Prosthesis alignment affects axial rotation motion after total knee replacement: a prospective in vivo study combining computed tomography and fluoroscopic evaluations

BMC Musculoskeletal Disorders

Jörg Lützner²  Stephan Kirschner²  Scott A Banks¹  Melinda K Harman³ 

[1] Department of Mechanical & Aerospace Engineering, University of Florida, P.O. Box 116250, Gainesville, FL, 32611-6250, USA;Orthopaedic Department, University Hospital Carl Gustav Carus Dresden, Fetscherstrasse 74, Dresden, 01307, Germany;Medical Technology Laboratory, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, Bologna, 40136, Italy

关键词: Knee arthroplasty;    Knee biomechanics;    Axial rotation;    Knee kinematics;    Surgical alignment;    Implant alignment;    Mobile-bearing prosthesis;    Total knee replacement;   

Others  :  1135764
DOI  :  10.1186/1471-2474-13-206

 received in 2012-01-18, accepted in 2012-09-20,  发布年份 2012

【 摘 要 】

Background

Clinical consequences of alignment errors in total knee replacement (TKR) have led to the rigorous evaluation of surgical alignment techniques. Rotational alignment in the transverse plane has proven particularly problematic, with errors due to component malalignment relative to bone anatomic landmarks and an overall mismatch between the femoral and tibial components’ relative positions. Ranges of nominal rotational alignment are not well defined, especially for the tibial component and for relative rotational mismatch, and some studies advocate the use of mobile-bearing TKR to accommodate the resulting small rotation errors. However, the relationships between prosthesis rotational alignment and mobile-bearing polyethylene insert motion are poorly understood. This prospective, in vivo study evaluates whether component malalignment and mismatch affect axial rotation motions during passive knee flexion after TKR.

Methods

Eighty patients were implanted with mobile-bearing TKR. Rotational alignment of the femoral and tibial components was measured from postoperative CT scans. All TKR were categorized into nominal or outlier groups based on defined norms for surgical rotational alignment relative to bone anatomic landmarks and relative rotational mismatch between the femoral and tibial components. Axial rotation motion of the femoral, tibial and polyethylene bearing components was measured from fluoroscopic images acquired during passive knee flexion.

Results

Axial rotation motion was generally accomplished in two phases, dominated by polyethylene bearing rotation on the tibial component in early to mid-flexion and then femoral component rotation on the polyethylene articular surface in later flexion. Opposite rotations of the femur-bearing and bearing-baseplate articulations were evident at flexion greater than 80°. Knees with outlier alignment had lower magnitudes of axial rotation and distinct transitions from external to internal rotation during mid-flexion. Knees with femoral-tibial rotational mismatch had significantly lower total axial rotation compared to knees with nominal alignment.

Conclusions

Maintaining relative rotational mismatch within ±5° during TKR provided for controlled knee axial rotation during flexion. TKR with rotational alignment outside of defined surgical norms, with either positive or negative mismatch, experienced measurable kinematic differences and presented different patterns of axial rotation motions during passive knee flexion compared to TKR with nominal mismatch. These findings support previous studies linking prosthesis rotational alignment with inferior clinical and functional outcomes.

Trial Registration

Clinical Trials NCT01022099

【 授权许可】

   
2012 Harman et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 2.

【 参考文献 】

• [1]Anderson KC, Buehler KC, Markel DC: Computer assisted navigation in total knee arthroplasty: Comparison with conventional methods. J Arthroplasty 2005, 20(7 Suppl 3):132-138.
• [2]Berend ME, Ritter MA, Meding JB, Faris PM, Keating EM, Redelman R, Faris GW, Davis KE: Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res 2004, 428:26-34.
• [3]Daubresse F, Vajeu C, Loquet J: Total knee arthroplasty with conventional or navigated technique: Comparison of the learning curves in a community hospital. Acta Orthop Belg 2005, 71(6):710-713.
• [4]Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S: Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res 2007, 457:156-162.
• [5]Lotke PA, Ecker ML: Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am 1977, 59(1):77-79.
• [6]Chauhan SK, Scott RG, Breidahl W, Beaver RJ: Computer-assisted knee arthroplasty versus a conventional jig-based technique: A randomised prospective trial. J Bone Joint Surg Br 2004, 86(3):372-377.
• [7]Conditt MA, Noble PC, Thompson MT, Ismaily SK, Moy GJ, Mathis KB: A computerized bioskills system for surgical skills training in total knee replacement. Proc Inst Mech Eng H 2007, 221(1):61-69.
• [8]Eckhoff DG, Metzger RG, Vandewalle MV: Malrotation associated with implant alignment technique in total knee arthroplasty. Clin Orthop Relat Res 1995, 321:28-31.
• [9]Ikeuchi M, Yamanaka N, Okanoue Y, Ueta E, Tani T: Determining the rotational alignment of the tibial component at total knee replacement: A comparison of two techniques. J Bone Joint Surg Br 2007, 89(1):45-49.
• [10]Mizu-uchi H, Matsuda S, Miura H, Okazaki K, Akasaki Y, Iwamoto Y: The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system. J Bone Joint Surg Br 2008, 90(8):1025-1031.
• [11]Spencer JM, Chauhan SK, Sloan K, Taylor A, Beaver RJ: Computer navigation versus conventional total knee replacement: No difference in functional results at two years. J Bone Joint Surg Br 2007, 89(4):477-480.
• [12]Stöckl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O: Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 2004, 426:180-186.
• [13]van der Linden HM, van der Zwaag HM, Valstar ER, van der Molen AJ, Nelissen RG: Transepicondylar axis accuracy in computer assisted knee surgery: A comparison of the CT-based measured axis versus the CAS-determined axis. Comput Aided Surg 2008, 13(4):200-206.
• [14]Barrack RL, Schrader T, Bertot AJ, Wolfe MW, Myers L: Component rotation and anterior knee pain after total knee arthroplasty. Clin Orthop Relat Res 2001, 392:46-55.
• [15]Lützner J, Krummenauer F, Wolf C, Günther KP, Kirschner S: Computer-assisted and conventional total knee replacement: A comparative prospective randomised study with radiological and CT evaluation. J Bone Joint Surg Br 2008, 90(8):1039-1044.
• [16]Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C: A prospective randomized study of computer-assisted and conventional total knee arthroplasty: Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 2007, 89(2):236-243.
• [17]Siston RA, Goodman SB, Patel JJ, Delp SL, Giori NJ: The high variability of tibial rotational alignment in total knee arthroplasty. Clin Orthop Rel Res 2006, 452:65-69.
• [18]Berger RA, Crossett LS, Jacobs JJ, Rubash HE: Malrotation causing patellofemoral complications after total knee arthroplasty. Clin Orthop Relat Res 1998, 356:144-153.
• [19]Uehara K, Kadoya Y, Kobayashi A, Ohashi H, Yamano Y: Bone anatomy and rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 2002, 402:196-201.
• [20]Wasielewski RC, Galante JO, Leighty RM, Natarajan RN, Rosenberg AG: Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Relat Res 1994, 299:31-43.
• [21]Breugem SJ, Sierevelt IN, Schafroth MU, Blankevoort L, Schaap GR, van Dijk CN: Less anterior knee pain with mobile-bearing prosthesis compared with a fixed-bearing prosthesis. Clin Orthop Relat Res 2008, 466:1959-1965.
• [22]Huddleston JI, Scott RD, Wimberley DW: Determination of neutral tibial rotational alignment in rotating platform TKA. Clin Orthop Relat Res 2005, 440:101-106.
• [23]Kaper BP, Smith PN, Bourne RB, Rorabeck CH, Robertson D: Medium-term results of a mobile bearing total knee replacement. Clin Orthop Relat Res 1999, 367:201-209.
• [24]Walker PS, Komistek RD, Barrett DS, Anderson D, Dennis DA, Sampson M: Motion of a mobile bearing knee allowing translation and rotation. J Arthroplasty 2002, 17(1):11-19.
• [25]Fantozzi S, Leardini A, Banks SA, Marcacci M, Giannini S, Catani F: Dynamic in-vivo tibio-femoral and bearing motions in mobile bearing knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2004, 12(2):144-151.
• [26]Haas BD, Komistek RD, Dennis DA: In vivo kinematics of the Low Contract Stress rotating platform total knee. Orthopedics 2002, 25(2 Supplement):219-226.
• [27]Stiehl JB, Dennis DA, Komistek RD, Keblish PA: In vivo kinematic analysis of a mobile bearing total knee prosthesis. Clin Orthop Relat Res 1997, 345:60-66.
• [28]Stukenborg-Colsman C, Ostermeier S, Wenger KH, Wirth CJ: Relative motion of a mobile bearing inlay after total knee arthroplasty: A dynamic in vitro study. Clin Biomech 2002, 17:49-55.
• [29]der Zwaag HMJ VdL-v, Bos J, van der Heide HJL, Nelissen RGHH: A computed tomography based study on rotational alignment accuracy of the femoral component in total knee arthroplasty using computer-assisted orthopaedic surgery. Int Orthop 2011, 35:845-850.
• [30]Jazrawi LM, Birdzell L, Kummer FJ, Di Cesare PE: The accuracy of computed tomography for determining femoral and tibial total knee arthroplasty component rotation. J Arthrop 2000, 15(6):761-766.
• [31]Merican AM, Ghosh KM, Iranpour F, Deehan DJ, Amis AA: The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011, 19:1479-1487.
• [32]Nicoll D, Rowley DI: Internal rotational error of the tibial component is a major cause of pain after total knee replacement. J Bone Joint Surg 2010, 92B:1238-1244.
• [33]Zihlmann MS, Stacoff A, Romero J, Quervain IK, Stüssi E: Biomechanical background and clinical observations of rotational malalignment in TKA: Literature review and consequences. Clin Biomech 2005, 20:661-668.
• [34]Rhoads DD, Noble PC, Reuben JD, Tullos HS: The effect of femoral component position on the kinematics of total knee arthroplasty. Clin Orthop Relat Res 1993, 286:122-129.
• [35]Banks SA, Hodge WA: Accurate measurement of three-dimensional knee replacement kinematics using single-plane fluoroscopy. IEEE Trans Biomed Eng 1996, 43:638-649.
• [36]Chouteau J, Lerat JL, Testa R, Moyen B, Fessy MH, Banks SA: Mobile-bearing insert translational and rotational kinematics in a PCL-retaining total knee arthroplasty. Ortho Traum Surg Res 2009, 95:254-259.
• [37]Delport HP, Banks SA, De Schepper J, Bellemans J: A kinematic comparison of fixed- and mobile-bearing knee replacements. J Bone Joint Surg Br 2006, 88(8):1016-1021.
• [38]Gamada K, Jayasekera N, Kashif F, Fennema P, Schmotzer H, Banks SA: Does ligament balancing technique affect kinematics in rotating platform PCL retaining knee arthroplasties? A prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2008, 16(2):160-166.
• [39]Garling EH, Kaptein BL, Nelissen RGHH, Valstar ER: Limited rotation of the mobile-bearing in a rotating platform total knee prosthesis. J Biomech 2007, 40(Suppl 1):S25-S30.
• [40]Colwell CW, Chen PC, D’Lima D: Extensor malalignment arising from femoral component malrotation in knee arthroplasty: Effect of rotating-bearing. Clin Biomech 2011, 26:52-57.
• [41]Lützner J, Günther KP, Kirschner S: Functional outcome after computer-assisted versus conventional total knee arthroplasty: A randomized controlled study. Knee Surg Sports Traumatol Arthrosc 2010, 18:1339-1344.