Changes in femoral rollback and rotation with increasing coupling in knee arthroplasty—a biomechanical in-vitro study
Abstract Background After total knee arthroplasty, 10–30% of patients still complain about knee pain, even after exact positioning of the components. Altered knee kinematics are crucial in this regard. The aim of our study was to experimentally determine the influence of different degrees of compone...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-023-06430-w |
| _version_ | 1827952977154932736 |
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| author | Andrea Lorenz Alexander Winter Moritz Mederake Clemens Freidhager Ulf Krister Hofmann Ulf Gunther Leichtle |
| author_facet | Andrea Lorenz Alexander Winter Moritz Mederake Clemens Freidhager Ulf Krister Hofmann Ulf Gunther Leichtle |
| author_sort | Andrea Lorenz |
| collection | DOAJ |
| description | Abstract Background After total knee arthroplasty, 10–30% of patients still complain about knee pain, even after exact positioning of the components. Altered knee kinematics are crucial in this regard. The aim of our study was to experimentally determine the influence of different degrees of component coupling of knee prostheses on joint kinematics during muscle-loaded knee flexion in-vitro. Methods Femoral rollback and femoral rotation of a standard cruciate retaining (GCR), a posterior stabilized (GPS), a rotational hinge (RSL) and a total hinge (SSL) design of the same series of knee replacement implants (SL-series) of one single manufacturer (Waldemar Link GmbH, Hamburg, Germany) were analyzed and set in relation to the motion of the corresponding native knee in a paired study design. All different coupling degrees were analyzed in the same human knees. To simulate muscle loaded knee flexion, a knee simulator was used. Kinematics were measured with an ultrasonic motion capture system and integrated in a calculated coordinate system via CT-imaging. Results The largest posterior motion on the lateral side was found for the native knee (8.7 ± 7.0 mm), followed by the GPS (3.2 ± 5.1 mm) and GCR (2.8 ± 7.3 mm) implants, while no motion was found for the RSL (0.1 ± 3.0 mm) and the SSL (-0.6 ± 2.7 mm) implants. In contrast, on the medial side, only the native knee showed a posterior motion (2.1 ± 3.2 mm). Regarding femoral external rotation, the only implant where the observed difference did not reach statistical significance when compared to the native knee was the GCR (p = 0.007). Conclusion The GCR and GPS kinematics closely imitate those of the native joint. Medial femoral rollback is reduced, however, with the joint pivoting around a rotational center located in the medial plateau. Without additional rotational forces, the coupled RSL and SSL prostheses closely resemble each other with no femoral rollback or relevant rotational component. The femoral axis, however, shifts ventrally in both models when compared with their primary counterparts. The positioning of the coupling mechanism in the femoral and tibial component thus can already lead to altered joint kinematics even in prostheses with an identical surface geometry. |
| first_indexed | 2024-04-09T14:05:47Z |
| format | Article |
| id | doaj.art-b8b3ba9592324910ba90de42c6954fa6 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-09T14:05:47Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-b8b3ba9592324910ba90de42c6954fa62023-05-07T11:03:15ZengBMCBMC Musculoskeletal Disorders1471-24742023-05-0124111210.1186/s12891-023-06430-wChanges in femoral rollback and rotation with increasing coupling in knee arthroplasty—a biomechanical in-vitro studyAndrea Lorenz0Alexander Winter1Moritz Mederake2Clemens Freidhager3Ulf Krister Hofmann4Ulf Gunther Leichtle5Austrian Center for Medical Innovation and Technology (ACMIT Gmbh)Department of Orthopaedic Surgery, University Hospital TübingenDepartment of Trauma and Reconstructive Surgery, BG Klinik, University of TübingenInstitute for Lightweight Design and Computational Biomechanics, TU WienDepartment of Orthopaedic Surgery, University Hospital TübingenDepartment of Orthopaedic Surgery, University Hospital TübingenAbstract Background After total knee arthroplasty, 10–30% of patients still complain about knee pain, even after exact positioning of the components. Altered knee kinematics are crucial in this regard. The aim of our study was to experimentally determine the influence of different degrees of component coupling of knee prostheses on joint kinematics during muscle-loaded knee flexion in-vitro. Methods Femoral rollback and femoral rotation of a standard cruciate retaining (GCR), a posterior stabilized (GPS), a rotational hinge (RSL) and a total hinge (SSL) design of the same series of knee replacement implants (SL-series) of one single manufacturer (Waldemar Link GmbH, Hamburg, Germany) were analyzed and set in relation to the motion of the corresponding native knee in a paired study design. All different coupling degrees were analyzed in the same human knees. To simulate muscle loaded knee flexion, a knee simulator was used. Kinematics were measured with an ultrasonic motion capture system and integrated in a calculated coordinate system via CT-imaging. Results The largest posterior motion on the lateral side was found for the native knee (8.7 ± 7.0 mm), followed by the GPS (3.2 ± 5.1 mm) and GCR (2.8 ± 7.3 mm) implants, while no motion was found for the RSL (0.1 ± 3.0 mm) and the SSL (-0.6 ± 2.7 mm) implants. In contrast, on the medial side, only the native knee showed a posterior motion (2.1 ± 3.2 mm). Regarding femoral external rotation, the only implant where the observed difference did not reach statistical significance when compared to the native knee was the GCR (p = 0.007). Conclusion The GCR and GPS kinematics closely imitate those of the native joint. Medial femoral rollback is reduced, however, with the joint pivoting around a rotational center located in the medial plateau. Without additional rotational forces, the coupled RSL and SSL prostheses closely resemble each other with no femoral rollback or relevant rotational component. The femoral axis, however, shifts ventrally in both models when compared with their primary counterparts. The positioning of the coupling mechanism in the femoral and tibial component thus can already lead to altered joint kinematics even in prostheses with an identical surface geometry.https://doi.org/10.1186/s12891-023-06430-wFemoral rollbackTotal knee arthroplastyHinged kneeKnee simulatorBiomechanics |
| spellingShingle | Andrea Lorenz Alexander Winter Moritz Mederake Clemens Freidhager Ulf Krister Hofmann Ulf Gunther Leichtle Changes in femoral rollback and rotation with increasing coupling in knee arthroplasty—a biomechanical in-vitro study BMC Musculoskeletal Disorders Femoral rollback Total knee arthroplasty Hinged knee Knee simulator Biomechanics |
| title | Changes in femoral rollback and rotation with increasing coupling in knee arthroplasty—a biomechanical in-vitro study |
| title_full | Changes in femoral rollback and rotation with increasing coupling in knee arthroplasty—a biomechanical in-vitro study |
| title_fullStr | Changes in femoral rollback and rotation with increasing coupling in knee arthroplasty—a biomechanical in-vitro study |
| title_full_unstemmed | Changes in femoral rollback and rotation with increasing coupling in knee arthroplasty—a biomechanical in-vitro study |
| title_short | Changes in femoral rollback and rotation with increasing coupling in knee arthroplasty—a biomechanical in-vitro study |
| title_sort | changes in femoral rollback and rotation with increasing coupling in knee arthroplasty a biomechanical in vitro study |
| topic | Femoral rollback Total knee arthroplasty Hinged knee Knee simulator Biomechanics |
| url | https://doi.org/10.1186/s12891-023-06430-w |
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