Knee implant kinematics are task-dependent

Schütz, Pascal; Postolka, Barbara; Gerber, Hans; Ferguson, Stephen J.; Taylor, William R.; List, Renate

doi:10.1098/rsif.2018.0678

Cited by 28 publications

(41 citation statements)

References 56 publications

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“…The lower range of rotation in the UC geometry, however, indicates that the implant with constrained medial and lateral compartments may restrict the joint axial rotation. Here, the UC geometry shows comparable values to those reported for level walking and stair descent with a cruciate retaining implant . The ranges of tibial rotation determined during the loaded stance phase of level walking (GMK Sphere: 7.3 ± 2.8°, GMK PS: 7.9 ± 1.3, GMK UC: 6.2 ± 2.8) and stair descent (GMK Sphere: 6.6 ± 2.4°, GMK PS: 6.6 ± 3.1, GMK UC: 6.0 ± 2.5) were comparable to studies investigating the healthy knee in vivo during the stance phase of normal gait and stair descent .…”

Section: Discussionsupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

“…To image complete, consecutive cycles of the knee joint during level walking, downhill walking and stair descent, the moving fluoroscope was employed to capture the relative movements of the femoral and tibial components with a measurement frequency of 25 Hz during the investigated gait activities. 26,27,29 Detailed information about the videofluoroscopic image capture are provided in the literature. 26,27,[29][30][31][32][33] Data Processing Two-dimensional/three-dimensional (2D/3D) registration The acquired digital images were corrected for distortion using a local correction algorithm based on a reference grid.…”

Section: Moving Fluoroscopementioning

confidence: 99%

“…To overcome the constraints of such static imaging approaches, dynamic systems have been developed that now allow investigation into tibio‐femoral kinematics throughout complete cycles of level walking, downhill walking, and stair descent. The use of such a system has, for the first time, recently shown that tibio‐femoral kinematics depend on the activity performed and that clear differences between the loaded stance and the unloaded swing phases of gait activities exist . Furthermore, it is now known that treadmill walking alters joint kinematics compared with free level walking …”

mentioning

confidence: 99%

“…The use of such a system has, for the first time, recently shown that tibio-femoral kinematics depend on the activity performed and that clear differences between the loaded stance and the unloaded swing phases of gait activities exist. 27 Furthermore, it is now known that treadmill walking alters joint kinematics compared with free level walking. 28 Whether the intended kinematic behavior of the GMK Sphere design principle, that has been presented during lunge and step-up activities, 6 is also present for dynamic gait activities and how the kinematics are altered in comparison to conventional posterior-stabilized (PS) and ultra-congruent (UC) geometries remains unknown.…”

mentioning

confidence: 99%

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Kinematic Evaluation of the GMK Sphere Implant During Gait Activities: A Dynamic Videofluoroscopy Study

Schütz

Taylor

Postolka

et al. 2019

Journal Orthopaedic Research

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Joint stability is a primary concern in total knee joint replacement. The GMK Sphere prosthesis was specifically designed to provide medial compartment anterior–posterior (A–P) stability, while permitting rotational freedom of the joint through a flat lateral tibial surface. The objective of this study was to establish the changes in joint kinematics introduced by the GMK Sphere prosthesis during gait activities in comparison to conventional posterior‐stabilized (PS) fixed‐bearing and ultra‐congruent (UC) mobile‐bearing geometries. The A–P translation and internal/external rotation of three cohorts, each with 10 good outcome subjects (2.9 ± 1.6 years postop), with a GMK Sphere, GMK PS or GMK UC implant were analysed throughout complete cycles of gait activities using dynamic videofluoroscopy. The GMK Sphere showed the smallest range of medial compartment A–P translation for level walking, downhill walking, and stair descent (3.6 ± 0.9 mm, 3.1 ± 0.8 mm, 3.9 ± 1.3 mm), followed by the GMK UC (5.7 ± 1.0 mm, 8.0 ± 1.7 mm, 8.7 ± 1.9 mm) and the GMK PS (10.3 ± 2.2 mm, 10.1 ± 2.6 mm, 11.6 ± 1.6 mm) geometries. The GMK Sphere exhibited the largest range of lateral compartment A–P translation (12.1 ± 2.2 mm), and the largest range of tibial internal/external rotation (13.2 ± 2.2°), both during stair descent. This study has shown that the GMK Sphere clearly restricts A–P motion of the medial condyle during gait activities while still allowing a large range of axial rotation. The additional comparison against the conventional GMK PS and UC geometries, not only demonstrates that implant geometry is a key factor in governing tibio‐femoral kinematics, but also that the geometry itself probably plays a more dominant role for joint movement than the type of gait activity. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2337–2347, 2019

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Section: Discussionsupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

Section: Moving Fluoroscopementioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Kinematic Evaluation of the GMK Sphere Implant During Gait Activities: A Dynamic Videofluoroscopy Study

Schütz

Taylor

Postolka

et al. 2019

Journal Orthopaedic Research

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Medial unicompartmental knee arthroplasty in ACL-deficient knees is a viable treatment option: in vivo kinematic evaluation using a moving fluoroscope

Zumbrunn¹,

Schütz²,

Knoch³

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose Unicompartmental knee arthroplasty (UKA), resulting in similar kinematics to native knees, is functionally superior to total knee arthroplasty (TKA). However, ACL deficiency is generally considered to be a contraindication. The main purpose of this study was to investigate if UKA in ACL‐deficient knees would result in similar kinematics to conventional UKA with an intact ACL. Methods Ten conventional UKA patients were compared to eight ACL‐deficient patients with a reduced tibial slope to compensate for instability, resulting from the deficient ACL. Knee kinematics was evaluated with a moving fluoroscope, tracking the knee joint during daily activities. In a standing position (baseline), posterior shift of the femur was observed for ACL‐deficient UKA patients, compared to conventional UKA patients. Results A significant posterior femoral shift in the ACL‐deficient group was observed during the first 25% (near extension) of deep knee bend, while there was no difference in kinematic waveforms for all other activities. No significant range of motion differences across different activities between the two UKA groups were detected, except for an increase of medial AP translation in the ACL‐deficient group, during deep knee bend and stair descent. Conclusion Despite the posterior femoral shift due to ACL deficiency, both UKA groups showed similar kinematic waveforms, indicating that posterior tibial slope reduction can partially compensate for ACL function. This supported our hypothesis that fixed bearing UKA can be a viable treatment option for selected ACL‐deficient patients, allowing patient‐specific kinematics. While anteroposterior laxity can be compensated, rotational stability was a prerequisite for this approach. Level of evidence III.

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Length-Change Patterns of the Collateral Ligaments During Functional Activities After Total Knee Arthroplasty

Nasab

Schütz

et al. 2020

Ann Biomed Eng

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This study aimed to quantify the elongation patterns of the collateral ligaments following TKA during functional activities of daily living. Using mobile videofluoroscopy to capture radiographic images of the knee in a group of six patients, each with an ultra-congruent knee implant, tibiofemoral kinematics were reconstructed throughout complete cycles of level gait, downhill walking, stair descent, and squat activities. Kinematic data were then used to drive subject-specific multibody knee models to estimate length-change patterns of the LCL as well as three bundles of the MCL. In addition, a sensitivity analysis examined the role of the attachment site in the elongation patterns. Our data indicate a slackening of the LCL but nonuniform length-change patterns across the MCL bundles (ranging from lengthening of the anterior fibers to shortening of the posterior fibers) with increasing knee flexion angle. Near-isometric behavior of the intermediate fibers was observed throughout the entire cycle of the studied activities. These length-change patterns were found to be largely consistent across different activities. Importantly, lengthchange patterns were critically sensitive to the location of the femoral attachment points relative to the femoral component. Thus, in TKA with ultra-congruent implants, implantation of the femoral component may critically govern postoperative ligament function.

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Knee implant kinematics are task-dependent

Cited by 28 publications

References 56 publications

Kinematic Evaluation of the GMK Sphere Implant During Gait Activities: A Dynamic Videofluoroscopy Study

Kinematic Evaluation of the GMK Sphere Implant During Gait Activities: A Dynamic Videofluoroscopy Study

Medial unicompartmental knee arthroplasty in ACL-deficient knees is a viable treatment option: in vivo kinematic evaluation using a moving fluoroscope

Length-Change Patterns of the Collateral Ligaments During Functional Activities After Total Knee Arthroplasty

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