Does lateral lift-off occur in static and dynamic activity in a medially spherical total knee arthroplasty? A pulsed-fluoroscopic investigation

Bone & Joint Research

article

S. Key¹  G. Scott¹  J. G. Stammers¹  M. A. R. Freeman²  V. Pinskerova³  R. E. Field⁴  J. Skinner⁶  S. A. Banks⁷ 

[1] Royal London Hospital;†M.A.R Freeman has deceased since the submission of this manuscript;First Orthopaedic Clinic, Faculty of Medicine, Charles University;St George’s, University of London;Director of Research, South West London Elective Orthopaedic Centre;Royal National Orthopaedic Hospital;University of Florida

关键词: Knee kinematics;    Knee fluoroscopy;    Total knee arthroplasty;    Coronal stability;   

DOI  :  10.1302/2046-3758.85.BJR-2018-0237.R1

学科分类：骨科学

来源: British Editorial Society Of Bone And Joint Surgery

【 摘 要 】

ObjectivesThe medially spherical GMK Sphere (Medacta International AG, Castel San Pietro, Switzerland) total knee arthroplasty (TKA) was previously shown to accommodate lateral rollback while pivoting around a stable medial compartment, aiming to replicate native knee kinematics in which some coronal laxity, especially laterally, is also present. We assess coronal plane kinematics of the GMK Sphere and explore the occurrence and pattern of articular separation during static and dynamic activities.MethodsUsing pulsed fluoroscopy and image matching, the coronal kinematics and articular surface separation of 16 well-functioning TKAs were studied during weight-bearing and non-weight-bearing, static, and dynamic activities. The closest distances between the modelled articular surfaces were examined with respect to knee position, and proportions of joint poses exhibiting separation were computed.ResultsOverall, 1717 joint poses were analyzed. At a 1.0 mm detection threshold, 37 instances of surface separation were observed in the lateral compartment and four medially (p < 0.001). Separation was activity-dependent, both laterally and medially (p < 0.001), occurring more commonly during static deep flexion in the lateral compartment, and during static rotation in the medial compartment. Lateral separation occurred more frequently than medial during kneeling (7/14 lateral vs 1/14 medial; p = 0.031) and stepping (20/1022 lateral vs 0/1022 medial; p < 0.001). Separation varied significantly between individuals during dynamic activities.ConclusionNo consistent association between closest distances of the articular surfaces and knee position was found during any activity. Lift-off was infrequent and depended on the activity performed and the individual knee. Lateral separation was consistent with the design rationale. Medial lift-off was rare and mostly in non-weight-bearing activities.

【 授权许可】

CC BY-NC