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J Knee Surg 2019; 32(09): 872-878
DOI: 10.1055/s-0038-1669952
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of Knee Kinematics and Kinetics during Stair Ascent in Single-Radius and Multiradius Total Knee Arthroplasty

Bonnie Sumner
1   Department of Research, MORE Foundation, Phoenix, Arizona
,
John D. McCamley
1   Department of Research, MORE Foundation, Phoenix, Arizona
,
David J. Jacofsky
2   Department of Adult Reconstruction, The CORE Institute, Phoenix, Arizona
,
Marc C. Jacofsky
3   Department of Research and Development, The CORE Institute, Phoenix, Arizona
› Author Affiliations
Further Information

Publication History

29 June 2018

27 July 2018

Publication Date:
18 September 2018 (online)

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Abstract

Traditionally total knee arthroplasty (TKA) design has been based on theories of the movement of the healthy knee joint. Currently, there are two competing theories on the flexion/extension axis of rotation of the knee with disparate radii of rotation, and thus differing movement patterns. The purpose of our study was to compare stair ascent kinematics and kinetics of single-radius (SR) and multiradius (MR) TKA subjects. We hypothesized that the knee kinematics and kinetics of SR TKA patients would more closely replicate healthy age matched controls during stair ascent than MR TKA patients, 1 year after TKA. Both patient groups had large improvements in biomechanical and clinical outcome measures following surgical intervention. However, the SR knee design performs closer to healthy controls than MR knees during stair ascent, supporting results that have been previously obtained for level walking. SR TKA subjects demonstrated reduced power production and sagittal moment compared with controls, albeit more than MR TKA subjects. This study demonstrates that patients who receive SR TKA have kinematics more closely aligned to normal patterns postoperatively than those who received an MR TKA. The power production and sagittal moment of the healthy controls most closely match previously published values of younger adults, SR TKA group most closely matches older adults, while the MR TKA group has lower power production and sagittal moments than either previously published age group. This strongly suggests that the biomechanical differences found in this study are evidence of functional deficiencies. Further research is needed to determine how these deficiencies progress with patient aging.

Keywords

total knee arthroplasty - stair ascent - knee axes of rotation - biomechanics
 

  • References

  • 1 Gunaratne R, Pratt DN, Banda J, Fick DP, Khan RJK, Robertson BW. Patient dissatisfaction following total knee arthroplasty: a systematic review of the literature. J Arthroplasty 2017; 32 (12) 3854-3860
    CrossrefPubMedSearch in Google Scholar
  • 2 Scott CE, Oliver WM, MacDonald D, Wade FA, Moran M, Breusch SJ. Predicting dissatisfaction following total knee arthroplasty in patients under 55 years of age. Bone Joint J 2016; 98-B (12) 1625-1634
    CrossrefPubMedSearch in Google Scholar
  • 3 Williams DP, O'Brien S, Doran E. , et al. Early postoperative predictors of satisfaction following total knee arthroplasty. Knee 2013; 20 (06) 442-446
    CrossrefPubMedSearch in Google Scholar
  • 4 Cook LE, Klika AK, Szubski CR, Rosneck J, Molloy R, Barsoum WK. Functional outcomes used to compare single radius and multiradius of curvature designs in total knee arthroplasty. J Knee Surg 2012; 25 (03) 249-253
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Larsen B, Jacofsky MC, Jacofsky DJ. Quantitative, comparative assessment of gait between single-radius and multi-radius total knee arthroplasty designs. J Arthroplasty 2015; 30 (06) 1062-1067
    CrossrefPubMedSearch in Google Scholar
  • 6 Mahoney OM, McClung CD, dela Rosa MA, Schmalzried TP. The effect of total knee arthroplasty design on extensor mechanism function. J Arthroplasty 2002; 17 (04) 416-421
    CrossrefPubMedSearch in Google Scholar
  • 7 Liu S, Long H, Zhang Y, Ma B, Li Z. Meta-analysis of outcomes of a single-radius versus multi-radius femoral design in total knee arthroplasty. J Arthroplasty 2016; 31 (03) 646-654
    CrossrefPubMedSearch in Google Scholar
  • 8 Ostermeier S, Hurschler C, Stukenborg-Colsman C. Quadriceps function after TKA--an in vitro study in a knee kinematic simulator. Clin Biomech (Bristol, Avon) 2004; 19 (03) 270-276
    CrossrefPubMedSearch in Google Scholar
  • 9 Gómez-Barrena E, Fernandez-García C, Fernandez-Bravo A, Cutillas-Ruiz R, Bermejo-Fernandez G. Functional performance with a single-radius femoral design total knee arthroplasty. Clin Orthop Relat Res 2010; 468 (05) 1214-1220
    CrossrefPubMedSearch in Google Scholar
  • 10 Hamilton DF, Burnett R, Patton JT. , et al. Implant design influences patient outcome after total knee arthroplasty: a prospective double-blind randomised controlled trial. Bone Joint J 2015; 97-B (01) 64-70
    CrossrefPubMedSearch in Google Scholar
  • 11 Wang H, Simpson KJ, Chamnongkich S, Kinsey T, Mahoney OM. A biomechanical comparison between the single-axis and multi-axis total knee arthroplasty systems for the stand-to-sit movement. Clin Biomech (Bristol, Avon) 2005; 20 (04) 428-433
    CrossrefPubMedSearch in Google Scholar
  • 12 Wang H, Simpson KJ, Ferrara MS, Chamnongkich S, Kinsey T, Mahoney OM. Biomechanical differences exhibited during sit-to-stand between total knee arthroplasty designs of varying radii. J Arthroplasty 2006; 21 (08) 1193-1199
    CrossrefPubMedSearch in Google Scholar
  • 13 Andriacchi TP, Andersson GB, Fermier RW, Stern D, Galante JO. A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am 1980; 62 (05) 749-757
    CrossrefPubMedSearch in Google Scholar
  • 14 Andriacchi TP, Galante JO, Fermier RW. The influence of total knee-replacement design on walking and stair-climbing. J Bone Joint Surg Am 1982; 64 (09) 1328-1335
    CrossrefPubMedSearch in Google Scholar
  • 15 Startzell JK, Owens DA, Mulfinger LM, Cavanagh PR. Stair negotiation in older people: a review. J Am Geriatr Soc 2000; 48 (05) 567-580
    CrossrefPubMedSearch in Google Scholar
  • 16 McAndrew Young PM, Dingwell JB. Voluntary changes in step width and step length during human walking affect dynamic margins of stability. Gait Posture 2012; 36 (02) 219-224
    CrossrefPubMedSearch in Google Scholar
  • 17 Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res 1990; 8 (03) 383-392
    CrossrefPubMedSearch in Google Scholar
  • 18 Reeves ND, Spanjaard M, Mohagheghi AA, Baltzopoulos V, Maganaris CN. Influence of light handrail use on the biomechanics of stair negotiation in old age. Gait Posture 2008; 28 (02) 327-336
    CrossrefPubMedSearch in Google Scholar
  • 19 Varnell MS, Bhowmik-Stoker M, McCamley J, Jacofsky MC, Campbell M, Jacofsky D. Difference in stair negotiation ability based on TKA surgical approach. J Knee Surg 2011; 24 (02) 117-123
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Saleh KJ, Mulhall KJ, Bershadsky B. , et al. Development and validation of a lower-extremity activity scale. Use for patients treated with revision total knee arthroplasty. J Bone Joint Surg Am 2005; 87 (09) 1985-1994
    CrossrefPubMedSearch in Google Scholar
  • 21 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
    PubMedSearch in Google Scholar
  • 22 R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2015
    Search in Google Scholar
  • 23 Riener R, Rabuffetti M, Frigo C. Stair ascent and descent at different inclinations. Gait Posture 2002; 15 (01) 32-44
    CrossrefPubMedSearch in Google Scholar
  • 24 Wilken JM, Sinitski EH, Bagg EA. The role of lower extremity joint powers in successful stair ambulation. Gait Posture 2011; 34 (01) 142-144
    CrossrefPubMedSearch in Google Scholar
  • 25 Nadeau S, McFadyen BJ, Malouin F. Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking?. Clin Biomech (Bristol, Avon) 2003; 18 (10) 950-959
    CrossrefPubMedSearch in Google Scholar
  • 26 Novak AC, Brouwer B. Sagittal and frontal lower limb joint moments during stair ascent and descent in young and older adults. Gait Posture 2011; 33 (01) 54-60
    CrossrefPubMedSearch in Google Scholar
  • 27 Reeves ND, Spanjaard M, Mohagheghi AA, Baltzopoulos V, Maganaris CN. Older adults employ alternative strategies to operate within their maximum capabilities when ascending stairs. J Electromyogr Kinesiol 2009; 19 (02) e57-e68
    CrossrefPubMedSearch in Google Scholar