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Purpose:
The purpose of this study was to compare knee kinematics during stair walking in patients with simultaneous total knee arthroplasty (TKA) and unicompartmental knee arthroplasties (UKA). It was hypothesized that UKA would reproduce more normalized knee kinematics than TKA during stair ascent and descent.
Methods:
Six patients who receive...
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ABSTRACT
Purpose/aim
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Methods:
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Objective: This study aims to evaluate the test–retest reliability of kinematics and kinetics during single and dual-task stair walking in the elderly.
Methods: Fifteen healthy elderly adults were recruited. Kinematic and kinetic parameters were measured using an infrared motion analysis system (Vicon, Oxford Metrics Ltd., Oxford, United Kingdom) a...
Citations
... Preservation of patella-femoral and contralateral tibio-femoral compartments along with cruciate ligaments resulting in less invasive surgery, lesser perioperative morbidity, enhanced postoperative functional recovery, and better patient satisfaction are all potential advantages of UKA. 3 In addition, kinematics of the knee joint has been reported to be more natural than total knee arthroplasty (TKA) in UKA. 4 Appropriate biomechanical alignment of the lower extremity depends on the bones of this extremity along with hip, knee, foot, and ankle joints. 5,6 Foot and/or ankle (F/A) problems are frequently encountered in TKA patients due to preoperative varus or valgus deformity resulting in abnormal loading and compensatory changes in the foot and ankle. ...
Objective
Foot and/or ankle (F/A) problems may be encountered in medial uni-compartmental knee (UKA) patients postoperatively due to the limb alignment changes and alterations in weight bearing of F/A. This study aimed to evaluate the risk factors and the incidence of foot and ankle (F/A) problems in (UKA) arthroplasty patients.
Methods
Patients who underwent UKA between 2016 and 2019 in our clinic were evaluated and the presence of F/A problems was recorded. Radiologic evaluations included hip knee ankle angle (HKA), medial proximal tibial angle, posterior tibial slope angle, talar tilt angle, talar inclination, talar dome to mechanical axis (TDMA), and talocrural angle (TCA) measured on preoperative and follow-up long-leg standing radiographs. The range of motion, Q angles, and muscle strengths were measured. Visual analog scale, physical performance limitations, and patient-reported activity limitations were evaluated for all patients. Patients with reported F/A problems were additionally evaluated with Foot Functional Index.
Results
Forty-four patients (38 female, 6 male; mean age 58.66 ± 8.6 years; mean BMI 31.30 ± 3.81, mean follow-up period 34.22 ± 18.95 months) were included in the study. There were 13 patients (29.5%) with reported F/A problems. Postoperative comparison of patients with and without F/A problems showed statistically significant differences in only WOMAC and SF12 physical health sub-scores ( p = 0.002, p = 0.003, respectively). There was no significant postoperative change in TDMA in patients with F/A problems ( p > 0.05) in contrast to patients without F/A problems ( p = 0.006). There was no statistically significant difference in preoperative TCA measurements between groups ( p = 0.79). Comparison of knee and ankle radiologic measurements between groups demonstrated significant difference only in postoperative HKA measurements (−2.82 ± 2.53 vs. −0.80 ± 3.12, p = 0.033).
Conclusion
F/A problems adversely affecting the functional status were frequent in our cohort of UKA patients. Postoperative residual varus deformity may be a risk factor for this. Therefore, if slight varus alignment is aimed at UKA patients, preoperative F/A status should be evaluated.
... While clinical assessments provide only a single snapshot in time, digital devices offer the opportunity for continuous monitoring of physical function and physiological measures [1][2][3]. To this end, inertial measurement unit (IMU) devices, generally consisting of both a triaxial accelerometer and gyroscope, have been used extensively to quantify motor function and quality of life in the home environment [4,5]. Specifically, IMU-based algorithms have been developed and validated for measuring various clinically relevant metrics, including physical activity, gait, and sleep [2,[6][7][8][9][10][11][12]. ...
Stair climb power (SCP) is a clinical measure of leg muscular function assessed in-clinic via the Stair Climb Power Test (SCPT). This method is subject to human error and cannot provide continuous remote monitoring. Continuous monitoring using wearable sensors may provide a more comprehensive assessment of lower-limb muscular function. In this work, we propose an algorithm to classify stair climbing periods and estimate SCP from a lower-back worn accelerometer, which strongly agrees with the clinical standard (r = 0.92, p < 0.001; ICC = 0.90, [0.82, 0.94]). Data were collected in-lab from healthy adults (n = 65) performing the four-step SCPT and a walking assessment while instrumented (accelerometer + gyroscope), which allowed us to investigate tradeoffs between sensor modalities. Using two classifiers, we were able to identify periods of stair ascent with >89% accuracy [sensitivity = >0.89, specificity = >0.90] using two ensemble machine learning algorithms, trained on accelerometer signal features. Minimal changes in model performances were observed using the gyroscope alone (±0–6% accuracy) versus the accelerometer model. While we observed a slight increase in accuracy when combining gyroscope and accelerometer (about +3–6% accuracy), this is tolerable to preserve battery life in the at-home environment. This work is impactful as it shows potential for an accelerometer-based at-home assessment of SCP.
... Also, UKA allows for movement of the femoral condyle on the medial tibial compartment, and the anterior cruciate ligament is still in place; for this reason, the kinematics are closer to the physiological kinematics of the knee than those of a TKA. 34,35 We only measured relative motion in 70° and 115° knee flexion in this experimental setup; relative motion during regular movement will exhibit more complex patterns. Nonetheless, the data obtained in our experiments are valid, as we minimized the influence of the abovementioned effects by using paired specimen. ...
Aims: The cemented Oxford unicompartmental knee arthroplasty (OUKA) features two variants: single and twin peg OUKA. The purpose of this study was to assess the stability of both variants in a worst-case scenario of bone defects and suboptimal cementation.
Methods: Single and twin pegs were implanted randomly allocated in 12 pairs of human fresh-frozen femora. We generated 5° bone defects at the posterior condyle. Relative movement was simulated using a servohydraulic pulser, and analyzed at 70°/115° knee flexion. Relative movement was surveyed at seven points of measurement on implant and bone, using an optic system.
Results: At the main fixation zone, the twin peg shows less relative movement at 70°/115°. At the transition zone, relative movements are smaller for the single peg for both angles. The single peg shows higher compression at 70° flexion, whereas the twin peg design shows higher compression at 115°. X-displacement is significantly higher for the single peg at 115°.
Conclusion: Bony defects should be avoided in OUKA. The twin peg shows high resilience against push-out force and should be preferred over the single peg.
... Unicompartmental knee arthroplasty (UKA) offers a good solution for higher demand patients motivated to return to physically demanding activities such as sport. Recent studies have highlighted the functional benefits of rapid recovery [2], more physiologic knee kinematics, and better gait parameters than TKA [3,4]. ...
Introduction:
Unicompartmental knee arthroplasty (UKA) has traditionally been contraindicated in the presence of an ACL deficient knee, bi-compartmental disease, or significant coronal deformity due to concerns regarding increased risk of persisted pain, knee instability, tibial loosening, or progression of osteoarthritis. The aim of this study was to evaluate the outcomes of patients undergoing UKA with an associated surgical procedure in these specific indications.
Method:
This was a retrospective cohort study of patients undergoing UKA between December 2015 and October 2020. Patients were categorized into groups based on associated procedures: UKA + ACL, UKA + HTO, and bicompartmental arthroplasty. Outcomes were assessed using the Knee Society Score (KSS) knee and function scores and the Forgotten Joint Score. Radiological and complication analysis was performed at the last clinical follow-up.
Results:
Thirty-two patients (13 men and 19 women) were included. The mean age was 56.2 years ± 11.1 (range, 33-84) with a mean follow-up of 26.3 months ± 15 (7.3-61.1). There was a significant improvement between the pre-and postoperative KSS Knee (+34.3 ± 16.5 [12-69]), Function (+34.3 ± 18.6 [0-75]), and Total scores (+68.5 ± 29.4 [24-129]) (p = 0.001). Seven patients (21.8%) required an arthroscopic arthrolysis for persistent stiffness. Two patients (UKA + PFA and UKA + ACL) underwent revision to TKA. Patient satisfaction was 90%, and mean flexion at last follow-up was 122° ± 6 (120-140). The implant survival rate was 94%.
Discussion:
This study found performing UKA with an additional procedure to address relative contraindications to the arthroplasty in physically active patients with monocompartmental knee arthritis is an efficient strategy with good results at short-term follow-up. It should be reserved for patients where TKA is likely to have unsatisfactory results, and the patient has been fully counseled regarding the management options. Even if there is a high rate of complications with stiffness requiring a re-intervention, the final results are very satisfying with no impact of the reintervention on the clinical result in the short term.
... Jung et al. investigated the difference during stair walking in patients with simultaneous TKA and UKA, and concluded that UKA knee might allow greater degree of rotation freedom, which resembled normal knee kinematics during stair walking. 22 In particular, UKA knees exhibited significantly greater degree of rotation in transverse planes, compared to TKA. However, in their study, peak tibial internal rotation moment in terminal stance phase was not evaluated. ...
Background/Objective
According to previous studies, physiological gait pattern was found in unicompartmental knee arthroplasty (UKA) as compared to total knee arthroplasty (TKA) concerning the gait parameters including gait speed, cadence, and step length. However, little attention had been paid to the detailed kinematic and kinetic differences during gait between TKAs and UKAs. The aim of the present study was to investigate and to clarify the biomechanical differences between posterior stabilized TKAs and fixed bearing UKAs during walking
Methods
A total of 28 patients participated in the present study. Fifteen patients who underwent TKA and thirteen patients who underwent UKA were enrolled. Gait analysis was done at an average of 12.9 months after surgery. The subjects performed level walking at a preferred speed. For each subject, three-dimensional kinematic, kinetic and ground reaction force data were recorded as well as clinical data including range of motion at the knee joint and plain radiographs. Differences of knee kinematics or kinetics were compared between TKAs and UKAs using two-tailed Mann Whitney U-test.
Results
On physical examination, passive range motion was significantly smaller in TKAs than in UKAs, while femorotibial angle on plain radiographs was not significantly different on plain radiographs. In terms of kinematics, TKAs were more flexed at heel contact and less extended in mid-stance phase compared to UKAs in the sagittal plane, and total excursion of TKAs were also smaller than UKAs. Regarding knee kinetics, TKA patients had significantly less peak tibial internal rotation moment in terminal stance phase. In addition, peak knee adduction moment was significantly larger in UKAs than in TKAs, while peak knee flexion moment was not significantly different.
Conclusion
Posterior stabilized TKAs exhibited less peak tibial internal rotation moment, which is known as pivot shift avoidance gait, in the present study, compared to fixed bearing UKAs. TKAs had similar gait pattern to anterior cruciate ligament deficient knees, compared to UKAs even if patients with TKAs had no subjective pain during walking.
... 7 31 Jung et al. studied patients with UKA in one limb and TKA in another limb. 30 They found that UKA limbs only displayed greater knee rotation in the transverse plane compared to TKA limb during stair ascent and Wiik et al. in a similar study report that patients prefer UKA over TKA limb during gait. 32 With scarcity of evidence on other activities of daily living such as stair negotiation post-UKA, it is imperative to study such activities to understand the functional and performance outcomes of UKA. ...
... Sixty healthy participants were recruited. Thirty (30) post-UKA patients with either MED-UKA (n = 20) or LAT-UKA (n = 10) and at least 6 months post-operative duration, non-diseased contralateral limbs, and no other musculoskeletal or other relevant health comorbidity and 30 healthy controls participated in the study ( Table 1). The surgery was performed by the same surgeon for consistency and to reduce the potential for surgical error, and the conditions of the contralateral knee was diagnosed as clinically healthy by the surgeon (author xxx) using standard radiographs. ...
Objective
Purpose of the study was to compare lower-limb kinematics and interlimb asymmetry during stair ascent in individuals post-medial or lateral unicompartmental knee arthroplasty (UKA).
Methods
60 patients (20 medial; 10 lateral) post-UKA and 30 matched healthy controls performed stair ascent. Spatio-temporal, lower-limb kinematics and interlimb asymmetries during stair ascent were compared.
Results
Medial-UKA group displayed 5° less knee extension of the UKA limb than controls (p = 0.005) and 2° less than the contralateral limb during stance phase. No interlimb asymmetries were found for lateral-UKA.
Conclusion
Patients post-UKA demonstrate satisfactory lower-limb kinematics and minimal interlimb asymmetry during stair ascent compared to healthy individuals.
... While the above techniques provide a direct measurement of articular surfaces, stationary states are typical requirements to achieve a clear picture of the targeted region, so these techniques are incapable to achieve dynamic joint properties. Motion-tracking systems consisted of multiple cameras and retroreflective markers provide an alternative approach to interpret joint properties with captured human joint motions [18][19][20] . Articular surfaces as well as ligament attachment areas were taken by digitization with a pointer using the Stryker Navigation System 21 . ...
... and the errors are listed in Table 4. It is shown that when there are no added noises, the difference mainly come from the numerical errors as well as the reduction from an infinite serial summation of (19) to a finite summation of (21 ...
Nonlinear articular geometries of biological joints have contributed to highly agile and adaptable human-body motions. However, human–machine interaction could potentially distort natural human motions if the artificial mechanisms overload the articular surfaces and constrain biological joint kinematics. It is desired to better understand the deformable articular geometries of biological joints in vivo during movements for design and control of wearable robotics. An articular geometry reconstruction method is proposed to measure the effective articular profile with a wearable compliant device and illustrated with its application to knee-joint kinematic analysis. Regarding the joint articulation as boundary constraints for the compliant mechanism, the equivalent articular geometry is constructed from the beam deformations driven by knee motions, where the continuous deformations are estimated with strain data from the embedded sensors. Both simulated analysis and experimental validation are presented to justify the proposed method.
... Furthermore, in most cases unnatural kneeling activities or simple level walking have been analyzed. In a study by Jung et al. [52] similar to the current study's transverse plane knee kinematics were reported in a TKA-and UKA-group during stair climbing, whereby the UKA-group was supposed to present knee motion closer to normal than the TKA-group. A healthy CG or the investigation of the non-op limb was not included. ...
Due to the significant role of rotational properties for normal knee function, this study aimed to investigate transverse plane kinematics and kinetics in total knee arthroplasty and unicondylar knee arthroplasty patients during activities of daily living compared to a healthy control group, including stair ascent and descent. The study participants consisted of a total knee arthroplasty group including posterior cruciate retaining and posterior stabilized designs as well as a unicondylar knee arthroplasty group and a healthy control group. Three-dimensional kinematics and kinetics were captured using a Vicon system and two Kistler force plates embedded in the floor and another two in a staircase. Inverse dynamics of the lower limbs was computed in Anybody™ Modeling System. Transverse plane joint angles and joint moments were analyzed utilizing the statistical non-parametric mapping approach, considering the entire curve shape for statistical analysis. The patients with total knee arthroplasty exhibited significantly reduced knee internal rotation of the operated knee compared to the control group and the patients’ unimpaired limb, especially during the stair climbing tasks. Both unicondylar and total knee arthroplasty patients were found to have similar reduced internal rotation motion time series in stair descent. In conclusion, potential kinematic and kinetic benefits of unicondylar knee arthroplasty over total knee arthroplasty could not be proven in the current study. Aside from the usually mentioned reasons inducing constrained knee internal rotation in total knee arthroplasty patients, future studies should investigate to what extent co-contraction may contribute to this functional impairment in patients after knee arthroplasty surgery.
... These findings dif- fer from previous reports that mean difference in coronal knee angle between the two methods was 6.5?during5?during the stance phase of stair descent. [29] This indicates that discrepancies between UKA and TKA in terms of kinematics and kinetics would be more apparent during neuro- physiologically more demanding locomotion tasks. Our meta-analysis also showed that the measurement methods of the included studies were primarily optoelectronic, force plate and inertial measurement unit (IMU) based, even though most previous studies reporting normal gait mechanics in UKA patients were conducted by means of fluoroscopic analysis. ...
This meta-analysis compared the gait patterns of unicompartmental knee arthroplasty (UKA) patients and total knee arthroplasty (TKA) patients during level walking by evaluating the kinetics, kinematics, and spatiotemporal parameters. Studies were included in the meta-analysis if they assessed the vertical ground reaction force (GRF), joint moment at stance, flexion at initial contact, flexion at swing, overall range of motion (ROM), coronal knee angle at stance, walking speed, cadence, and stride length in UKA patients or TKA patients. Seven non-randomized studies met the criteria for inclusion in this meta-analysis. UKA patients and TKA patients were similar in terms of vertical GRF (95% CI: -0.36 to 0.20; P = 0.60), joint moment (95% CI: -0.55 to 0.63; P = 0.90), kinematic outcomes (95% CI: -0.72 to 1.02; P = 0.74), walking speed (95% CI: -0.27 to 0.81; P = 0.32), and cadence (95% CI: -0.14 to 0.68; P = 0.20). In contrast, the stride length (95% CI: 0.01 to 0.80; P = 0.04) differed significantly between groups. Subgroup analyses revealed that the pooled data were similar between the groups: 1st maximum (heel strike), -0.18 BW (P = 0.53); 1st minimum (mid-stance), -0.43 BW (P = 0.08); and 2nd maximum (toe off), -0.03 BW (P = 0.87). On gait analysis, there were no significant differences in vertical GRF, joint moment at stance, overall kinematics, walking speed, or cadence between UKA patients and TKA patients during level walking. However, the TKA group had significantly shorter stride length than UKA patients. Although the comparison was inconclusive in determining which types of knee arthroplasty offered the closest approximation to normal gait, we consider it important to provide better rehabilitation programs to reduce the abnormal stride length in TKA patients compared to UKA patients.
... Unicompartmental knee arthroplasty (UKA) is a less-invasive procedure, resulting in faster rehabilitation, greater preservation of bone stock, reduced blood loss, and a lower risk of infection in comparison with TKA [3][4][5][6][7]. Furthermore, knee kinematics following UKA has been reported to be closer to those of the native knee than with TKA [8][9][10]. As such, UKA may represent a valuable alternative to TKA for patients who do not need the more invasive procedure [11]. ...
The current study was designed to determine (1) 10-year implant survival and (2) patient’s self-reported functional outcome in a single surgeon’s consecutive cohort of patients who had undergone minimally invasive unicondylar resurfacing with a modified cementation technique utilizing a cobalt–chromium femur/inlaid all-PE tibia, fixed-bearing unicompartmental prosthesis. We included 344 consecutive patients (361 knees) who had received the study device between January 2002 and December 2005 in this retrospective study. After 10 years, 78 patients (78 knees) had died, 59 (59 knees) were lost to follow-up and four (four knees) did not participate. Thirteen knees (11 patients) were revised after a mean of 5.8 ± 1.9 years. Hence, the study population at follow-up comprised 192 patients (207 knees). Ten-year implant survival was 94.6% (95% confidence interval, 90.9–96.8%). The Forgotten Joint Score and Oxford Knee Score were 68.9 ± 28.9 and 39 ± 9.1, respectively. Excellent survivorship and clinical outcomes were obtained with UKA with an inlaid all-PE tibia with a modified cementation technique.
