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J Knee Surg 2020; 33(10): 1020-1028
DOI: 10.1055/s-0039-1692652
Original Article

Comparison of Knee Kinematics and Kinetics during Stair Descent in Single- and Multi-Radius Total Knee Arthroplasty

Bonnie Sumner
1   Department of Research, MORE Foundation, Phoenix, Arizona
,
John 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
1   Department of Research, MORE Foundation, Phoenix, Arizona
3   Department of Research and Development, The CORE Institute, Phoenix, Arizona
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Abstract

Despite continuing advances, nearly 20% of patients remain dissatisfied with their total knee arthroplasty (TKA) outcomes. Single-radius (SR) and multiradius (MR) TKA designs are two commonly used knee replacement designs based on competing theories of the flexion/extension axis of the knee. Our aim was to characterize stair descent kinematics and kinetics in SR and MR TKA subjects. We hypothesized that 1 year after TKA, patients who received SR TKA will more closely replicate the knee kinematics and kinetics of healthy age-matched controls during stair descent, than will MR TKA patients. SR subjects (n = 12), MR subjects (n = 12), and age-matched controls (n = 12) descended four stairs affixed to force platforms, while 10 infrared cameras tracked markers attached to the body to collect kinematic and kinetic data. Both patient groups had improvements in stair descent kinetics and kinematics at the 1-year postoperative time point. However, SR TKA subjects were indistinguishable statistically from age-matched controls, while MR TKA subjects retained many differences from controls. Similar to previous reports for level walking, the SR knee design performs closer to healthy controls than MR knees during stair descent. This study demonstrates that patients who receive SR TKA have more improved kinematic normalization during stair descent postoperatively than those who received an MR TKA.

Keywords

total knee arthroplasty - stair descent - knee axis of rotation - biomechanics


Publication History

Received: 11 May 2018

Accepted: 05 May 2019

Article published online:
07 August 2019

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  • References

  • 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    Google Scholar
  • 2 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
    Google Scholar
  • 3 Scott CEH, 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
    CrossrefPubMedGoogle Scholar
  • 4 Williams DP, O'Brien S, Doran E. , et al. Early postoperative predictors of satisfaction following total knee arthroplasty. Knee 2013; 20 (06) 442-446
    CrossrefPubMedGoogle Scholar
  • 5 Parvizi J, Nunley RM, Berend KR. , et al. High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Relat Res 2014; 472 (01) 133-137
    CrossrefPubMedGoogle Scholar
  • 6 Weber W, Weber E. Mechanics of the Human Walking Apparatus (translated by Maquet P and Furlong R). Section 4: On the Knee. Berilin: Springer. (First published as Mechanik der menschlichen Gehwerkzeuge. Gottingen; 1992: 75)
    Google Scholar
  • 7 Eckhoff D, Hogan C, DiMatteo L, Robinson M, Bach J. Difference between the epicondylar and cylindrical axis of the knee. Clin Orthop Relat Res 2007; 461: 238-244
    CrossrefPubMedGoogle Scholar
  • 8 Soudan K, Van Audekercke R, Martens M. Methods, difficulties and inaccuracies in the study of human joint kinematics and pathokinematics by the instant axis concept. Example: the knee joint. J Biomech 1979; 12 (01) 27-33
    CrossrefPubMedGoogle Scholar
  • 9 Elias SG, Freeman MA, Gokcay EI. A correlative study of the geometry and anatomy of the distal femur. Clin Orthop Relat Res 1990; (260) 98-103
    CrossrefPubMedGoogle Scholar
  • 10 Hollister AM, Jatana S, Singh AK, Sullivan WW, Lupichuk AG. The axes of rotation of the knee. Clin Orthop Relat Res 1993; 290 (290) 259-268
    PubMedGoogle Scholar
  • 11 Churchill DL, Incavo SJ, Johnson CC, Beynnon BD. The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop Relat Res 1998; (356) 111-118
    CrossrefPubMedGoogle Scholar
  • 12 Asano T, Akagi M, Nakamura T. The functional flexion-extension axis of the knee corresponds to the surgical epicondylar axis: in vivo analysis using a biplanar image-matching technique. J Arthroplasty 2005; 20 (08) 1060-1067
    CrossrefPubMedGoogle Scholar
  • 13 Kosel J, Giouroudi I, Scheffer C, Dillon E, Erasmus P. Anatomical study of the radius and center of curvature of the distal femoral condyle. J Biomech Eng 2010; 132 (09) 091002
    CrossrefPubMedGoogle Scholar
  • 14 Lustig S, Lavoie F, Selmi TAS, Servien E, Neyret P. Relationship between the surgical epicondylar axis and the articular surface of the distal femur: an anatomic study. Knee Surg Sports Traumatol Arthrosc 2008; 16 (07) 674-682
    CrossrefPubMedGoogle Scholar
  • 15 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
    CrossrefPubMedGoogle Scholar
  • 16 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
    CrossrefPubMedGoogle Scholar
  • 17 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
    CrossrefPubMedGoogle Scholar
  • 18 Sumner B, McCamley JD, Jacofsky DJ, Jacofsky MC. Comparison of knee kinematics and kinetics during stair ascent in single-radius and multiradius total knee arthroplasty. J Knee Surg 2018; ; (e-pub ahead of print) DOI: 10.1055/s-0038-1669952.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 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
    CrossrefPubMedGoogle Scholar
  • 20 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
    CrossrefPubMedGoogle Scholar
  • 21 Startzell JK, Owens DA, Mulfinger LM, Cavanagh PR. Stair negotiation in older people: a review. J Am Geriatr Soc 2000; 48 (05) 567-580
    CrossrefPubMedGoogle Scholar
  • 22 Ezechieli M, Dietzek J, Becher C. , et al. The influence of a single-radius-design on the knee stability. Technol Health Care 2012; 20 (06) 527-534
    CrossrefPubMedGoogle Scholar
  • 23 Jo AR, Song EK, Lee KB, Seo HY, Kim SK, Seon JK. A comparison of stability and clinical outcomes in single-radius versus multi-radius femoral design for total knee arthroplasty. J Arthroplasty 2014; 29 (12) 2402-2406
    CrossrefPubMedGoogle Scholar
  • 24 McAndrew Young PM, Dingwell JB. Voluntarily changing step length or step width affects dynamic stability of human walking. Gait Posture 2012; 35 (03) 472-477
    CrossrefPubMedGoogle Scholar
  • 25 Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res 1990; 8 (03) 383-392
    CrossrefPubMedGoogle Scholar
  • 26 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 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
    CrossrefPubMedGoogle Scholar
  • 28 Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989; (248) 13-14
    PubMedGoogle Scholar
  • 29 R Core Team. A Language and Environment for Statistical Computing. Vienna, Austria: Foundation for Statistical Computing; 2015
  • 30 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 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
    CrossrefPubMedGoogle Scholar
  • 32 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
    CrossrefPubMedGoogle Scholar
  • 33 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
    CrossrefPubMedGoogle Scholar
  • 34 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
    CrossrefPubMedGoogle Scholar
  • 35 Zabala ME, Favre J, Scanlan SF, Donahue J, Andriacchi TP. Three-dimensional knee moments of ACL reconstructed and control subjects during gait, stair ascent, and stair descent. J Biomech 2013; 46 (03) 515-520
    CrossrefPubMedGoogle Scholar
  • 36 Trinler UK, Baty F, Mündermann A. , et al. Stair dimension affects knee kinematics and kinetics in patients with good outcome after TKA similarly as in healthy subjects. J Orthop Res 2016; 34 (10) 1753-1761
    CrossrefPubMedGoogle Scholar
  • 37 McClelland JA, Feller JA, Menz HB, Webster KE. Patterns in the knee flexion-extension moment profile during stair ascent and descent in patients with total knee arthroplasty. J Biomech 2014; 47 (08) 1816-1821
    CrossrefPubMedGoogle Scholar
  • 38 Igawa T, Katsuhira J. Biomechanical analysis of stair descent in patients with knee osteoarthritis. J Phys Ther Sci 2014; 26 (05) 629-631
    CrossrefPubMedGoogle Scholar
  • 39 Ostermeir S. Stukenborg-Cdsman. Quadriceps force after TKA with femoral single-radius. Acta Orthopaedica 2011; 82 (03) 339-343 . Doi: 10.3109/17453674.2011.574564
    CrossrefPubMedGoogle Scholar
  • 40 Enoka RM, Duchateau J. Muscle fatigue: what, why and how it influences muscle function. J Physiol 2008; 586 (01) 11-23
    CrossrefPubMedGoogle Scholar
  • 41 Bigland-Ritchie B, Woods JJ. Changes in muscle contractile properties and neural control during human muscular fatigue. Muscle Nerve 1984; 7 (09) 691-699
    CrossrefPubMedGoogle Scholar
  • 42 Søgaard K, Gandevia SC, Todd G, Petersen NT, Taylor JL. The effect of sustained low-intensity contractions on supraspinal fatigue in human elbow flexor muscles. J Physiol 2006; 573 (Pt. 2): 511-523
    CrossrefPubMedGoogle Scholar
  • 43 Egerton T, Brauer SG, Cresswell AG. Fatigue after physical activity in healthy and balance-impaired elderly. J Aging Phys Act 2009; 17 (01) 89-105
    CrossrefPubMedGoogle Scholar