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Bone & Joint Research
Vol. 11, Issue 10 | Pages 739 - 750
4 Oct 2022
Shu L Abe N Li S Sugita N

Aims. To fully quantify the effect of posterior tibial slope (PTS) angles on joint kinematics and contact mechanics of intact and anterior cruciate ligament-deficient (ACLD) knees during the gait cycle. Methods. In this controlled laboratory study, we developed an original multiscale subject-specific finite element musculoskeletal framework model and integrated it with the tibiofemoral and patellofemoral joints with high-fidelity joint motion representations, to investigate the effects of 2.5° increases in PTS angles on joint dynamics and contact mechanics during the gait cycle. Results. The ACL tensile force in the intact knee was significantly affected with increasing PTS angle. Considerable differences were observed in kinematics and initial posterior femoral translation between the intact and ACLD joints as the PTS angles increased by more than 2.5° (beyond 11.4°). Additionally, a higher contact stress was detected in the peripheral posterior horn areas of the menisci with increasing PTS angle during the gait cycle. The maximum tensile force on the horn of the medial meniscus increased from 73.9 N to 172.4 N in the ACLD joint with increasing PTS angles. Conclusion. Knee joint instability and larger loading on the medial meniscus were found on the ACLD knee even at a 2.5° increase in PTS angle (larger than 11.4°). Our biomechanical findings support recent clinical evidence of a high risk of failure of ACL reconstruction with steeper PTS and the necessity of ACL reconstruction, which would prevent meniscus tear and thus the development or progression of osteoarthritis. Cite this article: Bone Joint Res 2022;11(10):739–750


Bone & Joint Research
Vol. 11, Issue 2 | Pages 82 - 90
7 Feb 2022
Eckert JA Bitsch RG Sonntag R Reiner T Schwarze M Jaeger S

Aims

The cemented Oxford unicompartmental knee arthroplasty (OUKA) features two variants: single and twin peg OUKA. The purpose of this study was to assess the stability of both variants in a worst-case scenario of bone defects and suboptimal cementation.

Methods

Single and twin pegs were implanted randomly allocated in 12 pairs of human fresh-frozen femora. We generated 5° bone defects at the posterior condyle. Relative movement was simulated using a servohydraulic pulser, and analyzed at 70°/115° knee flexion. Relative movement was surveyed at seven points of measurement on implant and bone, using an optic system.


Bone & Joint Research
Vol. 10, Issue 11 | Pages 723 - 733
1 Nov 2021
Garner AJ Dandridge OW Amis AA Cobb JP van Arkel RJ

Aims

Bi-unicondylar arthroplasty (Bi-UKA) is a bone and anterior cruciate ligament (ACL)-preserving alternative to total knee arthroplasty (TKA) when the patellofemoral joint is preserved. The aim of this study is to investigate the clinical outcomes and biomechanics of Bi-UKA.

Methods

Bi-UKA subjects (n = 22) were measured on an instrumented treadmill, using standard gait metrics, at top walking speeds. Age-, sex-, and BMI-matched healthy (n = 24) and primary TKA (n = 22) subjects formed control groups. TKA subjects with preoperative patellofemoral or tricompartmental arthritis or ACL dysfunction were excluded. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were compared. Bi-UKA, then TKA, were performed on eight fresh frozen cadaveric knees, to investigate knee extensor efficiency under controlled laboratory conditions, using a repeated measures study design.


Bone & Joint Research
Vol. 10, Issue 1 | Pages 1 - 9
1 Jan 2021
Garner A Dandridge O Amis AA Cobb JP van Arkel RJ

Aims

Unicompartmental knee arthroplasty (UKA) and bicompartmental knee arthroplasty (BCA) have been associated with improved functional outcomes compared to total knee arthroplasty (TKA) in suitable patients, although the reason is poorly understood. The aim of this study was to measure how the different arthroplasties affect knee extensor function.

Methods

Extensor function was measured for 16 cadaveric knees and then retested following the different arthroplasties. Eight knees underwent medial UKA then BCA, then posterior-cruciate retaining TKA, and eight underwent the lateral equivalents then TKA. Extensor efficiency was calculated for ranges of knee flexion associated with common activities of daily living. Data were analyzed with repeated measures analysis of variance (α = 0.05).


Bone & Joint Research
Vol. 9, Issue 11 | Pages 768 - 777
2 Nov 2020
Huang C Lu Y Hsu L Liau J Chang T Huang C

Aims

The material and design of knee components can have a considerable effect on the contact characteristics of the tibial post. This study aimed to analyze the stress distribution on the tibial post when using different grades of polyethylene for the tibial inserts. In addition, the contact properties of fixed-bearing and mobile-bearing inserts were evaluated.

Methods

Three different grades of polyethylene were compared in this study; conventional ultra high molecular weight polyethylene (UHMWPE), highly cross-linked polyethylene (HXLPE), and vitamin E-stabilized polyethylene (VEPE). In addition, tibial baseplates with a fixed-bearing and a mobile-bearing insert were evaluated to understand differences in the contact properties. The inserts were implanted in neutral alignment and with a 10° internal malrotation. The contact stress, von Mises stress, and equivalent plastic strain (PEEQ) on the tibial posts were extracted for comparison.


Aims. Mobile-bearing unicompartmental knee arthroplasty (UKA) with a flat tibial plateau has not performed well in the lateral compartment, leading to a high rate of dislocation. For this reason, the Domed Lateral UKA with a biconcave bearing was developed. However, medial and lateral tibial plateaus have asymmetric anatomical geometries, with a slightly dished medial and a convex lateral plateau. Therefore, the aim of this study was to evaluate the extent at which the normal knee kinematics were restored with different tibial insert designs using computational simulation. Methods. We developed three different tibial inserts having flat, conforming, and anatomy-mimetic superior surfaces, whereas the inferior surface in all was designed to be concave to prevent dislocation. Kinematics from four male subjects and one female subject were compared under deep knee bend activity. Results. The conforming design showed significantly different kinematics in femoral rollback and internal rotation compared to that of the intact knee. The flat design showed significantly different kinematics in femoral rotation during high flexion. The anatomy-mimetic design preserved normal knee kinematics in femoral rollback and internal rotation. Conclusion. The anatomy-mimetic design in lateral mobile UKA demonstrated restoration of normal knee kinematics. Such design may allow achievement of the long sought normal knee characteristics post-lateral mobile UKA. However, further in vivo and clinical studies are required to determine whether this design can truly achieve a more normal feeling of the knee and improved patient satisfaction. Cite this article: Bone Joint Res 2020;9(7):421–428


Bone & Joint Research
Vol. 8, Issue 2 | Pages 55 - 64
1 Feb 2019
Danese I Pankaj P Scott CEH

Objectives

Elevated proximal tibial bone strain may cause unexplained pain, an important cause of unicompartmental knee arthroplasty (UKA) revision. This study investigates the effect of tibial component alignment in metal-backed (MB) and all-polyethylene (AP) fixed-bearing medial UKAs on bone strain, using an experimentally validated finite element model (FEM).

Methods

A previously experimentally validated FEM of a composite tibia implanted with a cemented fixed-bearing UKA (MB and AP) was used. Standard alignment (medial proximal tibial angle 90°, 6° posterior slope), coronal malalignment (3°, 5°, 10° varus; 3°, 5° valgus), and sagittal malalignment (0°, 3°, 6°, 9°, 12°) were analyzed. The primary outcome measure was the volume of compressively overstrained cancellous bone (VOCB) < -3000 µε. The secondary outcome measure was maximum von Mises stress in cortical bone (MSCB) over a medial region of interest.


Bone & Joint Research
Vol. 7, Issue 8 | Pages 501 - 507
1 Aug 2018
Phan C Nguyen D Lee KM Koo S

Objectives

The objective of this study was to quantify the relative movement between the articular surfaces in the tibiotalar and subtalar joints during normal walking in asymptomatic individuals.

Methods

3D movement data of the ankle joint complex were acquired from 18 subjects using a biplanar fluoroscopic system and 3D-to-2D registration of bone models obtained from CT images. Surface relative velocity vectors (SRVVs) of the articular surfaces of the tibiotalar and subtalar joints were calculated. The relative movement of the articulating surfaces was quantified as the mean relative speed (RS) and synchronization index (SIENT) of the SRVVs.


Bone & Joint Research
Vol. 7, Issue 6 | Pages 379 - 387
1 Jun 2018
Hansen L De Raedt S Jørgensen PB Mygind-Klavsen B Kaptein B Stilling M

Objectives. To validate the precision of digitally reconstructed radiograph (DRR) radiostereometric analysis (RSA) and the model-based method (MBM) RSA with respect to benchmark marker-based (MM) RSA for evaluation of kinematics in the native hip joint. Methods. Seven human cadaveric hemipelves were CT scanned and bone models were segmented. Tantalum beads were placed in the pelvis and proximal femoral bone. RSA recordings of the hips were performed during flexion, adduction and internal rotation. Stereoradiographic recordings were all analyzed with DRR, MBM and MM. Migration results for the MBM and DRR with respect to MM were compared. Precision was assessed as systematic bias (mean difference) and random variation (Pitman’s test for equal variance). Results. A total of 288 dynamic RSA images were analyzed. Systematic bias for DRR and MBM with respect to MM in translations (p < 0.018 mm) and rotations (p < 0.009°) were approximately 0. Pitman’s test showed lower random variation in all degrees of freedom for DRR compared with MBM (p < 0.001). Conclusion. Systematic error was approximately 0 for both DRR or MBM. However, precision of DRR was statistically significantly better than MBM. Since DRR does not require marker insertion it can be used for investigation of preoperative hip kinematics in comparison with the postoperative results after joint preserving hip surgery. . Cite this article: L. Hansen, S. De Raedt, P. B. Jørgensen, B. Mygind-Klavsen, B. Kaptein, M. Stilling. Marker free model-based radiostereometric analysis for evaluation of hip joint kinematics: A validation study. Bone Joint Res 2018;7:379–387. DOI: 10.1302/2046-3758.76.BJR-2017-0268.R1