A relationship between gait and clinical changes following high tibial osteotomy.

Prodromos, Chadwick C.; Andriacchi, T.P.; Jo, Galante

doi:10.2106/00004623-198567080-00007

Cited by 390 publications

(269 citation statements)

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“…While mechanical alignment is important, there are multiple surgically controllable variables involved in producing a successful TKA, including coronal, transverse, and sagittal plane soft tissue stability [1,4,6,17,21]. Also, in some varus knees, there are individuals who have a large adductor moment, which predicts failures in patients receiving high tibial osteotomy [16], but there is no similar study showing where muscle forces are mapped out that predicts a higher failure rate in TKA. However, there may be patients with strong tensor fascia latae muscles that can counter medial compartment forces in a varus knee after TKA surgery.…”

Section: Discussionmentioning

confidence: 99%

How Does TKA Kinematics Vary With Transverse Plane Alignment Changes in a Contemporary Implant?

Mihalko

Conner

Benner

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Assessment of patient function after TKA often focuses on implant alignment and daily activity capabilities, but the functional results and kinematics of the TKA are not easily predicted by some of these parameters during surgery. Questions/purposes We asked whether differences in implant alignment in the transverse plane may affect fluorokinematics and be one of the many variables that help explain the discrepancies in fluorokinematic results. Methods We utilized a computer model (LifeMOD TM / KneeSIM; LifeModeler, Inc, San Clemente, CA, USA) to show variability in polyethylene contact patterns. We imported components of a cruciate-retaining TKA into the model and subjected the systems to a simulated lunge. We modeled five different combinations of implant positioning in the transverse plane of both the femoral and tibial components in internal or external rotation and compared the resulting changes in joint rotations and displacements of these five variations to those for published fluorokinematic observations using the same modeled lunge-type maneuver for five patients. Results We observed variations in AP translation of the lateral and medial femoral condyles resembling several of those in the literature for individual patients with the same cruciate-retaining knee implant. The largest AP translational changes were seen with the tibia internally rotated 5°. Using the five different implant transverse plane alignment scenarios resulted in a coefficient of determination of 0.6 for the linear regression when compared to five subjects from a published fluorokinematic study. Conclusions Variations in implant positioning may be responsible for variations in fluorokinematics reported for individual subjects with the same implant design. Clinical Relevance If validated computer modeling can aid surgeons to predict the effects of individual implant alignment variations in TKA kinematics, a more personalized approach to implant positioning during TKA can be implemented.

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Section: Discussionmentioning

confidence: 99%

How Does TKA Kinematics Vary With Transverse Plane Alignment Changes in a Contemporary Implant?

Mihalko

Conner

Benner

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Several studies have reported the knee adduction moment during walking is associated with the presence [2,42] and rate of progression [36] of medial compartment knee osteoarthritis (OA) and has been used to predict the outcome of treatment interventions for OA [45]. Clinical and analytic studies [1,46] associate external adduction moment with excessive loading of the medial compartment.…”

Section: Orthoticsmentioning

confidence: 99%

The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

D’Lima

Patil

Steklov

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Tibiofemoral forces are important in the design and clinical outcomes of TKA. We developed a tibial tray with force transducers and a telemetry system to directly measure tibiofemoral compressive forces in vivo. Knee forces and kinematics traditionally have been measured under laboratory conditions. Although this approach is useful for quantitative measurements and experimental studies, the extrapolation of results to clinical conditions may not always be valid. Questions/purposes We therefore developed wearable monitoring equipment and computer algorithms for classifying and identifying unsupervised activities outside the laboratory. Methods Tibial forces were measured for activities of daily living, athletic and recreational activities, and with orthotics and braces, during 4 years postoperatively. Additional measurements included video motion analysis, EMG, fluoroscopic kinematic analysis, and ground reaction force measurement. In vivo measurements were used to evaluate computer models of the knee. Finite element models were used for contact analysis and for computing knee kinematics from measured knee forces. A thirdgeneration system was developed for continuous monitoring of knee forces and kinematics outside the laboratory using a wearable data acquisition hardware. Results By using measured knee forces and knee flexion angle, we were able to compute femorotibial AP translation (À12 to +4 mm), mediolateral translation (À1 to 1.5 mm), axial rotation (À3°to 12°), and adduction-abduction (À1°t o +1°). The neural-network-based classification system was able to identify walking, stair-climbing, sit-to-stand, and stand-to-sit activities with 100% accuracy. Conclusions Our data may be used to improve existing in vitro models and wear simulators, and enhance prosthetic designs and biomaterials.

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“…Many factors contribute to the development of knee OA, including heredity, biochemical changes in articular cartilage, and biomechanical compressive loads that lead to joint damage. In people with medial knee OA, compressive loads on the medial tibiofemoral joints are increased in the presence of varus knee alignment and may be manifested as elevated knee adduction moments during walking, both of which have become hallmarks of the disease (3)(4)(5)(6).…”

mentioning

confidence: 99%

Knee stabilization in patients with medial compartment knee osteoarthritis

Lewek¹,

Ramsey²,

Snyder‐Mackler³

et al. 2005

Arthritis & Rheumatism

113

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Objective. Individuals with medial knee osteoarthritis (OA) experience knee laxity and instability. Strategies aimed at muscle stabilization may influence the long-term integrity of the joint. This study sought to determine how individuals with medial knee OA respond to a rapid valgus knee movement, to investigate the relationship between muscle-stabilization strategies and knee instability.Methods. Twenty-one subjects with medial knee OA and genu varum and 19 control subjects were tested. Subjects stood with the test limb on a movable platform, comprising a plate that translated laterally to rapidly stress the knee's medial periarticular structures and create a potentially destabilizing sensation at the knee joint. Knee motion and muscle responses were recorded. Subjects rated the condition of their knee with a selfreport questionnaire about knee instability during daily activities.Results. Prior to plate movement, the OA subjects demonstrated more medial muscle co-contraction than did controls (P‫؍‬ 0.014). Following plate movement, the OA subjects shifted less weight off the test limb (P ‫؍‬ 0.013) and had greater medial co-contraction (P ‫؍‬ 0.037). OA subjects without knee instability had higher co-contraction of the vastus medialis medial hamstrings than did those who reported having instability that affected their daily activities (P ‫؍‬ 0.038). More knee stability correlated positively with higher co-contraction of the vastus medialis medial hamstrings prior to plate movement (r ‫؍‬ 0.459, P ‫؍‬ 0.042).Conclusion. Individuals with medial knee OA attempt to stabilize the knee with greater co-contraction of the medial muscle in response to laxity that appears on the medial side of the joint only. This strategy presumably contributes to higher joint compression and could exacerbate joint destruction, and therefore needs to be altered to slow or stop the progression of the OA disease process.

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A relationship between gait and clinical changes following high tibial osteotomy.

Cited by 390 publications

References 0 publications

How Does TKA Kinematics Vary With Transverse Plane Alignment Changes in a Contemporary Implant?

How Does TKA Kinematics Vary With Transverse Plane Alignment Changes in a Contemporary Implant?

The 2011 ABJS Nicolas Andry Award: ‘Lab’-in-a-Knee: In Vivo Knee Forces, Kinematics, and Contact Analysis

Knee stabilization in patients with medial compartment knee osteoarthritis

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