No differences in knee kinematics between active and passive flexion-extension movement: an intra-operative kinematic analysis performed during total knee arthroplasty

Abstract

Purpose: The objective of the present study was to acquire and compare by the use of a navigation system the intra-operative flexion-extension movement of the knee performed actively by the patient and passively by the surgeon before and after a total knee arthroplasty (TKA) implantation. Methods: A cohort of 31 patients with primary knee osteoarthritis (OA), candidate for TKA underwent intraoperative kinematics assessment with a commercial navigation system before and after the definitive implant positioning of a Cruciate Retaining (CR) Mobile Bearing (MB) prostheses. The kinematical data were acquired while surgeon performed the flexion-extension movement (passive ROM-pROM), and while the patient performed it (active ROM-aROM). Differences between pre-and post-implantation and between active and passive motions, were statistically analyzed using paired Student t-tests (p = 0.05). Results: No statistically significant difference were found between aROM and pROM with paired Student t-test regarding internal-external rotation and anterior-posterior translation of the femoral component with respect to the tibia during flexion-extension movement before and after TKA implant (p > 0.05). Conclusions: Active muscle contraction seems to not significantly affect TKA kinematics. The ROM performed by the surgeon during operation resemble the movement actively performed by the patient. The clinical relevance of this study further supports the use of CAS system in performing intra-operative analysis concerning knee biomechanics.

Medial Open Wedge High tibial Osteotomy (MOWHTO) does not relevantly alter patellar kinematics: a cadaveric study

“…Moreover, in a radiological investigation, Masri and McCormack reported, that quadriceps contraction does not alter the congruence angles obtained in 30° and 45° axial views [ 28 ]. Additionally, Grassi et al showed, that there were no differences in knee kinematics between active and passive flexion–extension movement cycles regarding intra-operative kinematic analysis [ 29 ]. Therefore, our results should reflect on comparable native patellar tracking in this experimental setup.…”

Efficacy of non-operative treatment of patients with knee arthrofibrosis using high-intensity home mechanical therapy: a retrospective review of 11,000+ patients

“…For the ROM data taken from physical therapy notes in Dataset 3, more than 90% of patients achieved at least 90° of flexion at the last recorded ROM measurement (93.6%). While data reported in this study is PROM, the difference between AROM and PROM has been reported to be small in previous studies of total knee arthroplasty patients [ 29 – 31 ]. The largest difference between AROM and PROM in these studies was 4%.…”

Comparison between passive knee kinematics during surgery and active knee kinematics during walking: A preliminary study

“…First, regarding anatomical and biomechanical differences, during CAS, knee kinematics are assessed after arthrotomy, passively and without loading, whereas gait kinematics are assessed with a closed knee, actively and with loading and impacts. One recent study suggested that there were no differences between active and passive knee flexion–extension angles after arthrotomy but without loading [ 7 ]. Moreover, good correlations were found between CAS measurements and impact-free weight-bearing knee kinematics assessed using monoplane fluoroscopy six months after surgery [ 8 , 9 ].…”

“…Grassi et al . recently showed that there were no significant differences between active and passive intra-operative knee kinematics as measured using a CAS system during knee flexion–extension before and after TKA [ 7 ]. Belvedere et al .…”

“…Understanding whether there is an association between passive knee kinematics measured during surgery (using CAS) and knee kinematics measured during daily activities such as walking (using KneeKG™) could help surgeons get closer to reproducing normal knee function during daily activities rather than focussing solely on component alignment. Grassi et al recently showed that there were no significant differences between active and passive intra-operative knee kinematics as measured using a CAS system during knee flexion-extension before and after TKA [7]. Belvedere et al showed that passive knee kinematics measured using CAS before wound closure, with the definitive TKA component in place, was predictive of post-surgical kinematics measured using monoplane fluoroscopy during multiple weight bearing activities (stair ascent, chair standing and sitting) and during flexionextension against gravity, six months after surgery [8,9].…”