Alterations of kinematics in knees after single versus multiple radius femoral prostheses total knee arthroplasty: a retrospective study

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Abstract

Background

Design modifications in prostheses may cause alterations in gait kinematics, thus influencing functional restoration of knees after total knee arthroplasty (TKA). The aim of the study was to investigate the differences in gait kinematics and clinical outcomes after single radius (SR) versus multiple radius (MR) TKA.

Method

The present retrospective study included 38 unilateral TKA involving 20 knees using MR design implant and 18 knees using SR design implant. Thirty-six healthy volunteers were also recruited. The mean follow-up time was 16 ± 3 months. At the end of follow-up, the 6 degrees of freedom (DOF) kinematics of knees and range of motion (ROM) were measured with a portable optical tracking system. Knee society score (KSS) and knee injury, and osteoarthritis outcome score (KOOS) were also collected.

Results

Patients in the SR group had significantly higher scores in activities of daily living (84.7 ± 15.9) and sports and recreation (67.5 ± 25.2) KOOS sub-score than MR group (69.9 ± 17.6, P = 0.012; 50.0 ± 20.8, P = 0.027, respectively). Significant differences were detected between MR knees and SR knees (1.82° ± 3.11° vs 4.93° ± 3.58°, P = 0.009), and MR knees and healthy knees (1.82° ± 3.11° vs 3.62° ± 3.52°, P = 0.032) in adduction/abduction ROM. The proximal/distal translation was significantly smaller in MR knees (0.58 ± 0.54 cm) compared with SR knees (1.03 ± 0.53 cm, P = 0.003) or healthy knees (0.84 ± 0.45 cm, P = 0.039). SR knees (0.24 ± 0.40 cm) had smaller translation compared with the MR group (0.54 ± 0.33 cm, P = 0.017) and control group (0.67 ± 0.36 cm, P = 0.028). No significant difference was detected in the other DOFs during the gait cycle. Significant difference was detected in extension/flexion, internal/external rotation, adduction/abduction, proximal/distal and medial/lateral among MR, SR and healthy knees.

Conclusion

After TKA, patients have altered gait kinematics compared with the control group. MR and SR design showed varied characteristics in 6 DOF gait kinematics, which could be the cause of the difference in functional outcome.

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Most cited references 19

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Projected increase in total knee arthroplasty in the United States - an alternative projection model.

M Inacio, E Paxton, S E Graves … (2017)

The purpose of our study was to estimate the future incidence rate (IR) and volume of primary total knee arthroplasty (TKA) in the United States from 2015 to 2050 using a conservative projection model that assumes a maximum IR of procedures. Furthermore, our study compared these projections to a model assuming exponential growth, as done in previous studies, for illustrative purposes.

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What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement

D. Hamilton, J V Lane, P Gaston … (2013)

Objectives To investigate the factors which influence patient satisfaction with surgical services and to explore the relationship between overall satisfaction, satisfaction with specific facets of outcome and measured clinical outcomes (patient reported outcome measures (PROMs)). Design Prospective cohort study. Setting Single National Health Service (NHS) teaching hospital. Participants 4709 individuals undergoing primary lower limb joint replacement over a 4-year period (January 2006–December 2010). Main outcome measures Overall patient satisfaction, clinical outcomes as measured by PROMs (Oxford Hip or Knee Score, SF-12), satisfaction with five specific aspects of surgical outcome, attitudes towards further surgery, length of hospital stay. Results Overall patient satisfaction was predicted by: (1) meeting preoperative expectations (OR 2.62 (95% CI 2.24 to 3.07)), (2) satisfaction with pain relief (2.40 (2.00 to 2.87)), (3) satisfaction with the hospital experience (1.7 (1.45 to 1.91)), (4) 12 months (1.08 (1.05 to 1.10)) and (5) preoperative (0.95 (0.93 to 0.97)) Oxford scores. These five factors contributed to a model able to correctly predict 97% of the variation in overall patient satisfaction response. The factors having greatest effect were the degree to which patient expectations were met and satisfaction with pain relief; the Oxford scores carried little weight in the algorithm. Various factors previously reported to influence clinical outcomes such as age, gender, comorbidities and length of postoperative hospital stay did not help explain variation in overall patient satisfaction. Conclusions Three factors broadly determine the patient's overall satisfaction following lower limb joint arthroplasty; meeting preoperative expectations, achieving satisfactory pain relief, and a satisfactory hospital experience. Pain relief and expectations are managed by clinical teams; however, a fractured access to surgical services impacts on the patient's hospital experience which may reduce overall satisfaction. In the absence of complications, how we deliver healthcare may be of key importance along with the specifics of what we deliver, which has clear implications for units providing surgical services.

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The movement of the normal tibio-femoral joint.

M.A.R. Freeman, V Pinskerova (2005)

This review describes the anatomy of the articular surfaces and their movement in the normal tibio-femoral joint, together with methods of measurement in volunteers. Forces and soft tissues are excluded. To measure movement, the articular surfaces and natural or inserted movement markers must be imaged by some combination of MRI, CT, RSA or fluoroscopy. With the aid of computer-imaging, the movements can then be related to an anatomy-based co-ordinate system to avoid kinematic cross-talk. Methods of depicting these movements which are understandable to engineers and clinicians are discussed. The shapes of the articular surfaces are reported. They are relevant to landmarks and co-ordinate systems and form a basis for inferring the nature of the movements which take place in the knee. The movements of the condyles are described from hyperextension to full passive flexion. Medially the condyle hardly moves antero-posteriorly from 0 degrees to 120 degrees but the contact area transfers from an anterior pair of tibio-femoral surfaces at 10 degrees to a posterior pair at about 30 degrees . Thus because of the shapes of the bones, the medial contact area moves backwards with flexion to 30 degrees but the condyle does not. Laterally the femoral condyle and the contact area move posteriorly but to a variable extent in the mid-range causing tibial internal rotation to occur with flexion around a medial axis. From 120 degrees to full flexion both condyles roll back onto the posterior horn so that the tibio-femoral joint subluxes.

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Author and article information

Contributors

Yuanchen Ma: myc0998@gmail.com

Qiujian Zheng:

ORCID: http://orcid.org/0000-0003-3860-1402

zqj650@126.com

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 4 July 2020

Publication date PMC-release: 4 July 2020

Publication date Collection: 2020

Volume: 21

Electronic Location Identifier: 434

Affiliations

[1 ]Division of Joint Osteopathy and Traumatology, Center of Orthopedics Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, 106 Zhongshaner Road, Yuexiu District, Guangzhou, 510080 PR China

[2 ]GRID grid.411679.c, ISNI 0000 0004 0605 3373, Shantou University Medical College, ; Shantou, 515063 PR China

Author information

Qiujian Zheng http://orcid.org/0000-0003-3860-1402

Article

Publisher ID: 3425

DOI: 10.1186/s12891-020-03425-9

PMC ID: 7334846

PubMed ID: 32622357

SO-VID: bb02d7b3-88c9-4553-95a3-12b81f2c481b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 12 March 2020

Date accepted : 16 June 2020

Funding

Funded by: Frontier and Key Technologies Innovation Funding Project of Department of Science and Technology of Guangdong Province

Award ID: 2015B020225007

Award Recipient : Qiujian Zheng

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ScienceOpen disciplines: Orthopedics

Keywords: total knee arthroplasty,single radius,multiple radius,gait kinematics

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ScienceOpen disciplines: Orthopedics

Keywords: total knee arthroplasty, single radius, multiple radius, gait kinematics

Alterations of kinematics in knees after single versus multiple radius femoral prostheses total knee arthroplasty: a retrospective study

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Orthopedics

Most cited references 19

Projected increase in total knee arthroplasty in the United States - an alternative projection model.

What determines patient satisfaction with surgery? A prospective cohort study of 4709 patients following total joint replacement

The movement of the normal tibio-femoral joint.

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