BACKGROUND. UKA is functionally superior to TKA, with kinematics similar to native knees, nevertheless, UKA implants are used in less than 10% of cases. While advantages of UKA are recognized, ACL-deficiency is generally considered a contraindication. The hypothesis of this study was that fix bearing UKA in
Introduction. Unicompartmental knee arthroplasty(UKA) has become a popular treatment alternative when one compartment of the knee is affected. Excellent intermediate results have been reported in association with the Miller-Galante unicompartmental implant. These excellent results are based on the development of the implants and the stringent patients selection. The functional cruciate ligaments has been a prerequisite for patients undergoing UKA. However, UKA can be one of the procedures in elderly patiants with deficient anterior cruciate ligaments(ACL) but with no symptoms of instability. The purpose of this report is to determine the clinical results after UKA in patients with
The question of whether to reconstruct an
Answering the question of what the patient can teach us about the future of joint replacement starts with a look to the past. The modern era of total joint replacement began in the late 1950's with the pioneering work of John Charnley that established the fundamental structure of a total joint replacement with a metal component bearing against polyethylene and provided many disabled patients with a substantial improvement in function. As the application of joint replacement expanded to a broader patient population it became apparent that a better understanding of the mechanics of patient function was needed to provide more rigorous design criteria and objective assessment of design changes. This presentation will examine how improvements in total knee replacement has been aided by objective measures of ambulatory function and the potential for future improvements in joint replacement that can be based on information from testing patients. Specifically, from a historical viewpoint one of the major problems limiting the use of total knee replacement in the 1970's was tibial component loosening. The problem of tibial component loosening could be related to the load imbalance between the medial and lateral surface of the tibia. The load asymmetry at the knee resulting from the adduction moment during gait provided a strong rationale for maintaining proper limb alignment following total knee arthroplasty. The analysis clearly showed that knees with a varus alignment of the mechanical axis were more likely to have a substantial load imbalance creating the type of stresses that would eventually lead to tibial component loosening. When the information from gait studies was combined with both clinical and biomechanical studies, tibial component designs were modified using metal backing of the polyethylene articulating surface and instrumentation was modified to allow for proper alignment of the mechanical axis and avoid residual varus deformity following total knee replacement. Similarly, knee kinematics and moments have been used to differentiate the functional characteristics of different types of designs during stair climbing. Patients with cruciate-sacrificing knee replacements had a tendency to reduce the moment sustained by the quadriceps by leaning forward during the portion of the support phase of ascending stairs when the quadriceps moment would reach a peak value, while patients with a posterior cruciate retaining design were able to sustain normal quadriceps function. The functional differences between the PCL-retaining and sacrificing designs were associated with the normal posterior movement of the femur on the tibia (rollback), with flexion. This finding indicated that TKR design must permit rollback in the early phases of knee flexion to sustain normal stair climbing. This presentation will conclude with a review of the functional performance of patients with an
The history of knee mechanics studies and the evolution of knee arthroplasty design have been well reported through the last decade (e.g. [1],[2]). Through the early 2000's, there was near consensus on the dominant motions occurring in the healthy knee among much of the biomechanics and orthopaedic communities. However, the past decade has seen the application of improved measurement techniques to permit accurate measurement of natural knee motion during activities like walking and running. The results of these studies suggest healthy knee motion is more complex than previously thought, and therefore, design of suitable arthroplasty devices more difficult. The purpose of this paper is to briefly review the knee biomechanics literature before 2008, to present newer studies for walking and running, and to discuss the implications of these findings for the design of knee replacement implants that seek to replicate physiologic knee motions. Many surgeons point to Brantigan and Voshell [3], an anatomic study of over one hundred specimens focusing on the ligamentous and passive stabilizers of the knee, as being an important influence in their thinking about normal knee function. M.A.R. Freeman and colleagues in London claim particular influence from this work, which motivated their extensive series of MR-based knee studies reported in 2000 [4,5,6]. These papers, perhaps more than any others, are responsible for the common impression that knee kinematics are well and simply described as having a ‘medial pivot’ pattern, where the medial condyle remains stationary on the tibial plateau while the lateral condyle translates posteriorly with knee flexion. Indeed, subsequent studies in healthy and arthritic knees during squatting and kneeling [7,8,9] and healthy and
