Physical examination and in vivo kinematics in two posterior cruciate ligament retaining total knee arthroplasty designs

Ploegmakers, Marieke J.M.; Ginsel, Bastiaan; Meijerink, Huub J; Rooy, Jacky W. de; Malefijt, M.C. de Waal; Banks, Scott A.

doi:10.1016/j.knee.2009.09.005

Cited by 17 publications

(22 citation statements)

References 39 publications

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“…In a large randomized controlled study designed with sufficient statistical power to assess TKA performance in bilateral TKA patients, Kim et al [ 23 ] were unable to detect differences between cruciate-retaining TKA and posterior-stabilized TKA using clinical outcome scores and goniometric measurements of the range of motion. Other studies have used combined clinical outcome scores and fluoroscopic assessment of knee flexion kinematics to detect inferior functional performance of TKA designs [ 14 , 39 , 40 , 46 ]. In a randomized controlled study of PCL-retaining mobile-bearing TKA assessed using fluoroscopy, Lützner et al [ 46 ] reported lack of functional improvement in some patients supported by significantly lower KSS function scores and axial rotation biased toward femoral internal rotation during nonweight bearing passive knee flexion.…”

Section: Discussionmentioning

confidence: 99%

Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament

Harman

Bonin

Leslie³

et al. 2014

Advances in Orthopedics

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Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL) is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee (96 ± 7) and function (92 ± 13) scores and radiographic outcomes were good to excellent for 84% of patients after 5–10 years in vivo. Range of motion averaged 124° ± 9°, with 126 knees exhibiting ≥120° flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL.

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Section: Discussionmentioning

confidence: 99%

Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament

Harman

Bonin

Leslie³

et al. 2014

Advances in Orthopedics

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“…Rehabilitation following onset of knee joint disease, injury or surgery often requires assessment of mobility during common activity of daily living, such as walking or rising from a chair [1,2], or deep knee bends [3,4]. In these studies, highly sophisticated optical or radiographic systems were used to assess knee joint motion; however, this technology is not available to the majority of clinics, and costs of personnel, training and maintenance can be prohibitive even when such facilities are readily available.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Strain-Gage and Fiber-Optic Goniometry for Measuring Knee Kinematics During Activities of Daily Living and Exercise

Mohamed

Baba

Beyea

et al. 2012

Journal of Biomechanical Engineering

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There is increasing interest in wearable sensor technology as a tool for rehabilitation applications in community or home environments. Recent studies have focused on evaluating inertial based sensing (accelerometers, gyroscopes, etc.) that provide only indirect measures of joint motion. Measurement of joint kinematics using flexible goniometry is more direct, and still popular in laboratory environments, but has received little attention as a potential tool for wearable systems. The aim of this study was to compare two goniometric devices: a traditional strain-gauge flexible goniometer, and a fiberoptic flexible goniometer, for measuring dynamic knee flexion/extension angles during activity of daily living: chair rise, and gait; and exercise: deep knee bends, against joint angles computed from a "gold standard" Vicon motion tracking system. Six young adults were recruited to perform the above activities in the lab while wearing a goniometer on each knee, and reflective markers for motion tracking. Kinematic data were collected simultaneously from the goniometers (one on each leg) and the motion tracking system (both legs). The results indicate that both goniometers were within 2-5 degrees of the Vicon angles for gait and chair rise. For some deep knee bend trials, disagreement with Vicon angles exceeded ten degrees for both devices. We conclude that both goniometers can record ADL knee movement faithfully and accurately, but should be carefully considered when high (>120 deg) knee flexion angles are required.

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“…This sharp edge may come in contact with the PCL, leading to damage and subsequent PCL laxity. In a previous study comparing the CKS and the PFC prostheses, kinematic analysis supported the suspicion that the CKS design has larger AP translations than the PFC design (Ploegmakers et al 2010). Although clinical ratings such as the KSS, total WOMAC, and VAS did not show any statistically significant difference in that study, subscores regarding higher flexion and higher-demanding activities showed greater limitations in knees with a CKS design.…”

Section: Discussionmentioning

confidence: 84%

Similar TKA designs with differences in clinical outcome

Meijerink¹,

Loon

Hannink

et al. 2011

Acta Orthopaedica

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Background and purpose To try to improve the outcome of our TKAs, we started to use the CKS prosthesis. However, in a retrospective analysis this design tended to give worse results. We therefore conducted a randomized, controlled trial comparing this CKS prosthesis and our standard PFC prosthesis. Because many randomized studies between different TKA concepts generally fail to show superiority of a particular design, we hypothesized that these seemingly similar designs would not lead to any difference in clinical outcome.Patients and methods 82 patients (90 knees) were randomly allocated to one or other prosthesis, and 39 CKS prostheses and 38 PFC prostheses could be followed for mean 5.6 years. No patients were lost to follow-up. At each follow-up, patients were evaluated clinically and radiographically, and the KSS, WOMAC, VAS patient satisfaction scores and VAS for pain were recorded.Results With total Knee Society score (KSS) as primary endpoint, there was a difference in favor of the PFC group at final follow-up (p = 0.04). Whereas there was one revision in the PFC group, there were 6 revisions in the CKS group (p = 0.1). The survival analysis with any reoperation as endpoint showed better survival in the PFC group (97% (95% CI: 92–100) for the PFC group vs. 79% (95% CI: 66–92) for the CKS group) (p = 0.02).Interpretation Our hypothesis that there would be no difference in clinical outcome was rejected in this study. The PFC system showed excellent results that were comparable to those in previous reports. The CKS design had differences that had considerable negative consequences clinically. The relatively poor results have discouraged us from using this design.

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Physical examination and in vivo kinematics in two posterior cruciate ligament retaining total knee arthroplasty designs

Cited by 17 publications

References 39 publications

Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament

Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament

Comparison of Strain-Gage and Fiber-Optic Goniometry for Measuring Knee Kinematics During Activities of Daily Living and Exercise

Similar TKA designs with differences in clinical outcome

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