oct;53(5):641-5.
Staats K, Wannmacher T, Weihs V, Koller U, Kubista B, Windhager R. Modern cemented total knee arthroplasty design shows a higher incidence of radiolucent lines compared to its predecessor. Knee Surg Sports Traumatol Arthrosc. 2019 Apr;27(4):1148-55. Epub 2018 Sep 22.
Hommel H, Abdel MP, Perka C. Kinematic femoral alignment with gap balancing and patient-specific instrumentation in total knee arthroplasty: a randomized clinical trial. Eur J Orthop Surg Traumatol. 2017 Jul;27(5):683-8. Epub 2016 Oct 6.
Hube R, Mayr HO, Kalteis T, Matziolis G. [Extension first technique for TKA implantation]. Oper Orthop Traumatol. 2011 Jul;23(3):241-8. German.
Hommel H, Perka C. Gap-balancing technique combined with patient-specific instrumentation in TKA. Arch Orthop Trauma Surg. 2015 Nov;135(11):1603-8. Epub 2015 Aug 28.
Hommel H, Perka C, Pfitzner T. Preliminary results of a new surgical technique in total knee arthroplasty (TKA) using the native ligament tension for femoral implant positioning in varus osteoarthritis. Arch Orthop Trauma Surg. 2016 Jul;136(7):991-7. Epub 2016 Jun 6.
Garling EH, Kaptein BL, Geleijns K, Nelissen RG, Valstar ER. Marker configuration model-based roentgen fluoroscopic analysis. J Biomech. 2005 Apr;38(4):893-901.
Ewald FC. The Knee Society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989 Nov;248:9-12.
Behrend H, Giesinger K, Giesinger JM, Kuster MS. The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty. 2012 Mar;27(3):430-436.e1. Epub 2011 Oct 13.
Na SE, Ha CW, Lee CH. A new high-flexion knee scoring system to eliminate the ceiling effect. Clin Orthop Relat Res. 2012 Feb;470(2):584-93. Epub 2011 Nov 29.
Moewis P, Wolterbeek N, Diederichs G, Valstar E, Heller MO, Taylor WR. The quality of bone surfaces may govern the use of model based fluoroscopy in the determination of joint laxity. Med Eng Phys. 2012 Dec;34(10):1427-32. Epub 2012 Feb 16.
Rachmat HH, Janssen D, Verkerke GJ, Diercks RL, Verdonschot N. In-situ mechanical behavior and slackness of the anterior cruciate ligament at multiple knee flexion angles. Med Eng Phys. 2016 Mar;38(3):209-15. Epub 2015 Dec 22.