Kinematics and center of axial rotation during walking after medial pivot type total knee arthroplasty

Abstract

Purpose In recent years, the medial pivot (MP) type total knee arthroplasty (TKA) implant has been developed and marketed for achieving more natural kinematics with MP. However, little is known about the pivot pattern during walking after MP type TKA. This study aimed to determine the kinematics and center of axial rotation during walking after MP type TKA. Methods This randomized prospective study enrolled 40 patients with MP type TKA, 20 with cruciate-substituting TKA (MP-CS group), 20 with posterior-stabilized TKA (MP-PS group), and 10 healthy volunteers (control group). The kinematics and center of axial rotation during overground walking were measured by a three-dimensional motion analysis system. The six-degrees-of-freedom kinematics of the knee were calculated by the point cluster method. Results The amount of change in knee flexion in early stance phase was significantly lower in the MP-CS and MP-PS groups than in the control group. The femur showed anterior translation during early stance phase in all three groups. The median center of axial rotation in the transverse plane was predominantly on the lateral side of the knee during stance in all groups. Conclusions Kinematics during gait are thought to be determined by physical posture, the kinetic chain during weight-bearing, and the kinematic features of adjacent structures, such as the behavior of the biarticular muscles. MP-CS and MP-PS did not necessarily induce rotational motion centered on the medial ball-in-socket component during walking; translational and lateral pivoting movements were also observed. Long-term follow-up is needed to monitor for polyethylene wear and implant loosening.

ISB clinical biomechanics award winner 2021: Tibio-femoral kinematics of natural versus replaced knees – A comparison using dynamic videofluoroscopy

“…1 and 2). In agreement with previous studies (Gray et al, 2020;Miura et al, 2020), more tibial internal rotation over the course of the gait cycles as well as a reduced range of tibial internal/external rotation was found for the natural compared to the TKR groups (Fig. 2 and Fig.…”

“…Existing studies report that specific implant design features are able to guide joint motion (Gray et al, 2020;Schütz et al, 2019b;Scott et al, 2016), with considerable inter-subject variability presented for less constrained designs (Schütz et al, 2019b), possibly due to the additional role of surgical implantation parameters and soft-tissue sufficiency. However, only a limited number of studies have directly compared tibio-femoral kinematics during functional gait activities in natural and replaced knees using a consistent measurement set-up, as well as analysis approach (Dennis et al, 2001;Ghirardelli et al, 2021;Gray et al, 2020;Miura et al, 2020). Independent of the implant design, more tibial external rotation has been observed for the TKR subjects compared to natural knees over the course of a gait cycle, especially during late stance and early swing phases (Gray et al, 2020;Miura et al, 2020).…”

“…However, only a limited number of studies have directly compared tibio-femoral kinematics during functional gait activities in natural and replaced knees using a consistent measurement set-up, as well as analysis approach (Dennis et al, 2001;Ghirardelli et al, 2021;Gray et al, 2020;Miura et al, 2020). Independent of the implant design, more tibial external rotation has been observed for the TKR subjects compared to natural knees over the course of a gait cycle, especially during late stance and early swing phases (Gray et al, 2020;Miura et al, 2020). Abduction/adduction has been controversially reported in the literature, while equal rotations were found among natural and TKR subjects (Gray et al, 2020), another study found a reduced range of motion (RoM) in TKR subjects (Ghirardelli et al, 2021).…”

Assessing the knee joint biomechanics and trunk posture according to medial osteoarthritis severity

“…The participants performed three sets of walking trials at their self-selected normal walking speeds. Gait data were collected as described previously [10,16,17]. Gait motion data were captured using a threedimensional motion analysis system with eight infrared light cameras (ProRe ex Qualisys AB Inc., Gothenburg, Sweden).…”

Loss of Knee Flexion and Femoral Rollback of the Medial-Pivot and Posterior-Stabilized Total Knee Arthroplasty During Early-Stance of Walking in Chinese Patients

“…To the author’s best knowledge, there is no data available regarding in vivo knee kinematics in Chinese MP TKA patients during daily activities, such as walking. Some studies have investigated knee kinematics during gait activity in Caucasian patients ( Papagiannis et al, 2016 ; Benjamin et al, 2018 ; Esposito et al, 2020 ; Miura et al, 2020 ), reporting better mimicking of normal knee kinematics of MP TKA than other designs. Nevertheless, Chinese patients are manifested with more severity of osteoarthritis and walking disabilities than Caucasian patients before surgery ( Zhang et al, 2001 ; Kang et al, 2009 ; Lin et al, 2010 ; Liu et al, 2017 ), which may restrict their function restoration after TKA surgery, such as adopting a slow walking speed.…”