Kinematic evaluation of cruciate-retaining total knee replacement patients during level walking: A comparison with the displacement-controlled ISO standard

Abstract

Differences between wear-scar features of simulator-tested and retrieved tibial total knee replacement (TKR) liners have been reported. This disagreement may result from differences between in vivo kinematic profiles and those defined by the International Organization for Standardization (ISO). The purpose of this study was to determine the knee kinematics of a TKR subject group during level walking and compare them with the motion profiles defined by the ISO standard for a displacementcontrolled knee wear testing simulator. Twenty-nine patients with a posterior cruciate ligamentretaining TKR design were gait tested using the point cluster technique to obtain flexion-extension (FE) rotation, anterior-posterior (AP) translation and internal-external (IE) rotation knee motions during a complete cycle of level walking. Relative ranges of motion and timing of key points within the in vivo motion data were compared against the same ranges and same key points from the input profiles of the displacement-controlled wear testing standard ISO14243-3. The subjects exhibited a FE pattern similar to ISO, with an insignificant difference in range of FE rotation from midstance to terminal stance. However, the subjects had a significantly higher range of knee flexion from terminal stance into swing. The subjects also exhibited a phase delay for the entire gait cycle. For AP translation, the standard profile had statistically significant lower magnitudes than seen in vivo. Opposite pattern of AP motion was also apparent from midstance and swing. Similarly, ISO specified a smaller IE total range of rotation with a motion pattern in complete opposition to that seen in vivo. In conclusion, significant differences were found in both the magnitudes and pattern of in vivo motion compared with ISO.

Measurement of in vivo anterior cruciate ligament strain during dynamic jump landing

“…1). The primary goal of this complex marker set was to over-constrain each anatomical segment (thigh, shank) so that the effects of skin motion could be minimized via numerical optimization, as demonstrated by previous investigators (Andriacchi et al, 1998; Alexander and Andriacchi, 2001; Ngai et al, 2009; Ngai and Wimmer, 2009). …”

“…In this fashion, marker sets which deviated the least from rigid body motion were chosen to optimize the motion of the underlying bony structures. Other investigators have demonstrated that over-constrained marker sets and optimization techniques, such as the point cluster technique (Andriacchi et al, 1998; Alexander and Andriacchi, 2001; Ngai et al, 2009; Ngai and Wimmer, 2009), can be used to minimize error associated with the soft tissue motion.…”

Osteolysis around total knee arthroplasty: A review of pathogenetic mechanisms

“…More representative wear scars have been obtained during in vitro testing, when other activities of daily living were included and generated wear rates were higher [127]. Gait kinematics has shown to be variable among patients, even for the same knee implant design [128, 129]. It is likely that this has effects on polyethylene wear and implant longevity.…”

Comparison of ISO Standard and TKR patient axial force profiles during the stance phase of gait

“…Thus, an existing standard must be constantly reassessed and its usefulness re-evaluated based on new information. Recent work in our laboratory has shown that the ISO anterior-posterior force/translation and internal-external torque/rotation inputs have different magnitudes and timings compared with measurements taken from TKR patients during gait analysis [8, 9]. The TKR patients had greater knee translations and rotations with different patterning than the ISO standards.…”