Central cone design demonstrates greater micromotion compared to keel design in cementless tibial baseplates: A biomechanical analysis.

PURPOSE: The purpose of this study was to compare micromotion of two new cementless tibial baseplates to a cementless design with well-published clinical success. METHODS: Three cementless tibial baseplate designs (fixed-bearing [FB] with keel and cruciform pegs, rotating-platform with porous central cone and pegs, FB with cruciform keel and scalloped pegs) were evaluated on sawbone models. Loading was applied to the baseplate at a rate of 1 Hz for 10,000 cycles, which represents 6-8 weeks of stair descent. This time frame also represents the approximate time length for the induction of biologic fixation of cementless implants. Compressive and shear micromotion at the sawbone-implant interface were measured. RESULTS: At the end of the loading protocol, the central cone rotating-platform design exhibited greater micromotion at the anterior (p < 0.001), posterior (p < 0.001) and medial locations (p = 0.049) compared to the other two implants. The central cone design also exhibited greater translational micromotion in the sagittal plane at the medial (p = 0.001) and lateral locations (p = 0.034) and in the coronal plane anteriorly (p = 0.007). CONCLUSION: The cementless central cone rotating-platform baseplate demonstrated greater vertical and translational micromotion compared to the two FB baseplates with a keel underloading. This may indicate lower initial mechanical stability in implants without a keel, which possibly affects osseointegration. The implication of this is yet unknown and requires further long-term clinical follow-up to correlate these laboratory findings. LEVEL OF EVIDENCE: V (biomechanical study).

Does surgical approach affect patient outcomes of total knee arthroplasty?

BACKGROUND: Surgical approaches for total knee arthroplasty (TKA) include the medial parapatellar (MPA), subvastus (SV), midvastus (MV), and lateral parapatellar approach (LPA); it remains unclear which approach is superior. METHODS: Patients having undergone TKA at our institution were retrospectively organized into matched groups according to surgical approach (MPA, MV, SV, or LPA). Outcomes between the groups were compared using the Short-Form 12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and range of motion (ROM) up to 2 years postoperative. RESULTS: Sixty-eight MV patients, 8 SV patients, and 4 LPA patients were matched with groups of MPA patients. There was no difference in outcomes between the MPA and MV groups up to 2 years. The SV group had significantly higher SF-12 Physical Composite Score (PCS; p = 0.036) and WOMAC stiffness score (p = 0.014) at 2 years, but significantly lower flexion at 1 year (p = 0.022) than the MPA group. The LPA group had significantly lower SF-12 PCS (p = 0.011) and WOMAC function scores (p = 0.022) at 1 year than the MPA group. CONCLUSION: There was no significant difference between the MPA and MV approach. The SV approach had some improved long-term outcomes over the MPA aproach (SF-12 and WOMAC), but had significantly lower flexion at 1 year. The LPA group showed inferior outcomes than the MPA group but had more severe valgus preoperative deformity (p = 0.024). Further studies are required to investigate the potential benefit of quadriceps-sparing approaches.

Lateral subvastus lateralis versus medial parapatellar approach for total knee arthroplasty: A cadaveric biomechanical study.

BACKGROUND: The standard of care for total knee arthroplasty (TKA) is a medial parapatellar approach (MPA). We aimed to study a novel lateral subvastus lateralis approach (SLA), which offers the benefit of keeping the extensor mechanism and medial soft tissues intact. To ensure the approach could be used safely in vivo, a biomechanical study was performed to assess whether the joint kinematics would be preserved after performing a TKA. METHODS: A biomechanical study was conducted using 14 fresh-frozen cadaveric knees, with seven specimens each for the MPA and SLA. After a single radius, cemented cruciate retaining TKA was performed, specimens were tested on a VIVO joint motion simulator to measure and compare anterior/posterior, internal/external, and varus/valgus kinematics and laxity. RESULTS: There was no significant difference in joint kinematics or laxity between the SLA and MPA groups. CONCLUSION: Both the SLA and MPA offer similar knee kinematics and laxity based on a cadaveric model. Although the surgical approach was different, inherently releasing different ligaments, both approaches resulted in a stable knee. This suggests that either approach will enable the surgeon to provide a stable knee, and that the implant itself may contribute a significant portion of the knee's kinematics.

A rigid body model for the assessment of glenohumeral joint mechanics: Influence of osseous defects on range of motion and dislocation.

The purpose of this study was to employ subject-specific computer models to evaluate the interaction of glenohumeral range-of-motion and Hill-Sachs humeral head bone defect size on engagement and shoulder dislocation. We hypothesized that the rate of engagement would increase as defect size increased, and that greater shoulder ROM would engage smaller defects. Three dimensional computer models of 12 shoulders were created. For each shoulder, additional models were created with simulated Hill-Sachs defects of varying severities (XS=15%, S=22.5%, M=30%, L=37.5%, XL=45% and XXL=52.5% of the humeral head diameter, respectively). Rotational motion simulations without translation were conducted. The simulations ended if the defect engaged the anterior glenoid rim with resultant dislocation. The results showed that the rate of engagement was significantly different between defect sizes (0.001

Accuracy assessment of 3D bone reconstructions using CT: an intro comparison.

Computed tomography provides high contrast imaging of the joint anatomy and is used routinely to reconstruct 3D models of the osseous and cartilage geometry (CT arthrography) for use in the design of orthopedic implants, for computer assisted surgeries and computational dynamic and structural analysis. The objective of this study was to assess the accuracy of bone and cartilage surface model reconstructions by comparing reconstructed geometries with bone digitizations obtained using an optical tracking system. Bone surface digitizations obtained in this study determined the ground truth measure for the underlying geometry. We evaluated the use of a commercially available reconstruction technique using clinical CT scanning protocols using the elbow joint as an example of a surface with complex geometry. To assess the accuracies of the reconstructed models (8 fresh frozen cadaveric specimens) against the ground truth bony digitization-as defined by this study-proximity mapping was used to calculate residual error. The overall mean error was less than 0.4 mm in the cortical region and 0.3 mm in the subchondral region of the bone. Similarly creating 3D cartilage surface models from CT scans using air contrast had a mean error of less than 0.3 mm. Results from this study indicate that clinical CT scanning protocols and commonly used and commercially available reconstruction algorithms can create models which accurately represent the true geometry.

Evaluation of a computational model to predict elbow range of motion.

Computer models capable of predicting elbow flexion and extension range of motion (ROM) limits would be useful for assisting surgeons in improving the outcomes of surgical treatment of patients with elbow contractures. A simple and robust computer-based model was developed that predicts elbow joint ROM using bone geometries calculated from computed tomography image data. The model assumes a hinge-like flexion-extension axis, and that elbow passive ROM limits can be based on terminal bony impingement. The model was validated against experimental results with a cadaveric specimen, and was able to predict the flexion and extension limits of the intact joint to 0° and 3°, respectively. The model was also able to predict the flexion and extension limits to 1° and 2°, respectively, when simulated osteophytes were inserted into the joint. Future studies based on this approach will be used for the prediction of elbow flexion-extension ROM in patients with primary osteoarthritis to help identify motion-limiting hypertrophic osteophytes, and will eventually permit real-time computer-assisted navigated excisions.

Development and evaluation of a semi-automatic technique for determining the bilateral symmetry plane of the facial skeleton.

During reconstructive surgery of the face, one side may be used as a template for the other, exploiting assumed bilateral facial symmetry. The best method to calculate this plane, however, is debated. A new semi-automatic technique for calculating the symmetry plane of the facial skeleton is presented here that uses surface models reconstructed from computed tomography image data in conjunction with principal component analysis and an iterative closest point alignment method. This new technique was found to provide more accurate symmetry planes than traditional methods when applied to a set of 7 human craniofacial skeleton specimens, and showed little vulnerability to missing model data, usually deviating less than 1.5° and 2 mm from the intact model symmetry plane when 30 mm radius voids were present. This new technique will be used for subsequent studies measuring symmetry of the facial skeleton for different patient populations.

Validation of a finite element model of the human elbow for determining cartilage contact mechanics.

It is important to study joint contact mechanics to better understand the processes which lead to cartilage degradation. The purpose of this study was to develop and validate a finite element (FE) model of a human elbow capable of predicting joint contact area and stress. A cylindrical constrained elbow joint loading apparatus was used to measure the cartilage compression and contact area for a single cadaveric specimen. A computer model of the same joint was created based on computed tomography images of the specimen, and the same loading was simulated using FE contact analysis. The model-predicted joint compression and contact area corresponded closely with experiment-measured results (differences of -4.9% and +9.6%). A sensitivity analysis showed that the model results were sensitive to cartilage and bone material properties, as well as the cartilage thickness distribution. The results of this study underline the importance of using accurate material properties and physiological cartilage thickness distributions when simulating cartilage contact mechanics.