Knee kinematics in medial osteoarthritis during in vivo weight‐bearing activities

Abstract

Dynamic knee kinematics were analyzed for medial osteoarthritic (OA) knees in three activities, including two types of maximum knee flexion. Continuous x-ray images of kneeling, squatting, and stair climbing motions were taken using a large flat panel detector. CT-derived bone models were used for the model registration-based 3D kinematic measurements. Three-dimensional joint kinematics and contact locations were determined using two methods: bone-fixed coordinate systems and by interrogation of CT-based bone model surfaces. The femur exhibited gradual external rotation with knee flexion for kneeling and squatting activities, and gradual internal rotation with knee extension for stair climbing. From 1008 to 1208 flexion, contact locations showed a medial pivot pattern similar to normal knees. However, knees with medial OA displayed a femoral internal rotation bias and less posterior translation when compared with normal knees. A classic screw-home movement was not observed in OA knees near extension. Decreased variability with both activities and methods of calculation were demonstrated for all three activities. In conclusion, the weight-bearing kinematics of patients with medial OA differs from normal knees. Pathological changes of the articulating surfaces and the ligaments correspond to observed abnormalities in knee kinematics. Keywords: tibiofemoral joint; kinematics; medial osteoarthritis; dynamic activity; axial rotation For about 15 years, 3D-to-2D model registration techniques have been used to determine knee arthroplasty motions from fluoroscopic image sequences.1,2 Kinematic information is now available while subjects with multiple designs of total knee arthroplasty (TKA) perform functional activities.3-12 These single-plane fluoroscopic techniques have recently been applied for motion measurement in joints without implants, where 3D surface models of the bones are created from computed tomography (CT), and magnetic resonance (MR) imaging. [13][14][15][16][17][18][19][20][21][22] Komistek et al. reported kinematic measurements using single-plane fluoroscopic projections and CT-derived bone models.15 Moro-oka et al. recently assessed the accuracy of their shape matching technique using bone models created from CT and MR, and analyzed 3D dynamic knee kinematics in kneeling, squatting, and stair climbing.18,19 Single-plane x-ray imaging and model-based shape matching appear to provide kinematic measurements with sufficient certainty to assess normal and pathological knee motions using either CT-or MR-derived models.Three-dimensional kinematic studies have focused on patients with TKA, 1-12 normal knees, [13][14][15][16][17][18][19]23 or anterior cruciate ligament (ACL) deficient knees. [20][21][22] To our knowledge, no studies have employed 3D-to-2D model registration techniques to study knees with osteoarthritis (OA). This information is critical to achieve a better understanding of how OA affects knee mechanics, and the state of the knee prior to TKA. Kinematics of OA knees have been evaluate...

Kinematics of medial osteoarthritic knees before and after posterior cruciate ligament retaining total knee arthroplasty

“…The differences might be due to variations in activities, choice of coordinate systems, and preoperative pathological changes. 13,18,22,23,39 After PCR-TKAs, we did not observe the characteristic internal tibial rotation between full extension and 30…”

“…Other studies also reported less posterior translation in OA compared to normal knees. 13,18,22 In PCR-TKA knees, the reduction of posterior femoral translation was been reported by many studies. 13,24,25 For example, Kitagawa et al observed posterior translation of the lateral condyle from full extension to maximum flexion reduced from 9 ± 1 mm for OA knees to 5 ± 0 mm for TKA knees.…”

“…17,18 Many in vitro studies compared knee kinematics before and after TKA, however, the knees were not at the end-stage of OA. [19][20][21] Most in vivo studies assessed the kinematics of either OA knees 18,22,23 or TKA knees. 7,9 Recently, one in vivo study evaluated the AP femoral translation and axial rotation of the knee before and after TKA under weight-bearing knee flexion.…”

Gait knee kinematic alterations in medial osteoarthritis: three dimensional assessment

“…This difference at this gait phase, which corresponds to maximal knee extension, may be due to the lack of full extension of OA knees. Hamai et al, evaluated rotational angles using CT and reported a femoral internal rotation bias compared with the control group [3]. Saari et al, using dynamic radiostereometric analysis (RSA), found a decreased internal rotation in the knee OA group.…”

“…Quantitative kinematic analysis is an important tool for a thorough understanding of joint function [1]. Kinematics of osteoarthritic (OA) knees has been evaluated using surgical navigation systems, magnetic resonance imaging (MRI) and computed tomography (CT) [2][3][4], but these techniques cannot be used to study weight-bearing activities, and their results may be therefore be affected. With advances in sophisticated motion-capture technology, 3D knee motion during weightbearing is now available.…”