Bi-unicondylar knee replacement laxity with changes to simulated soft tissue constraints

Unicondylar knee replacement systems have been shown to perform comparably to total knee replacements, while being much less surgically invasive. Proper ligament balancing, as well as knee laxity, has been shown to play an important role in optimizing kinematic behavior of these implant systems and improving long-term survival of the implant. This study investigates the effect of different simulated ligament laxity conditions of the anterior cruciate ligament and the posterior cruciate ligament on the resulting anteroposterior and mediolateral contact kinematics for medial and lateral pairs of UKR implants with flat and symmetric ultrahigh-molecular-weight polyethylene inserts during force-controlled ISO-14243-1 knee testing simulation. A novel method of capturing the tibiofemoral lowest point contact path was used to calculate the shear plane lowest point contact path kinematics in both the anteroposterior and the mediolateral directions. The results illustrated that multiple clinically relevant soft tissue configurations produce statistically different measured knee kinematics in unicondylar knee replacement systems than is seen in accepted “standard” knee simulator protocols with 95% confidence interval. The observed kinematic differences in anteroposterior and mediolateral movement from what was observed using standard wear testing protocols could aid in the development of unicondylar knee replacement design enhancements that are resistant to varying soft tissue deficiencies.

[1]  J. Newman,et al.  Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicompartmental arthritis. , 1998, The Journal of bone and joint surgery. British volume.

[2]  R. Bourne,et al.  The Role of Polyethylene Design on Postoperative TKA Flexion: An Analysis of 1534 Cases , 2010, Clinical orthopaedics and related research.

[3]  J D DesJardins,et al.  The use of a force-controlled dynamic knee simulator to quantify the mechanical performance of total knee replacement designs during functional activity. , 2000, Journal of biomechanics.

[4]  R. Nagamine,et al.  Effect of medial displacement of the tibial tubercle on patellar position after rotational malposition of the femoral component in total knee arthroplasty. , 1996, The Journal of arthroplasty.

[5]  Johan Bellemans,et al.  In Vivo Kinematics after a Cruciate-substituting TKA , 2010, Clinical orthopaedics and related research.

[6]  M. Harrison,et al.  Validation of the Soft Tissue Restraints in a Force-Controlled Knee Simulator , 2006, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[7]  Glen A. Livesay,et al.  Relative contribution of the ACL, MCL, and bony contact to the anterior stability of the knee , 1999, Knee Surgery, Sports Traumatology, Arthroscopy.

[8]  M. Hashizume,et al.  Posterior Displacement of the Tibia Increases in Deep Flexion of the Knee , 2010, Clinical orthopaedics and related research.

[9]  P. Müller,et al.  Influence of minimally invasive surgery on implant positioning and the functional outcome for medial unicompartmental knee arthroplasty. , 2004, The Journal of arthroplasty.

[10]  D. Dennis,et al.  Gap Balancing versus Measured Resection Technique for Total Knee Arthroplasty , 2010, Clinical orthopaedics and related research.

[11]  E. Grood,et al.  The posterior cruciate ligament in total knee arthroplasty. , 1997, The Journal of arthroplasty.

[12]  L. Sensi,et al.  Rotational Position of Femoral and Tibial Components in TKA Using the Femoral Transepicondylar Axis , 2008, Clinical orthopaedics and related research.

[13]  B. Saccomanni.  Erratum: Unicompartmental knee arthroplasty: a review of literature , 2010, Clinical Rheumatology.

[14]  H. Schmotzer,et al.  Does ligament balancing technique affect kinematics in rotating platform, PCL retaining knee arthroplasties? , 2007, Knee Surgery, Sports Traumatology, Arthroscopy.

[15]  Guoan Li,et al.  Function of the anterior cruciate ligament after unicompartmental knee arthroplasty: an in vitro robotic study. , 2004, The Journal of arthroplasty.

[16]  Peter S. Walker,et al.  Effects of patient and surgical alignment variables on kinematics in TKR simulation under force-control , 2006 .

[17]  Richard Iorio,et al.  Unicompartmental Arthritis of the Knee , 2003, The Journal of bone and joint surgery. American volume.

[18]  P. Cartier,et al.  Unicondylar knee arthroplasty , 1987 .

[19]  D R Broome,et al.  A knee simulating machine for performance evaluation of total knee replacements. , 1997, Journal of biomechanics.

[20]  P. Walker,et al.  Preclinical evaluation method for total knees designed to restore normal knee mechanics. , 2011, The Journal of arthroplasty.

[21]  M. Dyer,et al.  Environmental monitoring of the sediment pollution along the Thai-Laos Mekong , 2006 .

[22]  T. Wright,et al.  Tibial Post Wear in Posterior-stabilized Knee Replacements is Design-dependent , 2008, Clinical orthopaedics and related research.

[23]  S. Marya,et al.  Unicompartmental knee arthroplasty for tricompartment osteoarthritis in octogenarians , 2009, Indian journal of orthopaedics.

[24]  Y. Jung,et al.  Medium Term Results of a Mobile Bearing Total Knee Replacement , 2003 .

[25]  John Fisher,et al.  2009 Knee Society Presidential Guest Lecture: Polyethylene Wear in Total Knees , 2010, Clinical orthopaedics and related research.

[26]  A. Leardini,et al.  The Mark Coventry Award Articular: Contact Estimation in TKA Using In Vivo Kinematics and Finite Element Analysis , 2010, Clinical orthopaedics and related research.

[27]  A. Eskelinen,et al.  Unicondylar knee replacement for primary osteoarthritis: A prospective follow-up study of 1,819 patients from the Finnish Arthroplasty Register , 2007, Acta orthopaedica.

[28]  Tyson L Hedrick,et al.  Software techniques for two- and three-dimensional kinematic measurements of biological and biomimetic systems , 2008, Bioinspiration & biomimetics.

[29]  円山 茂樹.  Functional comparison of posterior cruciate-retaining versus posterior stabilized total knee arthroplasty , 2005 .

[30]  Benjamin J. Fregly,et al.  Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements , 2005, Knee Surgery, Sports Traumatology, Arthroscopy.

[31]  S. Affatato,et al.  Bi-unicondylar knee prosthesis functional assessment utilizing force-control wear testing , 2010, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[32]  J. Callaghan,et al.  THE JOHN INSALL AWARD: Unicompartmental Knee Replacement: A Minimum Twenty-One-Year Followup, End-Result Study , 2005, Clinical orthopaedics and related research.