The Association between In Vivo Knee Kinematics and Patient-Reported Outcomes during Squatting in Bicruciate-Stabilized Total Knee Arthroplasty

Abstract

Bicruciate-stabilized total knee arthroplasty (BCS TKA) has been developed to improve TKA kinematic performance. However, the relationship between in vivo kinematics and patient-reported outcomes (PROs) has not been well described. This study was performed to clarify the relationship between in vivo kinematics and PROs in a cohort of patients undergoing BCS TKA. Forty knees were evaluated using a two-dimensional to three-dimensional registration technique obtained from sagittal plane fluoroscopy. In vivo kinematics including anteroposterior (AP) translation and tibiofemoral rotation were evaluated. Knee Society scores (KSSs) and Knee injury and Osteoarthritis Outcome Scores (KOOSs) were assessed before and after surgery. Relationships between tibiofemoral kinematics assessed with the knee in different positions of knee flexion and PROs were evaluated using Spearman's correlation analysis. The study demonstrated a significant negative correlation (r =  − 0.33) between medial AP translation from minimum flexion to 30 degrees flexion and postoperative KOOS activities of daily living subscale. A significant positive correlation (r = 0.51) was found between the femoral external rotation from minimum flexion to 30 degrees flexion and improvement of the KOOS pain subscale. No correlation was found between the lateral AP translation and PROs. Achieving medial AP and femoral external rotation stability in early flexion may be important in optimizing postoperative PROs.

Keywords

total knee arthroplasty - bicruciate stabilized - in vivo kinematics - patient-reported outcomes

Publication History

Received: 29 May 2020

Accepted: 17 December 2020

Article published online:
05 February 2021

• References

• 1 Scott CE, Howie CR, MacDonald D, Biant LC. Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 2010; 92 (09) 1253-1258
• 2 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
• 3 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
• 4 Nam D, Nunley RM, Barrack RL. Patient dissatisfaction following total knee replacement: a growing concern?. Bone Joint J 2014; 96-b (11 supple A): 96-100
• 5 Grieco TF, Sharma A, Dessinger GM, Cates HE, Komistek RD. In vivo kinematic comparison of a bicruciate stabilized total knee arthroplasty and the normal knee using fluoroscopy. J Arthroplasty 2018; 33 (02) 565-571
• 6 Arbuthnot JE, Brink RB. Assessment of the antero-posterior and rotational stability of the anterior cruciate ligament analogue in a guided motion bi-cruciate stabilized total knee arthroplasty. J Med Eng Technol 2009; 33 (08) 610-615
• 7 Halewood C, Risebury M, Thomas NP, Amis AA. Kinematic behaviour and soft tissue management in guided motion total knee replacement. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 3074-3082
• 8 Victor J, Bellemans J. Physiologic kinematics as a concept for better flexion in TKA. Clin Orthop Relat Res 2006; 452 (452) 53-58
• 9 Luyckx L, Luyckx T, Bellemans J, Victor J. Iliotibial band traction syndrome in guided motion TKA. A new clinical entity after TKA. Acta Orthop Belg 2010; 76 (04) 507-512
• 10 Kono K, Inui H, Tomita T. et al. Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities. Knee Surg Sports Traumatol Arthrosc 2019; 27 (07) 2096-2103
• 11 Christen B, Kopjar B. Second-generation bi-cruciate stabilized total knee system has a lower reoperation and revision rate than its predecessor. Arch Orthop Trauma Surg 2018; 138 (11) 1591-1599
• 12 Hino K, Kutsuna T, Watamori K. et al. Bi-cruciate substituting total knee arthroplasty provides varus-valgus stability throughout the midflexion range. Knee 2018; 25 (05) 897-902
• 13 Kaneko T, Kono N, Mochizuki Y, Hada M, Toyoda S, Musha Y. Bi-cruciate substituting total knee arthroplasty improved medio-lateral instability in mid-flexion range. J Orthop 2017; 14 (01) 201-206
• 14 Mugnai R, Digennaro V, Ensini A, Leardini A, Catani F. Can TKA design affect the clinical outcome? Comparison between two guided-motion systems. Knee Surg Sports Traumatol Arthrosc 2014; 22 (03) 581-589
• 15 Inui H, Taketomi S, Yamagami R, Shirakawa N, Kawaguchi K, Tanaka S. The relationship between soft-tissue balance and intraoperative kinematics of guided motion total knee arthroplasty. J Knee Surg 2019; 32 (01) 91-96
• 16 Minoda Y, Watanabe K, Iwaki H, Takahashi S, Fukui M, Nakamura H. Theoretical risk of anterior femoral cortex notching in total knee arthroplasty using a navigation system. J Arthroplasty 2013; 28 (09) 1533-1537
• 17 Eckhoff DG, Metzger RG, Vandewalle MV. Malrotation associated with implant alignment technique in total knee arthroplasty. Clin Orthop Relat Res 1995; (321) 28-31
• 18 Shimizu N, Tomita T, Yamazaki T, Yoshikawa H, Sugamoto K. The effect of weight-bearing condition on kinematics of a high-flexion, posterior-stabilized knee prosthesis. J Arthroplasty 2011; 26 (07) 1031-1037
• 19 Yamazaki T, Watanabe T, Nakajima Y. et al. Visualization of femorotibial contact in total knee arthroplasty using X-ray fluoroscopy. Eur J Radiol 2005; 53 (01) 84-89
• 20 Yamazaki T, Watanabe T, Nakajima Y. et al. Improvement of depth position in 2-D/3-D registration of knee implants using single-plane fluoroscopy. IEEE Trans Med Imaging 2004; 23 (05) 602-612
• 21 Zuffi S, Leardini A, Catani F, Fantozzi S, Cappello A. A model-based method for the reconstruction of total knee replacement kinematics. IEEE Trans Med Imaging 1999; 18 (10) 981-991
• 22 Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 1983; 105 (02) 136-144
• 23 Scuderi GR, Sikorskii A, Bourne RB, Lonner JH, Benjamin JB, Noble PC. The Knee Society Short Form reduces respondent burden in the assessment of patient-reported outcomes. Clin Orthop Relat Res 2016; 474 (01) 134-142
• 24 Nakamura N, Takeuchi R, Sawaguchi T, Ishikawa H, Saito T, Goldhahn S. Cross-cultural adaptation and validation of the Japanese Knee Injury and Osteoarthritis Outcome Score (KOOS). J Orthop Sci 2011; 16 (05) 516-523
• 25 Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1: 64
• 26 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28 (02) 88-96
• 27 Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39 (02) 175-191
• 28 Nishio Y, Onodera T, Kasahara Y, Takahashi D, Iwasaki N, Majima T. Intraoperative medial pivot affects deep knee flexion angle and patient-reported outcomes after total knee arthroplasty. J Arthroplasty 2014; 29 (04) 702-706
• 29 Van Onsem S, Verstraete M, Van Eenoo W, Van Der Straeten C, Victor J. Are TKA kinematics during closed kinetic chain exercises associated with patient-reported outcomes? A preliminary analysis. Clin Orthop Relat Res 2020; 478 (02) 255-263
• 30 Nagai K, Muratsu H, Kanda Y. et al. Intraoperative soft tissue balance using novel medial preserving gap technique in posterior-stabilized total knee arthroplasty: comparison to measured resection technique. Knee Surg Sports Traumatol Arthrosc 2018; 26 (11) 3474-3481
• 31 Tsubosaka M, Muratsu H, Takayama K, Miya H, Kuroda R, Matsumoto T. Comparison of intraoperative soft tissue balance between cruciate-retaining and posterior-stabilized total knee arthroplasty performed by a newly developed medial preserving gap technique. J Arthroplasty 2018; 33 (03) 729-734
• 32 Blankevoort L, Huiskes R, de Lange A. The envelope of passive knee joint motion. J Biomech 1988; 21 (09) 705-720
• 33 Hallén LG, Lindahl O. The “screw-home” movement in the knee-joint. Acta Orthop Scand 1966; 37 (01) 97-106
• 34 Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee--the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am 1976; 58 (05) 583-594
• 35 Moglo KE, Shirazi-Adl A. Cruciate coupling and screw-home mechanism in passive knee joint during extension--flexion. J Biomech 2005; 38 (05) 1075-1083
• 36 Trent PS, Walker PS, Wolf B. Ligament length patterns, strength, and rotational axes of the knee joint. Clin Orthop Relat Res 1976; (117) 263-270
• 37 Kim HY, Kim KJ, Yang DS, Jeung SW, Choi HG, Choy WS. Screw-home movement of the tibiofemoral joint during normal gait: three-dimensional analysis. Clin Orthop Surg 2015; 7 (03) 303-309
• 38 Fuss FK. Principles and mechanisms of automatic rotation during terminal extension in the human knee joint. J Anat 1992; 180 (Pt 2): 297-304
• 39 Kono K, Tomita T, Futai K. et al. In vivo three-dimensional kinematics of normal knees during different high-flexion activities. Bone Joint J 2018; 100-b (01) 50-55
• 40 Horiuchi H, Akizuki S, Tomita T, Sugamoto K, Yamazaki T, Shimizu N. In vivo kinematic analysis of cruciate-retaining total knee arthroplasty during weight-bearing and non-weight-bearing deep knee bending. J Arthroplasty 2012; 27 (06) 1196-1202
• 41 Kurita M, Tomita T, Yamazaki T. et al. In vivo kinematics of high-flex mobile-bearing total knee arthroplasty, with a new post-cam design, in deep knee bending motion. Int Orthop 2012; 36 (12) 2465-2471
• 42 Scott G, Imam MA, Eifert A. et al. Can a total knee arthroplasty be both rotationally unconstrained and anteroposteriorly stabilised? A pulsed fluoroscopic investigation. Bone Joint Res 2016; 5 (03) 80-86
• 43 Planckaert C, Larose G, Ranger P, Lacelle M, Fuentes A, Hagemeister N. Total knee arthroplasty with unexplained pain: new insights from kinematics. Arch Orthop Trauma Surg 2018; 138 (04) 553-561