The Anterior-Posterior Stability of Partial, Combined Partial and Total Knee Arthroplasty

AbstractWe hypothesized that a total knee arthroplasty (TKA) with an intraoperative tibial force greater than the tibial force of the native knee has signs of stiffness as measured by loss of extension and flexion, and anterior translation of the tibia. Intraoperative forces in the medial and lateral tibial compartments were measured during passive motion in 71 patients treated with calipered kinematically aligned TKA. Maximum extension, flexion, and the anterior–posterior position of the tibia with respect to the distal femur at 90 degrees of flexion were measured. Measurements were repeated after exchanging to a 2 mm thicker insert. The sum of the average of the medial and lateral compartment forces at 0, 45, and 90 degrees of flexion represented the tibial force through a 90-degree motion arc. For the implanted insert, the tibial force averaged 28 ± 17 lb, which is comparable to the 20 ± 7 lb reported for the native knee. At 6 months, patients reported an average 40 point Oxford Knee and 15 point Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. For the 2 mm thicker insert, the tibial force averaged 50 ± 28 lb. A 30 lb tibial force greater than native generated a 3-degree loss of extension, a 3-degree loss of flexion, and 3-mm anterior translation of the tibia. Because a TKA with a tibial force greater than native has signs of stiffness, a strategy for lowering this risk is to match the tibial force of the native knee when balancing a TKA as this restored high function.

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Partial and Combined Partial Knee Arthroplasty: Greater Anterior-Posterior Stability than Posterior-Cruciate Retaining Total Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2021.06.025 ◽

2021 ◽

Author(s):

Amy Garner ◽

Oliver Dandridge ◽

Richard van Arkel ◽

Andrew Amis ◽

Justin Cobb

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Cruciate Retaining ◽

Partial Knee Arthroplasty ◽

Total Knee ◽

Anterior Posterior

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Which is better? Anterior or posterior referencing for femoral component position in total knee arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/23094990211002325 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902110023

Author(s):

Sho Nojiri ◽

Kazue Hayakawa ◽

Hideki Date ◽

Yasushi Naito ◽

Keigo Sato ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Femoral Condyle ◽

Standard Technique ◽

Component Position ◽

Intermediate Size ◽

Total Knee ◽

Left And Right ◽

Anterior Posterior

When sizing the femoral component or determining its placement in total knee arthroplasty (TKA), if the anterior–posterior diameter of the femoral condyle is between component sizes, the selected size will differ depending on whether anterior referencing (AR) or posterior referencing (PR) is used. As a result, the amount of resected bone will also vary. In the present prospective study, we compared the two referencing methods to determine which is more suitable for individual patients. We recruited 58 patients (92 joints) who received TKA using the standard technique with intermediate-size components. AR was used in 26 joints, and PR in 23 joints. Seventeen of the patients underwent same-day bilateral TKA in which components of different sizes were used for the left and right joints. AR resulted in significantly smaller anterior and posterior offsets than PR. Preoperative clinical evaluation revealed no significant differences among cases in which intermediate-size components were indicated, or those in which components of different sizes were indicated. When an intermediate-sized component was indicated using the AR method, moving the sizer forward resulted in a larger posterior gap, but this technique was nevertheless considered acceptable. AR is likely to be more suitable than PR as it achieves more physiological anterior clearance.

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Gender Influences Gait Asymmetry following Bicruciate-Retaining Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0039-1681092 ◽

2019 ◽

Vol 33 (06) ◽

pp. 582-588 ◽

Cited By ~ 1

Author(s):

David Hennessy ◽

Paul Arauz ◽

Christian Klemt ◽

Shuai An ◽

Young-Min Kwon

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Imaging System ◽

Knee Kinematics ◽

Male And Female ◽

Female Patients ◽

Total Knee ◽

Bcr Tka ◽

Anterior Posterior

AbstractThis is an experimental study. Gender has been reported to influence outcomes in patients with total knee arthroplasty (TKA) for knee osteoarthritis (OA). However, the influence of gender on three-dimensional (3D) in vivo kinematics during gait remains unclear. This study aimed to determine if 3D gait kinematics, including 3D knee translations and rotations, differed in men and women following bicruciate-retaining (BCR) TKA. Twenty-nine well-functioning unilateral BCR TKA patients (14 males and 15 females) underwent evaluation of both knees during level walking on a treadmill at a self-selected speed using a dual fluoroscopic imaging system. Interlimb comparisons of in vivo 6 degree-of-freedom kinematics were compared between male and female patients. Differences of pre- and postoperative Knee Society scores (KSSs) were compared between the groups. Both groups were matched regarding age and body mass index. Both male and female patients demonstrated improvement in their postoperative KSSs. Statistically significant differences were observed with respect to spatiotemporal anterior–posterior interlimb translations (p < 0.05). Although females presented more femoral posterior translation in the operative knee than the nonoperative knee during most of the stance phases (2.8 vs. −1.6 mm), males exhibited less femoral translation in the operative knee than the nonoperative knee (2.3 vs. −1.8 mm), when interlimb differences were detected during stance phase. Results demonstrated that there are 3D motion asymmetries of the knee in both male and female unilateral BCR TKA patients during gait with anterior–posterior interlimb asymmetries significantly greater in female than male participants. This suggests that gender may influence the in vivo knee kinematics in BCR TKA patients during gait.

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Diagnostic Algorithm in Patients with Flexion Instability after Cruciate-Retaining Total Knee Arthroplasty: A Case Report

Clinics and Practice ◽

10.3390/clinpract11030084 ◽

2021 ◽

Vol 11 (3) ◽

pp. 687-693

Author(s):

Lukas B. Moser ◽

Ponnaian Prabhakar ◽

Silvan Hess ◽

Michael T. Hirschmann

Keyword(s):

Total Knee Arthroplasty ◽

Case Report ◽

Knee Arthroplasty ◽

Cruciate Ligament ◽

Diagnostic Algorithm ◽

Tracer Uptake ◽

Cruciate Retaining ◽

Total Knee ◽

Dynamic Examination ◽

Anterior Posterior

A posterior flexion instability due to insufficiency of the posterior cruciate ligament (PCL) in cruciate retaining (CR) total knee arthroplasty (TKA) is an important but underdiagnosed problem. We hereby suggest a diagnostic algorithm, as demonstrated by a case report of a male patient suffering from anterior knee pain and instability after CR TKA. Clinical examination was followed by standard anterior–posterior and lateral radiographs. Stress radiographs in 30° and 90° posterior drawer position enabled a dynamic examination of the instability. SPECT/CT was used to determine the TKA component position in all planes and investigate bone tracer uptake (BTU) patterns. At revision surgery, an absent PCL after CR TKA was noted and a semi-constrained TKA was implanted.

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Short-Term Results of Total Knee Arthroplasty with Anterior-Posterior Glide LCS Mobile-Bearing System

Knee Surgery and Related Research ◽

10.5792/ksrr.2014.26.3.162 ◽

2014 ◽

Vol 26 (3) ◽

pp. 162-167

Author(s):

Kyung Taek Kim ◽

Min Soo Kang ◽

Young Hoon Lim ◽

Jin Woo Park ◽

Lih Wang

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Mobile Bearing ◽

Short Term ◽

Total Knee ◽

Bearing System ◽

Anterior Posterior

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Bone Cuts Accuracy of a System for Total Knee Arthroplasty including an Active Robotic Arm

Journal of Clinical Medicine ◽

10.3390/jcm10163714 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3714

Author(s):

Killian Cosendey ◽

Julien Stanovici ◽

Jaad Mahlouly ◽

Patrick Omoumi ◽

Brigitte M. Jolles ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Statistical Tests ◽

Robotic Arm ◽

Orthopaedic Surgeons ◽

Total Knee ◽

Level Of Experience ◽

Different Levels ◽

Posterior Position ◽

Anterior Posterior

This study aimed to assess the bone cuts accuracy of a system for total knee arthroplasty including an active robotic arm. A second objective was to compare the accuracy among orthopaedic surgeons of different levels of experience. To this end, three orthopaedic surgeons cut 10 sawbone knees each. Planned and actual bone cuts were compared using computed tomography. Difference with respect to the planning was expressed as three position and three orientation errors following the anatomical planes. Statistical tests were performed to detect bias and compare surgeons. None of the 30 knees presented an outlier error, meaning an error ≥3 mm or ≥3°. The root-mean-square values of the 12 error types were below 0.8 mm or 0.8°, except for the femoral proximal–distal errors (1.7 mm) and the tibial anterior-posterior errors (1.4 mm). Biases were observed, particularly in femoral proximal–distal and tibial anterior–posterior positions. Median differences between surgeons were all lower than 0.8 mm and 0.5°, with statistically significant differences among surgeons in the femoral proximal–distal errors and the tibial anterior–posterior errors. In conclusion, the system tested in this study achieved accurate bone cuts independently of the surgeon’s level of experience. Biases were observed, suggesting that there might be options to improve the accuracy, particularly in proximal–distal position for the femur and in anterior–posterior position for the tibia.

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