Clinical and functional comparison of uni- and bicondylar sledge prostheses.

The aim of the present study was the evaluation of differences in clinical results, proprioceptive performance and gait in patients with unicondylar and bicondylar sledge prostheses of the knee. In a retrospective study, 17 patients with unicondylar sledge prostheses were compared with 15 patients with bicondylar sledge prostheses. Clinical examination was rated using HSS, Knee Society, and patellar scores and a visual analogue scale for pain. Proprioceptive performance was examined using sway measurements during single leg stance on a force platform. In addition, the patients underwent 3-D gait analysis including measurements of ground reaction forces and surface electromyographic (EMG) investigation of the lower extremity. Comparing both patient groups in clinical scores, gait, EMG and proprioception, no significant differences were found. Implantation of bicondylar sledge prostheses retaining both cruciate ligaments achieves functional results as good as unicompartmental arthroplasty. The presented results might encourage future research on new models of total joint replacement with preservation of both cruciate ligaments.

Clinical and functional comparison of bicondylar sledge prostheses retaining all ligaments and constrained total knee replacement.

OBJECTIVE: Comparison of different total knee replacements regarding clinical and functional differences with respect to gait and electromyographic analyses. DESIGN: Retrospective, comparative, clinical and functional study. METHODS: Three groups (control group of 11 healthy subjects, 15 patients with bicondylar sledge prostheses retaining all ligaments (cemented unicondylar prostheses in both the medial and lateral compartment), 15 patients with constrained total knee replacement sacrificing all cruciate and collateral ligaments (cemented total knee prosthesis with intramedullary stems and a large intercondylar tibial post) were compared by clinical evaluation using a number of clinical evaluation scores, a pain scale, surface electromyographic examinations of the lower limb, and gait analysis. RESULTS: Clinical scores revealed significantly worse results for patients with constrained prostheses. Both patient groups had significantly lower clinical scores compared to the control group. Gait analysis and electromyographic parameters revealed no significant differences between both patient groups. Compared to the control group, patients revealed significantly impaired parameters. Electromyography also demonstrated significant differences between patients and controls: mean electromyographic activities were reduced in vastus medialis and lateralis, semitendinosus, tibialis anterior and gastrocnemius. Peak activities were reduced in all muscles but rectus femoris. CONCLUSION: Clinical scores demonstrated significantly better results in bicondylar sledge than in constrained prostheses. Nevertheless, gait and electromyographic analyses did not reveal significant differences. RELEVANCE: Retaining of ligaments in bicondylar sledge prostheses apparently improved the activities of daily living but is not reflected in gait and electromyographic parameters.

[Correlation of electromyography and clinical results after bicondylar knee joint prosthesis implantation]. / Korrelation von elektromyographischen und klinischen Ergebnissen nach bikondylären Kniegelenksprothesen.

AIM OF THE STUDY: To investigate clinical findings in patients receiving bicondylar sledge prostheses, and their correlation with electromyographic measurements in comparison with healthy volunteers. MATERIAL AND METHODS: An average of 31.9 months after implantation of a bicondylar sledge prosthesis, 15 patients were clinically examined and compared with 11 control subjects. Electromyographic measurements of the rectus femoris, vastus medialis and lateralis, semitendinosus, biceps femoris, tibialis anterior, and gastrocnemius muscles were obtained. RESULTS: All clinical scores were significantly poorer in the patient group. The activity of the vastus lateralis was significantly reduced. The activity in the lower leg of the operated side was significantly higher than in the control group. Significant differences were found in the tibialis anterior and gastrocnemius muscles between controls and patients. Analysis of the correlation between the clinical scores and the electromyographic measurements showed no significance. CONCLUSION: The clinical results correlated only slightly with the electromyographic activity of the muscles investigated. The commonly presumed quadriceps insufficiency was not confirmed.

[Results of bicondylar sledge prostheses with special reference to the gait pattern]. / Ergebnisse von Doppelschlittenprothesen unter besonderer Berücksichtigung des Gangbildes.

AIM: To establish whether the clinical results obtained with bicondylar sledge prostheses correlate with clinical findings, and whether clinical results influence gait pattern. MATERIAL AND METHODS: 15 patients with bicondylar sledge prostheses were compared with healthy controls. The clinical examination was documented using the HSS, Knee Society, Tegner, and patella scores, and the Visual Analogue Scale. Gait analysis was done with a three-dimensional motion analysis system and force platforms. RESULTS: A comparison of patients and controls showed significant differences in the clinical results, whereas the parameters gait function, muscle force and pain did not. No significant differences were found between the operated and non-operated legs. In comparison with controls, patients showed significant differences in the ground reaction forces. DISCUSSION: The abnormal gait findings showed no correlation with clinical results, nor did such parameters as age, weight and duration of follow-up appear to have any influence. The non-operated leg adapted to the gait pattern of the operated leg, to restore gait symmetry. CLINICAL RELEVANCE: Subjective complaints or clinical results show little relationship to gait parameters in patients receiving a bicondylar sledge prosthesis.