Article

Gait analysis after bi-compartmental knee replacement

Biomechanics Laboratory, School of Physical Education, Sport, and Exercise Science, Ball State University Muncie, IN 47306, USA.
Clinical biomechanics (Bristol, Avon) (Impact Factor: 1.97). 08/2009; 24(9):751-4. DOI: 10.1016/j.clinbiomech.2009.07.014
Source: PubMed

ABSTRACT

It is reported that a majority of the patients with knee osteoarthritis have cartilage degeneration in medial and patellofemoral compartments. A bi-compartmental knee replacement system was designed to treat osteoarthritis at medial and patellofemoral compartments. To date, there is very little information regarding the knee mechanics during gait after bi-compartmental knee replacement. The purpose of the study was to evaluate knee strength and mechanics during level walking after knee replacement.
Ten healthy control subjects and eight patients with unilateral bi-compartmental knee replacement participated in the study. Maximal isokinetic concentric knee extension strength was evaluated. 3D kinematic and kinetic analyses were conducted for level walking. Paired Student t-test was used to determine difference between surgical and non-involved limbs. One way MANOVA was used to determine difference between surgical and control groups.
The surgical knee exhibited less peak torque and initial abduction moment than both the non-involved and control limbs (P<0.05). The non-involved limb had less knee extension at stance and greater knee extensor moment during push-off than both the surgical and control limbs (P<0.05). No differences were found for other typical knee mechanics among the surgical, non-involved, and control limbs during walking (P>0.05).
Patients with bi-compartmental knee replacement exhibited good frontal plane knee mechanics and were able to produce the same level of knee extensor moment as healthy control limbs during walking. While showing some compensatory patterns during walking, patients with bi-compartmental knee replacement largely exhibited normal gait patterns and knee mechanics.

Download full-text

Full-text

Available from: Eric L Dugan, Feb 12, 2014
  • Source
    • "One alternative to the TKR, especially for more active patients, is partial knee replacement (PKR), which leaves the lateral knee compartment and cruciate ligaments intact while replacing the affected knee compartments (e.g., medial compartment and patellofemoral joint). PKR results in fast recovery times, less bone loss and normal knee mechanics [8, 12–15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Partial knee replacement (PKR) results in fast recovery and good knee mechanics and is ideal to treat medial knee osteoarthritis. Cementless PKR depends on bone growing into the implant surface for long-term fixation. Implant loosening may occur due to high tensile strain resulted from large mechanical loads during rehab exercises. The purpose of this study is to investigate whether external fixations such as superior screw and frontal flange could reduce the tensile strain at the implant-bone interface. Three medial PKRs were designed. The first PKR had no external fixations. A superior screw and a frontal flange were then added to the first PKR to form the second and third PKR designs, respectively. Finite element analysis was performed to examine the tensile strain at the implant-bone interface during weight-bearing exercises. The PKR with no external fixations exhibited high tensile strain at the anterior implant-bone interface. Both the screwed and flanged PKRs effectively reduced the tensile strain at the anterior implant-bone interface. Furthermore, the flanged PKR resulted in a more uniform reduction of the tensile strain than the screwed PKR. In conclusion, external fixations are necessary to alleviate tensile strain at the implant-bone interface during knee rehab exercises.
    Full-text · Article · May 2012 · International Journal of Rheumatology
  • Source
    • "Bi-compartmental knee arthroplasty (BKA), replacing the medial and patellofemoral compartments, attempts to satisfy the fact that these compartments are most often affected by osteoarthritis [6,7]. The surgical approach for BKA is either to combine UKA and patellofemoral arthroplasty (PFA) in a modular design [8,9], or to use a recently developed non-modular femoral design [10-13]. In BKA, the anterior and posterior cruciate ligaments (PCL) can be preserved, and the reasons for retaining the cruciate ligaments in knee arthroplasty (KA) design include enhanced stability, decreased shear force between implant-bone interface, more physiological tibiofemoral kinematics, and maintenance of proprioception [14,15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The cruciate ligaments are important stabilizers of the knee joint and determine joint kinematics in the natural knee and after cruciate retaining arthroplasty.No in vitro data is available to biomechanically evaluate the ability of the anterior cruciate ligament (ACL) to maintain knee joint kinematics after bicruciate-retaining bi-compartmental knee arthroplasty (BKA).Therefore, the objective of the current study was to investigate the kinematics of the natural knee joint, before and after installing bicruciate-retaining BKA and posterior cruciate retaining total knee arthroplasty. Specifically, we incorporated a dynamic knee simulator to simulate weight-bearing flexions on cadaveric knee specimen before and after surgical manipulations. In this cadaveric study we investigated rotational and translational tibiofemoral kinematics during simulated weight-bearing flexions of the intact knee, after bi-compartmental knee arthroplasty (BKA+), after resecting the ACL in BKA (BKA-), and after posterior cruciate retaining total knee arthroplasty (TKA). Rotation of BKA+ is closest to the intact knee joint, whereas TKA shows significant differences from 30 to 90 degree of flexion. Within the tested flexion range (15 to 90 degree of flexion), there was no significant difference in the anterior-posterior translation among intact, BKA+, and TKA knees. Resecting the ACL in BKA leads to a significant anterior tibial translation. BKA with intact cruciate ligaments resembles rotation and translation of the natural knee during a simulated weight-bearing flexion. It is a suitable treatment option for medial and patellofemoral osteoarthritis with advantages in rotational characteristics compared to TKA.
    Full-text · Article · Jan 2011 · BMC Musculoskeletal Disorders
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Einleitung Die Journey-Deuce-Prothese ist ein bikompartimenteller Oberflächenersatz für Patienten mit einer medialen und patellofemoralen Arthrose und stellt eine Erweiterung der prothetischen Versorgungsmöglichkeiten der Kniegelenkarthrose dar. Die Prothese besteht aus einem Femurschild, der die mediale Kondyle und Trochlea bedeckt, sowie aus einem medialen Hemi-Ersatz des Tibiaplateaus. Die Vorteile gegenüber der totalen Kniegelenkprothese sollen in der knochensparenden und kreuzbanderhaltenden Implantationstechnik liegen. Untersuchungen des Patientenoutcomes, der Erfolgs- und Komplikationsrate sowie möglicher Optimierungsstrategien liegen bisher kaum vor. Ziel der Arbeit ist daher, das frühfunktionelle Outcome sowie die Revisions- und Komplikationsraten von Patienten mit einer Journey-Deuce-Prothese innerhalb der ersten 2 Jahre nach Implantation zu evaluieren und zu analysieren. Methoden Dreiundvierzig Patienten (25w/18 m, 62,4±8 Jahre, 27,3±4,5 kg/m2) wurde im Zeitraum 03/2008–03/2009 eine Journey-Deuce-Prothese implantiert. Einschlusskriterien waren eine klinisch und radiologisch gesicherte mediale und patellofemorale Arthrose, ein intakter Bandapparat sowie eine Flexion > 90°. Ausschlusskriterien waren eine Bandinstabilität, eine Achsfehlstellung > 10° und ein patellofemorales Malalignment. Das Follow-up betrug 6, 12 und 24 Monate. Neben einer klinischen und radiologischen Untersuchung wurden der Knee Society Score (KSS), ein Schmerzscore VAS (visuelle Analogskala, 0–10) und die Zufriedenheit der Patienten evaluiert. Ergebnisse Fünfunddreißig (82%) der 43 Patienten erreichten das 2-Jahres-Follow-up. Von diesen 35 wiesen 26 (75%) eine gute bis sehr gute Zufriedenheit, einen adäquaten KSS- (Mittel 93 [65–100]) und geringen Schmerzscore (Mittel 1,2 [0–4]) auf. Nach 12 Monaten hatten alle Patienten eine Kniegelenkbeweglichkeit von > 90° (Mittel 116° [95–140°]). Lockerungen lagen nicht vor. Bei 8 (18%) Patienten wurden innerhalb der ersten 17 (5–17 Monate) aufgrund eines persistierenden Kniegelenkschmerzes durch Malalignment oder ligamentärer Instabilität auf eine Totalendoprothese gewechselt. Schlussfolgerung Die Journey-Deuce-Prothese ermöglicht bei klarer Indikationsstellung und exakter anatomischer Positionierung ein gutes bis sehr gutes funktionelles Outcome. Es resultiert allerdings eine erhöhte Revisionsrate aufgrund technischer Komplexität und unzureichender Implantatauswahl, die zu Fehlpositionierungen und Instabilitäten führen. Zusätzliche Positionierungshilfen sowie eine größere Variabilität bei Implantatgrößen und -design sind zukünftig notwendig, um eine adäquate Versorgung mit anatomisch korrekter Positionierung zu gewährleisten. Dann wäre die Journey-Deuce-Prothese prinzipiell eine sinnvolle Erweiterung des endoprothetischen Spektrums, die eine individuellere und selektive Patientenversorgung ermöglichen würde.
    Full-text · Article · Nov 2012 · Der Orthopäde
Show more