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1.
Kengo Harato Takeo Nagura Hideo Matsumoto Toshiro Otani Yoshiaki Toyama Yasunori Suda 《Knee surgery, sports traumatology, arthroscopy》2014,22(11):2608-2613
Purpose
The aim of this study was to evaluate weight-bearing distribution in patients with bilateral end-stage knee osteoarthritis (OA) and to clarify the gait parameters affecting the weight-bearing distribution during both standing and walking using gait analysis.Methods
Twenty-five patients (averaged 71 years) with symptomatic bilateral end-stage medial knee OA participated in this study. They performed relaxed standing, placing one foot on a force plate and thereafter, level walking. First, knee resultant force was calculated on bilateral knees during standing. The knees in each patient were divided into Higher and Lower force side for the definition of dominant side limb. Second, gait parameters in each subject were compared between both sides.Results
Each patient had large weight-bearing asymmetry, though passive range of motion, subjective pain level, femorotibial angle and radiographic disease severities were not significantly different between both sides. In standing, knees on Higher force side were significantly extended (11.2 ± 6.5°) than on Lower force side (14.4 ± 7.3°, P = 0.0086). Similarly, knees on Higher force side were also significantly extended at heel strike during gait. Besides, peak values of extension moment, knee adduction moment, knee adduction moment impulse and vertical force during gait were significantly greater on Higher force side.Conclusions
Ability to extend the knee in standing was considered to be an essential factor to decide loading condition. It is clinically important to examine the ability to extend the knee in standing when considering loading asymmetry during gait in patients with bilateral knee OA.Level of evidence
III. 相似文献2.
Eisaku Fujimoto Yoshiaki Sasashige Yasuji Masuda Takashi Hisatome Akio Eguchi Tetsuo Masuda Mikiya Sawa Yoshinori Nagata 《Knee surgery, sports traumatology, arthroscopy》2013,21(12):2704-2712
Purpose
The intra-operative femorotibial joint gap and ligament balance, the predictors affecting these gaps and their balances, as well as the postoperative knee flexion, were examined. These factors were assessed radiographically after a posterior cruciate-retaining total knee arthroplasty (TKA). The posterior condylar offset and posterior tibial slope have been reported as the most important intra-operative factors affecting cruciate-retaining-type TKAs. The joint gap and balance have not been investigated in assessments of the posterior condylar offset and the posterior tibial slope.Methods
The femorotibial gap and medial/lateral ligament balance were measured with an offset-type tensor. The femorotibial gaps were measured at 0°, 45°, 90° and 135° of knee flexion, and various gap changes were calculated at 0°–90° and 0°–135°. Cruciate-retaining-type arthroplasties were performed in 98 knees with varus osteoarthritis.Results
The 0°–90° femorotibial gap change was strongly affected by the posterior condylar offset value (postoperative posterior condylar offset subtracted by the preoperative posterior condylar offset). The 0°–135° femorotibial gap change was significantly correlated with the posterior tibial slope and the 135° medial/lateral ligament balance. The postoperative flexion angle was positively correlated with the preoperative flexion angle, γ angle and the posterior tibial slope. Multiple-regression analysis demonstrated that the preoperative flexion angle, γ angle, posterior tibial slope and 90° medial/lateral ligament balance were significant independent factors for the postoperative knee flexion angle. The flexion angle change (postoperative flexion angle subtracted by the preoperative flexion angle) was also strongly correlated with the preoperative flexion angle, posterior tibial slope and 90° medial/lateral ligament balance.Conclusion
The postoperative flexion angle is affected by multiple factors, especially in cruciate-retaining-type TKAs. However, it is important to pay attention not only to the posterior tibial slope, but also to the flexion medial/lateral ligament balance during surgery. A cruciate-retaining-type TKA has the potential to achieve both stability and a wide range of motion and to improve the patients’ activities of daily living. 相似文献3.
Noboru Shimada Masataka Deie Kazuhiko Hirata Yasuhiko Hiate Naoya Orita Daisuke Iwaki Yoshihiro Ito Hiroaki Kimura Evangelos Pappas Mitsuo Ochi 《Knee surgery, sports traumatology, arthroscopy》2016,24(8):2506-2511
Purpose
In total knee arthroplasty (TKA), dynamic knee loading may loosen the artificial joint and bone or cause polyethylene wear after prolonged use. TKA decreases knee adduction moment at 6 months, but this effect is lost by 1 year post-operatively. However, lateral thrust after TKA has not been clarified. We hypothesized that like knee adduction moment, lateral thrust would return to baseline levels by 1 year post-operatively.Methods
Participants were 15 patients who underwent TKA for medial knee OA. Japanese Orthopaedic Association (JOA) score, numeric rating scale, and gait analysis (measurement of peak knee adduction moment, knee varus angle at peak knee adduction moment, lateral thrust, and gait speed) were performed preoperatively (baseline) and 3 weeks, 3 and 6 months, and 1 year post-operatively.Results
JOA score improved from 55 ± 9.8 to 78 ± 12.1 at 1 year post-operatively, and pain decreased significantly from baseline at each follow-up (p < 0.001). Significant increases in gait speed were observed at 6 months and 1 year (p < 0.001). Peak knee adduction moment during stance phase was significantly lower at 3 weeks, 3 months, and 6 months compared to baseline (p < 0.05), but no significant changes were seen at 1 year. Knee varus at peak knee adduction moment did not differ significantly between any measurement points, while lateral thrust was decreased at 6 months and 1 year compared to baseline (p < 0.05).Conclusions
Temporal courses of changes up to 1 year after TKA differed between knee adduction moment and lateral thrust, so our hypothesis was rejected.Level of evidence
IV.4.
Takashi Takenaka Kazuya Ikoma Suzuyo Ohashi Yuji Arai Yusuke Hara Keiichiro Ueshima Koushiro Sawada Toshiharu Shirai Hiroyoshi Fujiwara Toshikazu Kubo 《Knee surgery, sports traumatology, arthroscopy》2016,24(8):2442-2446
Purpose
It has previously been found that valgus hindfoot alignment (HFA) improves 3 weeks following total knee arthroplasty (TKA) for varus knee osteoarthritis (OA). In the present study, HFA was evaluated prior to TKA, as well as 3 weeks and 1 year following TKA. Using these multiple evaluations, the chronological effects of TKA on HFA were investigated.Methods
The study included 71 patients (73 legs) who underwent TKA for varus knee OA. Radiograph examinations of the entire limb and hindfoot were performed in the standing position prior to TKA, as well as 3 weeks and 1 year following TKA. The varus–valgus angle was used as an indicator of HFA in the coronal plane. Patients were divided into two groups according to the preoperative varus–valgus angle: a hindfoot varus group (varus–valgus angle <76°) and a hindfoot valgus group (varus–valgus angle ≥76°). The changes in the varus–valgus angle were evaluated and compared in both groups.Results
In the hindfoot valgus group, the mean ± standard deviation varus–valgus angle significantly declined from 80.5 ± 3.1° prior to TKA to 78.6 ± 3.7° 3 weeks following TKA and 77.1 ± 2.7° 1 year following TKA. However, in the hindfoot varus group, the mean varus–valgus angle prior to TKA (72.7 ± 2.6°) did not differ significantly from the mean varus–valgus angles 3 weeks (72.3 ± 3.3°) or 1 year (73.5 ± 3.0°) following TKA.Conclusions
HFA improved chronologically in legs with hindfoot valgus as a result of the alignment compensation ability of the hindfoot following TKA. However, no improvement was noted in legs with hindfoot varus because the alignment compensation ability of the hindfoot had been lost. The patients with hindfoot varus should be attended for ankle pain in the outpatient clinic after TKA.Level of evidence
III.5.
Tomoyuki Matsumoto Hirotsugu Muratsu Seiji Kubo Kiyonori Mizuno Keisuke Kinoshita Kazunari Ishida Takehiko Matsushita Ken Sasaki Katsumasa Tei Koji Takayama Hiroshi Sasaki Shinya Oka Masahiro Kurosaka Ryosuke Kuroda 《Knee surgery, sports traumatology, arthroscopy》2011,19(6):880-886
Purposes
Minimal incision surgery (MIS) total knee arthroplasty (TKA) is widely promoted as a possible improvement over conventional TKA, and accurate implantations have recently been reported using navigation systems. However, soft tissue balance during MIS-TKA remains challenging. Therefore, in this report, joint gap (component gap) and ligament balance (varus angle) were assessed during MIS-TKA using a tensor, which enables soft tissue balance assessment with a reduced patellofemoral joint and femoral component in place.Methods
Results were compared to those of conventional TKA. Posterior stabilized TKA were performed in 50 knees (25 knees: MIS-TKA using quadriceps-sparing approach; 25 knees: conventional TKA using medial parapatellar approach) with varus osteoarthritis. Component gap and varus angle were measured using the tensor with a reduced patellofemoral joint at 0, 10, 45, 90, and 135°.Results
Whereas the component gap in MIS-TKA was significantly larger through the entire arc of flexion compared with conventional TKA, the pattern of joint looseness showed no difference between the two procedures. The varus angle in MIS-TKA was significantly larger than that in conventional TKA at 0, 90, and 135° of knee flexion.Conclusions
MIS-TKA may lead to ligament imbalance due to the difficulties induced by a limited working space. Understanding this pattern allows surgeons to be able to adjust the soft tissue balance more accurately and thereby expect a better post-operative outcome even in MIS-TKA. 相似文献6.
Purpose
Unsteady ambulation shortly after total knee arthroplasty (TKA) may cause falling. Postural sway may predict the risk of falling. This prospective single-blinded observational study therefore evaluated the effects of TKA on single-limb standing balance (SLSB) and factors related to change in SLSB.Methods
Patients with varus deformity and medial compartment degeneration were evaluated between September and December 2010. The Western Ontario and McMaster Universities Osteoarthritis Index and Kellgren/Lawrence scale were assessed, as were varus angle, number of painful knees, isometric peak torque of the quadriceps femoris, balance index of double limbs, and postural sway of single limbs.Results
Twelve patients were enrolled and 11 were analysed. The mean ± SD postural sway of single limbs (i.e., SLSB) was reduced significantly after TKA, from 30.3 ± 20.8 cm to 18.5 ± 9.3 cm (p = 0.02). Amelioration was in proportion to pre-operative postural sway (β = 0.92).Conclusions
SLSB in patients with varus knees with osteoarthritis was improved significantly 11 days after TKA. Poorer pre-operative SLSB was associated with better post-operative SLSB. TKA may be useful for the immediate reduction of falling in patients with osteoarthritis.Level of evidence
Therapeutic study, case series, Level IV. 相似文献7.
Purpose
The external knee adduction moment during gait has previously been associated with knee osteoarthritis, and although it has been shown to be greater following anterior cruciate ligament (ACL) reconstruction surgery compared to a control group, it has not been compared between different graft types. Given that the incidence of radiographic knee osteoarthritis appears to be greater following patellar tendon compared to hamstring tendon ACL reconstruction, this study tested the hypothesis that the knee adduction moment would also be increased following patellar tendon ACL reconstruction.Methods
In 48 male participants (16 patellar tendon graft, 16 hamstring graft and 16 controls), the external knee adduction moment was measured during level walking in a gait laboratory at mean of 10?months after surgery.Results
There was no difference in the knee adduction moment between the hamstring and patellar tendon groups, and both patient groups had a significantly reduced knee adduction moment compared to the control group. In the hamstring group, the smaller adduction moment was associated with the patients walking with less knee varus whereas in the patellar tendon group, the smaller moment was associated with the patients walking with a decreased vertical ground reaction force.Conclusions
These results indicate that in male patients during the early stages of recovery from ACL reconstruction, the knee adduction moment is not greater than controls for either hamstring or patellar tendon graft types. Although the knee adduction moment was similar between the two graft types, the overall magnitude of the moment was influenced by different biomechanical factors.Level of evidence
III. 相似文献8.
Luc Vanlommel Jan Vanlommel Steven Claes Johan Bellemans 《Knee surgery, sports traumatology, arthroscopy》2013,21(10):2325-2330
Purpose
Restoration of correct alignment is one of the main objectives of total knee arthroplasty (TKA). However, the influence of residual malalignment on clinical and functional outcomes is currently uncertain. This study was therefore undertaken to ascertain its influence in patients undergoing TKA for varus osteoarthritis of the knee.Methods
A cohort of 132 consecutive patients (143 knees) with pre-operative varus alignment was evaluated with a mean follow-up period of 7.2 years. Based upon the post-operative alignment, patients were stratified into three groups: neutral, mild varus, and severe varus. These groups were compared with respect to clinical and functional outcomes.Results
All patients had post-operative improvements in Knee Society Score (KSS). Knees that were left in mild varus scored significantly better for the KSS and the Western Ontario and McMaster Universities Arthritis Index, compared with knees that were corrected to neutral and knees that were left in severe varus exceeding 6°. No revisions occurred in any of the groups at midterm follow-up.Conclusion
The results of this study contradict the conventional assumption that correction to neutral mechanical alignment leads to the best outcome following TKA. Patients with pre-operative varus had better clinical and functional outcome scores if the alignment was left in mild varus, as compared with patients with an alignment correction to neutral.Level of evidence
Therapeutic study, Level III. 相似文献9.
Satoshi Hamai Hiromasa Miura Ken Okazaki Takeshi Shimoto Hidehiko Higaki Yukihide Iwamoto 《Knee surgery, sports traumatology, arthroscopy》2014,22(8):1799-1804
Purpose
In vivo fluoroscopic analyses have revealed the kinematics after total knee arthroplasty (TKA), including femoral condylar lift-off. This study asked whether differences in static varus–valgus laxity or coronal limb alignment after TKA affect lift-off under weight-bearing conditions. It was hypothesised that there is a correlation between coronal laxity or alignment and lift-off during walking.Methods
The current study analysed nineteen subjects undergoing cruciate-retaining TKA performed by the measured resection technique. The varus–valgus laxity at knee extension was measured using a 150 N stress radiograph. The mechanical axis was measured using a full-standing radiograph. Continuous radiological images were taken while the subject walked on a treadmill, and the images during single-leg stance were analysed to determine the lift-off using a 3D-to-2D image-to-model registration technique.Results
The average angle in varus/valgus stress was 6.8 ± 1.8°/6.6 ± 2.1°. No statistically significant differences were observed between the varus and valgus laxity. The average amount of lift-off was 0.7 ± 0.4 mm. The static varus–valgus laxity (n. s.) or the differences in the laxities (n. s.) on the stress radiograph did not influence lift-off. The weight-bearing ratio was achieved within the middle third of the knee in 90 % of subjects. Two outliers with valgus alignment (68 ± 1 %) demonstrated no significant difference in lift-off in comparison with the majority of the subjects (46 ± 9 %).Conclusion
The static coronal laxity and alignment did not influence the lift-off under dynamic weight-bearing conditions after well-balanced and aligned cruciate-retaining TKA. Measured resection technique can produce sufficient coronal stability and alignment without significant lift-off during walking.Level of evidence
IV. 相似文献10.
Myung-Chul Jung Jun Young Chung Kwang-Hyun Son Hui Wang Jaejin Hwang Jay Joong Kim Joon Ho Kim Byoung-Hyun Min 《Knee surgery, sports traumatology, arthroscopy》2014,22(8):1879-1886
Purpose
The purpose of this study was to compare knee kinematics during stair walking in patients with simultaneous total knee arthroplasty (TKA) and unicompartmental knee arthroplasties (UKA). It was hypothesized that UKA would reproduce more normalized knee kinematics than TKA during stair ascent and descent.Methods
Six patients who received UKA in one knee and TKA in the other knee were included in the study. For this study, a four-step staircase was assembled with two force platforms being positioned at the centre of the second and third steps. Each patient was attached with 16 reflective markers at both lower extremities and was asked to perform five roundtrip trials of stair climbing. Kinematic parameters including stance duration, knee angle, vertical ground reaction force (GRF), joint reaction force, and moments were obtained and analysed using a10-camera motion system (VICON, Oxford, UK). Nonparametric Friedman test was used to compare the results between two arthroplasty methods and between stair ascent and descent.Results
Compared to TKA, UKA knees exhibited significantly greater degree of rotation in transverse planes (5.0 degrees during ascent and 6.0 degrees during descent on average), but showed no difference in terms of the other parameters. When comparing the results during stair ascent with descent, overall greater knee angle, vertical GRF, joint reaction force, and moment were observed during stair descent.Conclusions
Both UKA and TKA knees have shown overall similar knee kinematics, though UKA knee may allow greater degree of rotation freedom, which resembles normal knee kinematics during stair walking.Level of evidence
Case–control study, Level III. 相似文献11.
Guo L Yang L Briard JL Duan XJ Wang FY 《Knee surgery, sports traumatology, arthroscopy》2012,20(9):1760-1765
Purpose
Clinical factors related to cruciate-retaining knee arthroplasty failure in a long-term follow-up are yet unclear. The study was designed to evaluate the long-term survival rate of cruciate-retaining arthroplasty and clinical factors that may contribute to its failure.Methods
A total of 162 patients (188 knees) who received cruciate-retaining press-fit condylar arthroplasty from June 1993 to May 1994 were followed up. All patients were assessed clinically and radiographically. Revision for any reason was regarded as failure of arthroplasty.Results
A total of 120 patients (138 knees) were successfully followed up. Survivorship over 17?years was 92.5%. Fourteen knees were revised. Tibial varus angle of the operated knee in the unrevised patient group was greater than in revised group. There was statistical difference between these two groups (P?0.05).Conclusion
Long-term survivorship of cruciate-retaining arthroplasty was fair. Varus and valgus deformity of the unoperated contralateral knee and tibial varus deformity of the operated knee could be important factors related to arthroplasty failure.Clinical relevance
This long-term follow-up result of Press-Fit Condylar cruciate-retaining arthroplasty was good considering it was an old design. The alignment of the operated knee and deformity of the unoperated contralateral knee are important clinical factors that should be paid attention to avoid unexpected arthroplasty failure.Level of evidence
IV. 相似文献12.
Shinya Oka Hirotsugu Muratsu Tomoyuki Matsumoto Seiji Kubo Akihiro Maruo Hidetoshi Miya Ryosuke Kuroda Masahiro Kurosaka 《Knee surgery, sports traumatology, arthroscopy》2012,20(6):1064-1068
Purpose
This study aims to clarify the influence of surgical exposure on intra-operative soft tissue balance measurements using a new tensor in minimal incision total knee arthroplasty (TKA).Methods
Sixty patients with osteoarthritis of the knee received minimal incision TKAs. Twenty patients received a posterior-stabilized TKA using a quadriceps sparing approach, and the other forty patients, using a limited medial parapatellar (mini) approach. After femoral trial placement, soft tissue balance was measured using an offset type tensor at full extension and 90° of knee flexion, with the patella both laterally retracted and reduced. The joint component gap and varus imbalance were used to assess the difference in patellar position and surgical exposure.Results
At extension, the joint component gap and varus imbalance showed no statistical difference regardless of patellar position in either TKA. However, the joint component gaps decreased at 90° of flexion when the patella was laterally retracted in both TKAs. Additionally, a significantly smaller joint gap was observed in the quadriceps sparing TKA than the mini-TKA with a retracted patella at 90° of flexion. Varus ligament imbalances decreased with the patella laterally retracted at 90° of flexion in the quadriceps sparing TKA, not in the mini-TKA.Conclusion
Surgeons should be aware of the influence in surgical exposure of the joint gap and ligament balance during patella shift in minimal incision TKA.Level of evidence
III. 相似文献13.
Yasushi Yoshihara Yuji Arai Shuji Nakagawa Hiroaki Inoue Keiichiro Ueshima Hiroyoshi Fujiwara Ryo Oda Daigo Taniguchi Toshikazu Kubo 《Knee surgery, sports traumatology, arthroscopy》2016,24(8):2512-2516
Purpose
Favourable long-term results after total knee arthroplasty (TKA) require appropriate soft tissue balance. However, the relationships between long-term results after TKA surgery and mediolateral laxities at extension and at 90° flexion remain unknown. This study therefore quantitatively assessed ligament balance at extension and at 90° knee flexion at least 10 years after primary TKA, as well as clarifying the relationships between long-term outcomes and mediolateral laxities.Methods
This study included 49 knees (19 CR type and 30 PS type) of 33 patients followed up for at least 10 years after TKA at our hospital. Plain radiographs were obtained with about 150 N of varus or valgus stress using a Telos arthrometer at extension. At 90° flexion, epicondylar views were obtained under a 1.5-kg load and with about 10 kg of varus or valgus stress.Results
Lateral laxity of about 5° was observed in both extension and flexion, with total laxities of varus and valgus stress each less than 10°. Postoperative clinical outcomes were good, with significant improvements in extension angle, femorotibial angle, and KSS, and no loosening in any knee.Conclusions
Good long-term results of TKA can be obtained with a lateral laxity of about 5°, equivalent to that of healthy knees.Level of evidence
III.14.
Irina Grosu Patricia Lavand’homme Emmanuel Thienpont 《Knee surgery, sports traumatology, arthroscopy》2014,22(8):1744-1758
Purpose
Despite the recent advances in the understanding of pain mechanisms and the introduction of new drugs and new techniques in the postoperative management, pain after total knee arthroplasty (TKA) is still an unresolved issue. It affects the quality of life and rehabilitation of an important percentage of patients undergoing TKA. The aim of this narrative review was to give an overview on pain mechanisms and multimodal pain management.Methods
A review of all peer-reviewed articles on pain after knee arthroplasty was performed by two reviewers. Recent articles on incisional pain mechanisms were included because of their importance in the understanding of postsurgical pain. Search was performed in Pubmed, Cochrane and Google Scholar data bases.Results
Postsurgical pain mechanisms are based on both local and systemic inflammatory reactions. Peri-operative pain management starts with the anaesthetic technique and resides on a multimodal analgesia regimen. New concepts, drugs and techniques have shown their efficacy in reducing the severity of acute postoperative pain and the risk of developing chronic pain after TKA.Conclusion
This narrative review offers a clear overview of pain mechanism after knee arthroplasty and an understanding on how multimodal pain management can reduce the intensity and duration of pain after knee arthroplasty.Level of evidence
IV. 相似文献15.
Bi O Jeong Tae Yong Kim Jong Hun Baek Hyuk Jung Seung Hyun Song 《Knee surgery, sports traumatology, arthroscopy》2018,26(11):3230-3237
Purpose
This study aimed to assess radiological changes of the ankle joint, subtalar joint and foot following the correction of varus deformity of the knee with total knee arthroplasty (TKA). It was hypothesized that following the correction of varus deformity by TKA, compensatory reactions would occur at the subtalar joint in accordance with the extent of the correction.Methods
For this prospective study, 375 knees of patients who underwent TKA between 2011 and 2012 were enrolled. The varus angle of the knee, talar tilt of the ankle joint (TT), ground-talar dome angle of the foot (GD), anterior surface angle of the distal tibia and lateral surface angle of the distal tibia, heel alignment ratio (HR), heel alignment angle (HA), and heel alignment distance (HD) were measured on radiographs obtained pre-operatively and at post-operative 6 months.Results
The mean correction angle in varus deformity of the knee was 10.8?±?4.1°. TT and GD changed significantly from 0.4?±?1.9° and 6.5?±?3.1° pre-operatively to 0.1?±?1.8° and 0.2?±?2.1°, respectively (p?=?0.007, p?<?0.001). No correlation was found between the preop–postop variance in mechanical axis of the lower extremity (MA) and TT, but there was a strong correlation between the preop–postop variance in MA and GD (r?=?0.701). HR, HA and HD also changed significantly post-operatively, and the preop–postop variance in MA showed correlations with the preop–postop variances in HR, HA and HD (r?=?0.206, ??0.348, and ??0.418). TT and the three indicators of hindfoot alignment all shifted to varus whereas GD was oriented in valgus.Conclusion
Following the correction of varus deformity of the knee through TKA, significant compensatory changes occurred not only at the ankle and subtalar joints, but also at the foot. The findings of this study are useful in predicting the orientation of changes in the ankle and subtalar joints and the foot following TKA, and in determining the sequence of surgery when both the ankle and knee have a problem. In other words, changes in the parts of the lower extremity below the ankle joint following the correction of varus deformity of the knee must be considered when TKA is planned and performed. Patients who have problems at the ankle, subtalar, and foot joints in addition to varus deformity of the knee are recommended to undergo knee joint correction first.Level of evidence
II.16.
《Gait & posture》2020
BackgroundGait function after total knee arthroplasty (TKA) is suboptimal. However, quantified analysis with comparing a control group is lacking.Research questionThe aims of this study were 1) to compare the gait before and after TKA and 2) to compare postoperative gait to that of an age-sex matched control group.MethodsThis study consisted of 46 female and 38 male patients with end-stage knee osteoarthritis who underwent bilateral TKA, and 84 age- and sex-matched controls without knee pain and osteoarthritis. Seven gait parameters, including lower extremity alignment, knee adduction moment (KAM), knee flexion angle, external knee flexion moment, hip adduction angle, external hip adduction moment, and the varus-valgus arc during the stance phase, were collected using a commercial opto-electric gait analysis system. Principal component analysis was used for data processing and the standardized mean differences (SMDs) of the principal component scores were compared.ResultsThe most significant gait change after TKA was the alignment (SMD 1.62, p < 0.001). The average stance phase alignment changed from varus 7.3° to valgus 0.5°. The second significant change was a decrease of the KAM (SMD 1.08, p < 0.001). These two features were closely correlated (r = 0.644, p < 0.001). The gait feature that differed most from the controls was the varus-valgus arc during the stance phase (SMD 1.68, p < 0.001), which was constrained by 31% after TKA (p < 0.001) and was only 37% compared to the controls (p < 0.001).SignificanceImprovement in gait after TKA was obtained through alignment correction. However, TKA significantly constrained coronal knee motion. TKA improved gait suboptimally; the gait was significantly different from that of controls. 相似文献
17.
Mutsumi Watanabe Shinichi Kuriyama Shinichiro Nakamura Yoshihisa Tanaka Kohei Nishitani Moritoshi Furu Hiromu Ito Shuichi Matsuda 《Knee surgery, sports traumatology, arthroscopy》2017,25(11):3459-3466
Purpose
Abnormal knee motion under various conditions has been described after total knee arthroplasty (TKA). However, differences in kinematics and kinetics of knees with varus femoral versus varus tibial alignment have not been evaluated. It was hypothesized that varus femoral and tibial alignments have the same impact on knee motion.Methods
A musculoskeletal computer simulation was used. Femoral and tibial alignment in the coronal plane was each varied from neutral to 5° of varus in 1° increments. Lift-off, defined as an intercomponent distance of >2 mm, and tibiofemoral contact forces were evaluated during gait up to 60° of knee flexion. Knee kinematics and contact stresses were also examined during squat, with up to 130° of knee flexion.Results
During gait, lift-off occurred readily with more than 3° of varus tibial alignment and slight lateral joint laxity. In contrast, lift-off did not occur with varus femoral or tibial alignment of up to 5° during squat. Peak medial contact forces with varus femoral alignment were approximately twice those observed with varus tibial alignment. The lowest points of the femoral condyles moved internally with varus femoral alignment, contrary to the kinematics with neutral or varus tibial alignment. On the other hand, there was femoral medial sliding and edge loading against the tibia in mid-flexion with varus tibial alignment.Conclusion
Varus femoral alignment affects the non-physiological rotational movement of the tibiofemoral joint, whereas varus tibial alignment causes medial–lateral instability during mid-flexion. Varus femoral and tibial alignments might lead to post-TKA discomfort and unreliability.18.
Atsushi Kitagawa Kazunari Ishida Takaaki Chin Nobuhiro Tsumura Tetsushiro Iguchi 《Knee surgery, sports traumatology, arthroscopy》2014,22(7):1599-1606
Purpose
The objectives of the study were to examine knee kinematics in knees with severe valgus deformities and to compare pre- and post-operative knee kinematics for the same subjects implanted with medial-pivot total knee arthroplasty (TKA).Methods
Seven subjects with severe valgus deformities due to osteoarthritis (OA) or rheumatoid arthritis (RA) were enrolled in the prospective study. Prior to TKA, three-dimensional (3D) kinematics were assessed by 3D to 2D registration technique using the image matching software ‘Knee Motion’, under in vivo, weight-bearing conditions. Postoperatively, each subject again performed the same motion under fluoroscopic surveillance.Results
Preoperative kinematics demonstrated external rotation of tibias from extension to flexion, and small posterior femoral translations dominated in the medial condyle associated with anterior slides during partial range of motion. Postoperatively, these non-physiological tibial rotations were restored, and most subjects exhibited small internal rotations of tibias. On average, preoperative tibial internal rotation was ?4.7° ± 7.6° from full extension to maximum flexion, and the angle was 4.8° ± 3.1° postoperatively (p = 0.01). In addition, small amounts of posterior translation of the lateral condyle and anterior translation of the medial condyle were confirmed in most subjects postoperatively.Conclusions
The study showed that the preoperative kinematic pattern established in severe valgus deformity was different from the physiological knee pattern. In addition, post-operative results suggest that the non-physiological kinematics were partially restored after TKA by using the prosthesis design even in the absence of the posterior cruciate ligament (PCL) and the cam–post mechanism.Level of evidence
II. 相似文献19.
Jerry Yongqiang Chen Seng Jin Yeo Andy Khye Soon Yew Darren Keng Jin Tay Shi-Lu Chia Ngai Nung Lo Pak Lin Chin 《Knee surgery, sports traumatology, arthroscopy》2014,22(3):630-635
Purpose
The aim of this study was to investigate the post-operative radiological outcomes of patient-specific instrumentation (PSI) surgery versus conventional total knee arthroplasty (TKA).Methods
Sixty patients scheduled for a primary TKA were prospectively divided into PSI or conventional technique. Coronal and sagittal radiographic long limb films were taken post-operatively. The accepted values for normal alignment were 180° ± 3° for hip-knee-ankle angle; 90° ± 3° for coronal femoral component angle or coronal tibia component angle; 0° to 3° flexion for sagittal femoral component angle and 0° to 7° posterior slope for sagittal tibia component angle.Results
For hip-knee-ankle angle, there were 21 % more outliers in the PSI group compared to the conventional group (p = 0.045). Most of these outliers had valgus deformity in the PSI group and varus deformity in the conventional group (p = 0.045). For implant placement, there was no difference in the proportion of outliers between the two groups. There was also no difference in the duration of surgery.Conclusions
This study showed that PSI surgery is associated with a larger proportion of outliers for lower limb alignment. PSI surgery as an alternative to conventional TKA is not advisable.Level of evidence
II. 相似文献20.
Erling Laxafoss Steffen Jacobsen Kasper K. Gosvig Stig Sonne-Holm 《Skeletal radiology》2013,42(4):531-540