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Objective To explore the proprioception characteristics of knee joints for knee osteoarthritis (KOA) patients before unicondylar knee arthroplasty (UKA) and total knee arthroplasty (TKA). Methods Twenty-nine single-compartment KOA patients were selected. Fifteen patients were treated with UKA (UKA group) and fourteen patients were treated with TKA (TKA group). The test was performed 1 to 3 days before the operation.The keen society scores (KSS) of KOA patients in UKA group and TKA group were compared, and their joint position sense and kinesthesia were compared with control group. Results Significant differences in KSS were found in TKA group and UKA group, and the knee joint position sense and kinesthesia showed no significant differences between TKA group and UKA group.There were no significant differences in the knee joint position sense and kinesthesia between the operated leg and unoperated leg in TKA group and UKA group, and between the left leg and right leg in control group. Compared with control group, there were significant differences between UKA group and TKA group in 60° position sense of the operated leg and unoperated leg.The kinesthesia of the operated leg and unoperated leg in UKA group and TKA group were also significantly different from that in control group. Conclusions Compared with control group, the proprioception of the knee joint in KOA patients was significantly reduced before the surgery, but the characteristics of proprioception in UKA group and TKA group were similar.
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Objective To compare and analyze the lower limb muscle activity and knee joint force during the stance periods of gait cycle in patients with osteoarthritis before and after total knee arthroplasty (TKA). Methods Based on the OpenSim platform, lower extremity musculoskeletal models of one healthy subject and three patients with osteoarthritis before and after TKA were established. A three-dimensional （3D） motion capture system and a force platform were used to collect the lower limb kinematic data and the ground reaction force during walking, which were used as input parameters to simulate the lower limb muscle activation and knee joint forces. Results The results from the musculoskeletal model were consistent with the results by inverse dynamics based on the 3D motion capture system. The patient's rectus femoris was activated in the loading response and mid stance phases, which was different from that of healthy subject. The activation timing and amplitude of the quadriceps muscle in 3 patients were significantly different before and after TKA. The peak joint forces of 3 patients before TKA were 2.95, 3.15 and 3.43 times of body weight (BW) with the constant load of more than 2 times of BW during stand phase. The peak joint force after TKA were 2.09, 2.48 and 3.96 times of BW respectively. The joint force was not improved and the knee function did not reach the normal level six months after TKA. Conclusions The results of the established musculoskeletal model have certain reliability, and this model can provide a biomechanical auxiliary method for TKA surgery in the future.
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Objective To observe the analgesia efficacy of continuous fascia iliaca compartment block (FICB) and adductor canal block (ACB) on elderly patients undergoing total knee arthroplasty (TKA) with multimodal analgesia and their early rehabilitation. Methods Sixty TKA patients (26 female and 34 male, 60-75 years old) were randomly divided into two groups and received ultrasound-guided either continuous FICB (n=30) or continuous ACB (n=30) using 0.25% ropivacaine for controlled analgesia. All the patients had no previous experiences of knee surgery. Quality of analgesia was assessed by dynamic and static visual analogue scale (VAS) based on pain intensity. In addition, rehabilitation training compliance, range of motion (ROM) and knee function were assessed at different times after rehabilitation training. Results No significant differences were found in VAS scores during resting and passive functional exercise at 6, 12, 24, 48 h after TKA surgery (P>0.05); ACB group had significant differences in rehabilitation training compliance, knee ROM and HSS scores in comparison with FICB group (P<0.05). Conclusions Ultrasound-guided continuous ACB with multimodal analgesia could promote early rehabilitation after TKA．
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Objective To explore the correlation between gait parameters at 14 days and knee function and quality of life at 3 months after total knee arthroplasty (TKA). Methods Eighteen patients who underwent TKA were analyzed by using three-dimensional gait analysis system to observe their gait parameters. Knee joint function and life quality of the patients at 3 months after TKA were evaluated with WOMAC (Western Ontario and McMaster Universities Arthritis Index) and SF-36 (short form 36-item health survey scores) assessment scale and their correlations were analyzed simultaneously. Results At 14 days after TKA, single support time (SST) and peak knee flexion at swing (PKF) of the operated side of the leg were significantly smaller than those of the healthy side of the leg. The knee flexion angle at mid-stance (MKF) and knee valgus angle at mid-stance (MKV) of the operated side of the leg were significantly larger than those of the healthy side of the leg. There was a moderate negative correlation between the spatiotemporal parameters of the operated side of the leg and the WOMAC score during gait, while a high correlation between the WOMAC score and peak knee flexion at swing (PKF), MKF and MKV. Except for the step length and forward velocity, the other gait parameters were significantly correlated with SF-36 life quality score. The single support time (SST) and PKF had a highly positive correlation, while the MKF and MKV had a moderate negative correlation with SF-36 life quality score. Conclusions The SST, MKF, MKV and PKF in postoperative early gait analysis (14 days) results can be used as the effective indicators to judge postoperative knee function and rehabilitation efficacy of life quality after TKA surgery.
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Objective To obtain different biomechanical conditions of the tibia section with different osteotomy thickness under different activity states,so as to provide theoretical basis for total knee arthroplasty (TKA) and patient activities after operation.Methods The three-dimensional models of lower limb were reconstructed and the proximal tibia was resect by 0 mm,5 mm,7 mm,9 mm,respectively,based on the principle of bone resection in TKA.The tibia models after osteotomy were assigned with the material properties,and the stress and strain of the tibia cross-section were then analyzed under the following activity states:standing,walking,running and climbing upstairs.Results The stress and displacement of the tibia cross-section increased with the increase of osteotomy thickness under the same activity state.The maximum stress and displacement of tibia cross-section with the same osteotomy thickness showed an increasing trend when the strength of activity increased.Conclusions For TKA in clinic,the stress and strain on tibia cross-section become larger with the thicker tibia osteotomy and the stronger postoperative activity.Excessive osteotomy in TKA and activity too intensively after TKA should be avoided,so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.
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Objective To obtain different biomechanical conditions of the tibia section with different osteotomy thickness under different activity states,so as to provide theoretical basis for total knee arthroplasty (TKA) and patient activities after operation.Methods The three-dimensional models of lower limb were reconstructed and the proximal tibia was resect by 0 mm,5 mm,7 mm,9 mm,respectively,based on the principle of bone resection in TKA.The tibia models after osteotomy were assigned with the material properties,and the stress and strain of the tibia cross-section were then analyzed under the following activity states:standing,walking,running and climbing upstairs.Results The stress and displacement of the tibia cross-section increased with the increase of osteotomy thickness under the same activity state.The maximum stress and displacement of tibia cross-section with the same osteotomy thickness showed an increasing trend when the strength of activity increased.Conclusions For TKA in clinic,the stress and strain on tibia cross-section become larger with the thicker tibia osteotomy and the stronger postoperative activity.Excessive osteotomy in TKA and activity too intensively after TKA should be avoided,so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.
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Objective To obtain different biomechanical conditions of the tibia section with different osteotomy thickness under different activity states,so as to provide theoretical basis for total knee arthroplasty (TKA) and patient activities after operation.Methods The three-dimensional models of lower limb were reconstructed and the proximal tibia was resect by 0 mm,5 mm,7 mm,9 mm,respectively,based on the principle of bone resection in TKA.The tibia models after osteotomy were assigned with the material properties,and the stress and strain of the tibia cross-section were then analyzed under the following activity states:standing,walking,running and climbing upstairs.Results The stress and displacement of the tibia cross-section increased with the increase of osteotomy thickness under the same activity state.The maximum stress and displacement of tibia cross-section with the same osteotomy thickness showed an increasing trend when the strength of activity increased.Conclusions For TKA in clinic,the stress and strain on tibia cross-section become larger with the thicker tibia osteotomy and the stronger postoperative activity.Excessive osteotomy in TKA and activity too intensively after TKA should be avoided,so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.
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Objective To obtain biomechanical conditions of the tibia section with different osteotomy thickness under different activity states, so as to provide theoretical basis for osteotomy thickness in total knee arthroplasty (TKA) and activities of patients after operation. Methods The three-dimensional models of the lower limb were reconstructed and the proximal tibia was resected by 0 mm,5 mm,7 mm,9 mm respectively based on the principle of bone resection in TKA. The tibia model after osteotomy were assigned the material properties and the stress and strain of the tibia cross-section were analyzed under the following activity states: standing, walking, running and going upstairs. Results The stress and displacement of the tibia cross-section increased with the increase in osteotomy thickness under the same activity state. The maximum stress and displacement of tibia cross-section increased in general with the same osteotomy thickness, when the strength of activity increased. Conclusions During TKA in clinic, the stress and strain on tibia cross-section became larger as the tibia osteotomy became thicker and the postoperative activity became stronger. Excessive osteotomy in TKA and high intensive activity after TKA should be avoided, so as to reduce stress and strain of the tibia plateau and promote long-term life of the prosthesis.
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Objective To study the optimal radiographic conditions for patients with knee arthroplasty (TKA) and the feasibility of clinical application.Methods According to the different exposure modes,including automatic exposure control (AEC) or manual exposure mode (FIXED),the human body specimen was exposed at a certain kV and different mA or mAs.The entrance surface dose (ESD) and dose exposure index(DEI) were recorded,and the subjective image quality was assessed.The test group with optimum parameters obtained with statistical analysis were compared with control group in radiation dose and subjective evaluation.Results In AEC group,ESD and kV showed a negative correlation (r =-0.973,P ＜ 0.05).At the same mA,DEI was firstly decreased and then increased with kV increasing.The subjective image quality score was (1.96 ± 0.56).DEI and physician ratings showed negative correlation (r =-0.840,P ＜ 0.05).In FIXED group,ESD increased with the increasing mAs (r=0.845,P＜0.05).DEI and kV,mAs indicated a positive correlation(r=0.845,P＜0.05).The subjective image quality scores was(4.33 ±0.79) without correlation with DEI.Compared with the control group,the subjective image quality scores of test group increased,and the radiation dose decreased significantly.Conclusion It is optimal using manual exposure mode with 80 kV/l.25-1 mAs,75 kV/2-1 mAs,70 kV/2.5-1.25 mAs,65 kV/3.2-1.6 mAs and 60 kV/3.2-2 mAs for patients with TKA.
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Objective To obtain panorama X-ray images of the lower extremity with a simple method,eliminate the mosai-cing error,and apply this manual stitching technique for digital radiography to the measurement of the force line in total knee arthroplasty.Methods The track of X-ray tube was preset,and Dicom format data were collected by using digital X-ray ima-ging.Then,the data were imported to photoshop CS4 for manual image registration and image fusion.The reliability of the film was tested by comparing the vertical length of the body symbols proj ection in the coronal plane with that on the panorama X-ray (AutoCAD 2010)images.Moreover,the hip-knee-ankle angle was compared before and after operation.Results The matching sample t-test showed there were no significant differences in the length(4 groups of data)between the greater trochanter femur and the fibular head,and between the fibular head and the lateral malleolus between before and after operation(P>0.05 for all) .The hip-knee-ankles angle was much greater after operation than that before operation.Conclusion This manual stitching technique for digital radiography can produce seamless and precise panorama X-ray images,which can be used to reflect the length and angle of the lower extremity before and after operation.
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Objective To reconstruct the 3D motion of the knee joint after total knee arthroplasty (TKA) and measure the kinematics and the articular contacts between the posterior stabilized TKAs. Methods Sixteen knees undergoing TKAs were scanned by fluoroscopy. An algorithm of automatic registration was developed to match the 3D TKA models and 2D images. The kinematical parameters and articular contact of the tibiofemoral joint was investigated. ResultsThe time for a single image was less than 30 seconds. The in-plane repeatability was within 0.4 mm and 0.5 degree. The application of the high-flex insert didn’t obviously improve the ability of the flexion and the internal/external tibial rotation. When the knee flexed, the contact point on the lateral side moved more posteriorly than that on the medial side. The contact between the post-cam and the femoral prosthesis occurred with the flexion at about 30 degrees. The average range of the contact was within 9 mm. Conclusions The 3D kinematics of the in vivo TKA knee joint was accurately measured by using 2D-3D automatic registration technique. The result can provide references for the biomechanical study of TKA knees and the improvement of TKA prosthesis design.
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Knee joint is the largest joint in human body, with the most complex anatomy and the highest demand on motor function. The number of patients who receive the total knee arthroplasty (TKA) grows at the rate of over 10% annually around the world. TKA was developed from total hip arthroplasty, and has been developed rapidly during the thirty years' development. In this paper, evolution of prosthesis types, geometric shape and size of prosthesis and breakthrough in biomechanics of knee joint were reviewed; controversial issues in contemporary TKA studies were discussed; and the development of TKA in future was forecasted.
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Objective To provide the anatomic parameters and X-ray data of adult knee joint for the Northwestern Chinese people through measuring the knee joint of Northwestern aged people; at the same time, to provide reference for total knee arthroplasty (TKA) prosthesis design, selection and skills of surgery. Methods Totally 200 Northwestern Chinese aged people, aged above 40 years old, 100 males and 100 females, were selected randomly. X-ray films of knee were shot in the anterioposterior view and lateral position. Measurement and recording: angle PT, angle FT, patellar thickness, tibial plateau to fibular head distance (DPF). When the values were obtained, they were statistically analyzed based on gender and side. And we compared them with foreign data. Results Angle PT, angle FT, H and DPF did not differ significantly between the two sides (P>0.05). The differences in patellar thickness and DPF between patients of different gender was obvious (P<0.05), but there was no significant difference in angle PT and angle FT between the two genders (P>0.05). The differences in patellar thickness, DPF, angle PT and angle FT between the Chinese people and foreigners were obvious (P<0.05). Conclusion Angle PT, Angle FT, DPF and patellar thickness should be measured routinely before TKA in order to ensure successful operations.
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PURPOSE: To analyze the effect of clearing the protruding posterior femoral condyle from the femoral component (PFC: Posterior femoral clearance) on knee flexion in patients who underwent LCS(R) rotating platform TKA. MATERIALS AND METHODS: Twelve patients were male and one hundred seventy-eight patients were female. The patients were divided into the following two groups: Group A (62 patients 84 knees), TKA without PFC; and Group B (128 patients 182 knees), TKA with PFC. The clinical and radiology follow-up were carried out using the HSS score and tibiofemoral angle, and the possibility of squatting was evaluated in each group, respectively. RESULTS: The mean flexion contracture improved 10.8degrees in group A, and 10.3degrees in group B. The mean further flexion improved 13degrees in group A, and 24degrees in group B. The improvement of knee flexion with PFC showed statistical significance. The mean HSS knee scores improved 30.5 points in group A, and 36.3 points in group B. The improvement in the HSS knee score with PFC showed statistical significance. Squatting was possible 50.0% of group A, and 67.4% of group B. CONCLUSION: PFC is effective in increasing the level of knee flexion and improving the HSS score. PFC can be a good solution for high demand patients, particularly those from Asian countries.
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Female , Humans , Male , Arthroplasty , Asian People , Contracture , Follow-Up Studies , Knee Joint , KneeABSTRACT
[Objective]To measure the verus inclination of the proximal tibial of young Chinese through radiographs and determine how many degrees should the femoral prothesis be externally rotationed during total knee arthroplasty(TKA).[Method]Standardized anteroposterior radiographs of the entire lower legs of 200 volunteers' were taken. Two angles were measured as followes:Angle PT: angle between tibial articular margins and a line perpendicular to the tibial mechanical axis;Angle FT:angle between the transcondylar tangent anda line perpendicular to the tibial mechanical axis. [Result]Angle PT has a mean value of 4.06? and Angle FT is 5.00?. [Conclusion]When the posterior condylar axis is used during TKA for Chinese, the femoral prothesis should be externally rotationed 5.00? to get the optimum rotational orientation.