Clinical biomechanics of instability related to total knee arthroplasty

Athwal, Kiron K.; Hunt, Nicola; Davies, Andrew; Deehan, David J.; Amis, Andrew A.

doi:10.1016/j.clinbiomech.2013.11.004

Cited by 63 publications

(57 citation statements)

References 88 publications

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“…Knowledge of the complex kinematics of the native knee is a prerequisite for a successful reconstructive procedure, because preservation of the native knee kinematics is likely to result in superior clinical outcomes [1][2][3][4][5]. The behavior of the knee in the coronal plane has recently become of particular interest, as several authors have shown that failure to restore proper coronal plane knee kinematics during reconstructive knee surgery may result in specific patterns of medial-lateral knee instability, especially in the range of mid-flexion (30 to 45°) [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Primary and coupled motions of the native knee in response to applied varus and valgus load

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Primary and coupled motions of the native knee in response to applied varus and valgus load

et al. 2016

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“…For knee arthroplasty patients, the MCL may play an even more crucial role, as other stabilizing ligaments are often sacrificed during surgery (e.g. the anterior cruciate ligament) [5], and maintaining a stable knee can be critical to implant success [6–10] and patient satisfaction [11]. The MCL is also frequently injured as it is involved in 42% of all ligamentous injuries in the knee [12].…”

Section: Introductionmentioning

confidence: 99%

The measurement of medial knee gap width using ultrasound

Slane

Scheys³

2017

Arch Orthop Trauma Surg

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Introduction Medial knee instability is a key clinical parameter for assessing ligament injury and arthroplasty success, but current methods for measuring stability are typically either qualitative or involve ionizing radiation. The purpose of this study was to perform a preliminary analysis of whether ultrasound (US) could be used as an alternate approach for quantifying medial instability by comparing an US method with an approach mimicking the current gold standard fluoroscopy method. Materials and Methods US data from the medial knee were collected while cadaveric lower limbs (n=8) were loaded in valgus (10 Nm). During post-processing, the US gap width was measured by identifying the medial edges of the femur and tibia and computing the gap width between these points. For comparison, mimicked fluoroscopy (mFluoro) images were created from specimen-specific bone models, developed from segmented CT scans, and from kinematic data collected during testing. Then, gap width was measured in the mFluoro images based on two different published approaches, with gap width measured either at the most medial or most distal aspect of the femur. Results Gap width increased significantly with loading (p<0.001), and there were no significant differences between the US method (unloaded: 8.7±2.4 mm, loaded: 10.7±2.2 mm) and the mFluoro method that measured gap width at the medial femur. In terms of the change in gap width with load, no correlation with the change in abduction angle was observed, with no correlation between the various methods. Inter-rater reliability for the US method was high (0.899–0.952). Conclusions Ultrasound shows promise as a suitable alternative for quantifying medial instability without radiation exposure. However, the outstanding limitations of existing approaches and lack of true ground-truth data require that further validation work is necessary to better understand the clinical viability of an US approach for measuring medial knee gap width.

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“…The PCL is in cruciate retaining knee arthroplasty systems one main factor to control anterior-posterior translation [2-4] and is also responsible for the amount of joint compression [5]. However, to quantify the amount of ligament release and its effect on load bearing and kinematics in TKA is complex and limited both in vivo and in vitro .…”

Section: Introductionmentioning

confidence: 99%

Posterior cruciate ligament balancing in total knee arthroplasty: a numerical study with a dynamic force controlled knee model

Steinbrück¹,

Woiczinski²,

Weber³

et al. 2014

BioMed Eng OnLine

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BackgroundAdequate soft tissue balancing is a key factor for a successful result after total knee arthroplasty (TKA). Posterior cruciate ligament (PCL) is the primary restraint to posterior translation of the tibia after cruciate retaining TKA and is also responsible for the amount of joint compression. However, it is complex to quantify the amount of ligament release with its effects on load bearing and kinematics in TKA and limited both in vivo and in vitro. The goal of this study was to create a dynamic and deformable finite element model of a full leg and analyze a stepwise release of the PCL regarding knee kinematics, pressure distribution and ligament stresses.MethodsA dynamic finite element model was developed in Ansys V14.0 based on boundary conditions of an existing knee rig. A cruciate retraining knee prosthesis was virtually implanted. Ligament and muscle structures were simulated with modified spring elements. Linear elastic materials were defined for femoral component, inlay and patella cartilage. A restart algorithm was developed and implemented into the finite element simulation to hold the ground reaction force constant by adapting quadriceps force. After simulating the unreleased PCL model, two models were developed and calculated with the same boundary conditions with a 50% and 75% release of the PCL stiffness.ResultsFrom the beginning of the simulation to approximately 35° of flexion, tibia moves posterior related to the femur and with higher flexion anteriorly. Anterior translation of the tibia ranged from 5.8 mm for unreleased PCL to 3.7 mm for 75% PCL release (4.9 mm 50% release).A decrease of maximum von Mises equivalent stress on the inlay was given with PCL release, especially in higher flexion angles from 11.1 MPa for unreleased PCL to 8.9 MPa for 50% release of the PCL and 7.8 MPa for 75% release.ConclusionsOur study showed that dynamic FEM is an effective method for simulation of PCL balancing in knee arthroplasty. A tight PCL led in silico to more anterior tibia translation, a higher collateral ligament and inlay stress, while retropatellar pressure remained unchanged. Surgeons may take these results in vivo into account.

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Clinical biomechanics of instability related to total knee arthroplasty

Cited by 63 publications

References 88 publications

Primary and coupled motions of the native knee in response to applied varus and valgus load

Primary and coupled motions of the native knee in response to applied varus and valgus load

The measurement of medial knee gap width using ultrasound

Posterior cruciate ligament balancing in total knee arthroplasty: a numerical study with a dynamic force controlled knee model

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