Knee Joint Loading and Tibial Component Loosening

Abstract

We report a prospective study of gait and tibial component migration in 45 patients with osteoarthritis treated by total knee arthroplasty (TKA). Migration was measured over two years using roentgen stereophotogrammetry. We used the previously established threshold of 200 m migration in the second postoperative year to distinguish two groups: a risk group of 15 patients and a stable group of 28 patients.We performed gait analysis before operation and at six months and at two years after TKA. On all three occasions we found significant differences between the two groups in the mean sagittal plane moments of the knee joint. The risk group walked with higher peak flexion moments than the stable group. The two groups were not discriminated by any clinical or radiological criteria or other gait characteristics.The relationship which we have found between gait with increased flexion moments and risk of tibial component loosening warrants further study as regards the aetiology of prosthetic loosening and possible methods of influencing its incidence.

Knee kinetics during walking at different speeds in people who have undergone total knee replacement

“…Larger magnitudes of the knee adductor moment have also been associated with early loosening of the TKR prosthesis [13,14]. Again, the reduction of this moment in TKR patients suggests that this is less of a concern in this group.…”

“…Joint moments are considered particularly relevant in the assessment of outcome from TKR because they closely represent the forces acting across the knee and the subsequent demand for muscle activity to stabilise the knee against these forces [12]. Since excessive knee moments have been associated with prosthesis loosening in TKR patients [13,14], motion analysis may provide unique information about the predicted long-term outcome from surgery.…”

“…Given the reported limitations in patient function and the proposed relationship between excessive knee moments and loosening of the prosthesis [13,14] it is important to know whether the differences in knee moments between patients and controls are maintained during walking at faster speeds. To date there has been no study that compares the knee kinetics between these groups at faster walking speeds.…”

Total knee replacement influences both knee and hip joint kinematics during stair climbing

“…Cloutier [5] found that knee flexion during stair climbing was greater in the patients with nonconstrained prostheses than in those with a semiconstrained total condylar prosthesis. Other authors have, however, not been able to confirm these differences [3,9].…”

Variability of walking and other daily activities in patients with total knee replacement

“…Three-dimensional motion analysis has been used by researchers to assess the gait of patients who have undergone total knee replacement (TKR) [1][2][3]. Motion analysis has been advocated as a useful assessment tool in this patient group because it provides objective and biomechanical information about patients' walking and functional outcome that is not available from subjective questionnaires or standard clinical assessment.…”