Impact of femoro-tibial size combinations and TKA design on kinematics.

INTRODUCTION: The variability in patients' femoral and tibial anatomy requires to use different tibia component sizes with the same femoral component size. These size combinations are allowed by manufacturers, but the clinical impact remains unclear. Therefore, the goals of our study were to investigate whether combining different sizes has an impact on the kinematics for two well-established knee systems and to compare these systems' kinematics to the native kinematics. MATERIALS AND METHODS: Six fresh frozen knee specimens were tested in a force controlled knee rig before and after implantation of a cruciate retaining (CR) and a posterior-stabilized (PS) implant. Femoro-tibial kinematics were recorded using a ultrasonic-based motion analysis system while performing a loaded squat from 30° to 130°. In each knee, the original best fit inlay was then replaced by different inlays simulating a smaller or bigger tibia component. The kinematics obtained with the simulated sizes were compared to the original inlay kinematics using descriptive statistics. RESULTS: For all size combinations, the difference to the original kinematics reached an average of 1.3 ± 3.3 mm in translation and - 0.1 ± 1.2° in rotation with the CR implant. With the PS implant, the average differences reached 0.4 ± 2.7 mm and  - 0.2 ± 0.8°. Among all knees, no size combination consistently resulted in significantly different kinematics. Each knee showed a singular kinematic pattern. For both knee systems, the rotation was smaller than in the native knee, but the direction of the rotation was preserved. The PS showed more rollback and the CR less rollback than the native knee. CONCLUSION: TKA systems designed with a constant tibio-femoral congruency among size combinations should enable to combine different sizes without having substantial impact on the kinematics. The rotational pattern was preserved by both TKA systems, while the rollback could only be maintained by the PS design.

Isolated effects of patellar resurfacing in total knee arthroplasty and their relation to native patellar geometry.

The isolated effects of patellar resurfacing on patellar kinematics are rarely investigated. Nonetheless, knowing more about these effects could help to enhance present understanding of the emergence of kinematic improvements or deteriorations associated with patellar resurfacing. The aim of this study was to isolate the effects of patellar resurfacing from a multi-stage in vitro study, where kinematics after total knee arthroplasty before and after patellar resurfacing were recorded. Additionally, the influence of the native patellar geometry on these effects was analysed. Eight fresh frozen specimens were tested successively with different implant configurations on an already established weight bearing knee rig. The patello-femoral kinematics were thereby measured using an ultrasonic measurement system and its relation to the native patellar geometries was analysed. After patellar resurfacing, the specimen showed a significantly medialized patellar shift. This medialization of the patellar tracking was significantly correlated to the lateral facet angle of the native patella. The patellar shift after patellar resurfacing is highly influenced by the position of the patellar button and the native lateral patellar facet angle. As a result, the ideal medio-lateral position of the patellar component is affected by the geometry of the native patella.

Ultrasound-based registration of the pelvic coordinate system in the lateral position using symmetry for total hip replacement.

In total hip replacement, patient placement in the lateral position is preferred by many surgeons. However, it complicates registration of the so-called pelvic coordinate system that is the standard reference for surgeons to measure cup orientation. This coordinate system comprises the anterior pelvic plane and the mid-sagittal plane, and it is conventionally registered on the basis of bony anatomical landmarks including the left and the right anterior superior iliac spine (ASIS). Ultrasound has been suggested for transcutaneous palpation of the bone surface. The difficulty in registration of the pelvic coordinate system with the patient in the lateral position arises because the contralateral ASIS cannot be reached easily by a mechanical pointer and is not accessible by means of an ultrasound probe. Up to now, methods to compensate for these missing data have not been used in clinical routine. This paper describes a new ultrasound-based method that requires neither image segmentation nor statistical shape models and uses symmetry to approximate the position of the contralateral ASIS. A detailed analysis based on computed tomography data of 60 hips following a cadaver study is presented to show the ability of our method to reliably reconstruct the pelvic coordinate system. The median angles between ground truth planes and the "reconstructed" planes were <2°. By choosing a standard cup orientation w.r.t. the "reconstructed" planes, the median abduction and version angle errors were <2°, too.