Download PDF
J Knee Surg 2021; 34(09): 1014-1025
DOI: 10.1055/s-0040-1701265
Original Article

Can Computer-Assisted Total Knee Arthroplasty Support the Prediction of Postoperative Three-Dimensional Kinematics of the Tibiofemoral and Patellofemoral Joints at the Replaced Knee?

Claudio Belvedere 
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Silvia Tamarri
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Andrea Ensini
2   1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Stefano Durante
3   Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Maurizio Ortolani
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Alberto Leardini
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
› Author Affiliations Funding The study was funded by the Italian Ministry of Economy and Finance, program “5 per mille.”.
› Further Information
    Permissions and Reprints

Abstract

The aim of this study was to analyze the extent to which postoperative patellofemoral joint (PFJ) kinematics assessed at 6-month follow-up after total knee arthroplasty (TKA) mimics the intraoperative kinematics after final component implantation. The study hypothesis, already proved in terms of tibiofemoral joint (TFJ) kinematics, is that the intraoperative assessment of PFJ kinematics after component implantation is also capable of predicting postoperative knee kinematics during activities of daily living. Twenty patients selected for TKA with patellar resurfacing were implanted using surgical navigation, including patellar component positioning via a novel computer-assisted procedure. This allowed for intraoperative TFJ and PFJ kinematic assessment after final component implantation. At 6-month follow-up, all patients were contacted for follow-up control; in addition to clinical examination, this implied postoperative kinematics assessments by three-dimensional video fluoroscopy of the replaced knee during standard activities of daily living. Several traditional PFJ, as well as TFJ, rotations and translations were calculated intra- and postoperatively and then statistically compared. Good postoperative replication of the intraoperative measurements was observed for most of PFJ variables analyzed, as well as those for TFJ. Relevant statistical analysis also supported the significant consistency between the intra- and postoperative measurements. Pertaining to the present findings on a statistical basis, intraoperative measurements performed at both TFJ and PFJ kinematics using a surgical navigation system under passive conditions, are predictive of the overall knee kinematics experienced at postoperative follow-ups by the same replaced knees in typical activities of daily living.

Keywords

computer-assisted surgery - surgical navigation - Three-dimensional video-fluoroscopy - knee motion - patellar tracking

Ethical Approval

The study was approved by the ethical committee of the Istituto Ortopedico Rizzoli, Bologna, Italy (Prot. Gen 0039521, November 16 2012). The authors certify that the institution approved the investigation protocol that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Relevant study details are also reported in the clinicaltrials.gov repository with identification number NCT03448198.


Authors’ Contributions

C.B., A.E., and A.L. contributed to study design; C.B., S.T., S.D., and A.E. contributed in the technical development of the adopted instrumentation; A.E. was involved in patient selection, and in pre- and postclinical evaluations; C.B., S.T., M.O., and A.E. contributed to data acquisition; C.B., S.T., M.O. and A.L. contributed in technical/morphological data analysis and interpretation; C.B., S. D., and A.E. were involved in clinical and radiological data analysis and interpretation. All authors were involved in combined data interpretation, in manuscript drafting and in the critical revision of this manuscript. All authors have read and approved the final submitted manuscript.




Publication History

Received: 09 May 2019

Accepted: 13 December 2019

Article published online:
19 February 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA 2012; 308 (12) 1227-1236
    CrossrefPubMedGoogle Scholar
  • 2 Losina E, Walensky RP, Kessler CL. et al. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med 2009; 169 (12) 1113-1121 , discussion 1121–1122
    CrossrefPubMedGoogle Scholar
  • 3 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
    CrossrefPubMedGoogle Scholar
  • 4 Brander V, Gondek S, Martin E, Stulberg SD. Pain and depression influence outcome 5 years after knee replacement surgery. Clin Orthop Relat Res 2007; 464 (464): 21-26
    CrossrefPubMedGoogle Scholar
  • 5 Seil R, Pape D. Causes of failure and etiology of painful primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19 (09) 1418-1432
    CrossrefPubMedGoogle Scholar
  • 6 Barbadoro P, Ensini A, Leardini A. et al. Tibial component alignment and risk of loosening in unicompartmental knee arthroplasty: a radiographic and radiostereometric study. Knee Surg Sports Traumatol Arthrosc 2014; 22 (12) 3157-3162
    CrossrefPubMedGoogle Scholar
  • 7 McClelland JA, Webster KE, Feller JA. Gait analysis of patients following total knee replacement: a systematic review. Knee 2007; 14 (04) 253-263
    CrossrefPubMedGoogle Scholar
  • 8 Belvedere C, Catani F, Ensini A, Moctezuma de la Barrera JL, Leardini A. Patellar tracking during total knee arthroplasty: an in vitro feasibility study. Knee Surg Sports Traumatol Arthrosc 2007; 15 (08) 985-993
    CrossrefPubMedGoogle Scholar
  • 9 Bull AM, Katchburian MV, Shih YF, Amis AA. Standardisation of the description of patellofemoral motion and comparison between different techniques. Knee Surg Sports Traumatol Arthrosc 2002; 10 (03) 184-193
    CrossrefPubMedGoogle Scholar
  • 10 Schindler OS, Scott WN. Basic kinematics and biomechanics of the patello-femoral joint. Part 1: the native patella. Acta Orthop Belg 2011; 77 (04) 421-431
    PubMedGoogle Scholar
  • 11 Belvedere C, Ensini A, Leardini A. et al. Tibio-femoral and patello-femoral joint kinematics during navigated total knee arthroplasty with patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2014; 22 (08) 1719-1727
    CrossrefPubMedGoogle Scholar
  • 12 Stiehl JB. A clinical overview patellofemoral joint and application to total knee arthroplasty. J Biomech 2005; 38 (02) 209-214
    CrossrefPubMedGoogle Scholar
  • 13 Scuderi GR, Insall JN, Scott NW. Patellofemoral pain after total knee arthroplasty. J Am Acad Orthop Surg 1994; 2 (05) 239-246
    CrossrefPubMedGoogle Scholar
  • 14 Amis AA, Senavongse W, Bull AM. Patellofemoral kinematics during knee flexion-extension: an in vitro study. J Orthop Res 2006; 24 (12) 2201-2211
    CrossrefPubMedGoogle Scholar
  • 15 Belvedere C, Leardini A, Ensini A, Bianchi L, Catani F, Giannini S. Three-dimensional patellar motion at the natural knee during passive flexion/extension. An in vitro study. J Orthop Res 2009; 27 (11) 1426-1431
    CrossrefPubMedGoogle Scholar
  • 16 Heinert G, Kendoff D, Preiss S, Gehrke T, Sussmann P. Patellofemoral kinematics in mobile-bearing and fixed-bearing posterior stabilised total knee replacements: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2011; 19 (06) 967-972
    CrossrefPubMedGoogle Scholar
  • 17 Merican AM, Ghosh KM, Iranpour F, Deehan DJ, Amis AA. The effect of femoral component rotation on the kinematics of the tibiofemoral and patellofemoral joints after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19 (09) 1479-1487
    CrossrefPubMedGoogle Scholar
  • 18 Philippot R, Chouteau J, Testa R, Moyen B. In vitro analysis of patellar kinematics: validation of an opto-electronic cinematic analysis protocol. Knee Surg Sports Traumatol Arthrosc 2010; 18 (02) 161-166
    CrossrefPubMedGoogle Scholar
  • 19 Zavatsky AB, Oppold PT, Price AJ. Simultaneous in vitro measurement of patellofemoral kinematics and forces. J Biomech Eng 2004; 126 (03) 351-356
    CrossrefPubMedGoogle Scholar
  • 20 Anglin C, Ho KC, Briard JL. et al. In vivo patellar kinematics during total knee arthroplasty. Comput Aided Surg 2008; 13 (06) 377-391
    CrossrefPubMedGoogle Scholar
  • 21 Carpenter RD, Brilhault J, Majumdar S, Ries MD. Magnetic resonance imaging of in vivo patellofemoral kinematics after total knee arthroplasty. Knee 2009; 16 (05) 332-336
    CrossrefPubMedGoogle Scholar
  • 22 Hamai S, Dunbar NJ, Moro-oka TA, Miura H, Iwamoto Y, Banks SA. Physiological sagittal plane patellar kinematics during dynamic deep knee flexion. Int Orthop 2013; 37 (08) 1477-1482
    CrossrefPubMedGoogle Scholar
  • 23 Leszko F, Sharma A, Komistek RD, Mahfouz MR, Cates HE, Scuderi GR. Comparison of in vivo patellofemoral kinematics for subjects having high-flexion total knee arthroplasty implant with patients having normal knees. J Arthroplasty 2010; 25 (03) 398-404
    CrossrefPubMedGoogle Scholar
  • 24 Lin F, Makhsous M, Chang AH, Hendrix RW, Zhang LQ. In vivo and noninvasive six degrees of freedom patellar tracking during voluntary knee movement. Clin Biomech (Bristol, Avon) 2003; 18 (05) 401-409
    CrossrefPubMedGoogle Scholar
  • 25 Nha KW, Papannagari R, Gill TJ. et al. In vivo patellar tracking: clinical motions and patellofemoral indices. J Orthop Res 2008; 26 (08) 1067-1074
    CrossrefPubMedGoogle Scholar
  • 26 Stagni R, Fantozzi S, Catani F, Leardini A. Can patellar tendon angle reveal sagittal kinematics in total knee arthroplasty?. Knee Surg Sports Traumatol Arthrosc 2010; 18 (07) 949-954
    CrossrefPubMedGoogle Scholar
  • 27 Tang TS, MacIntyre NJ, Gill HS. et al. Accurate assessment of patellar tracking using fiducial and intensity-based fluoroscopic techniques. Med Image Anal 2004; 8 (03) 343-351
    CrossrefPubMedGoogle Scholar
  • 28 Ensini A, Catani F, Biasca N, Belvedere C, Giannini S, Leardini A. Joint line is well restored when navigation surgery is performed for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20 (03) 495-502
    CrossrefPubMedGoogle Scholar
  • 29 Ensini A, Catani F, Leardini A, Romagnoli M, Giannini S. Alignments and clinical results in conventional and navigated total knee arthroplasty. Clin Orthop Relat Res 2007; 457 (457): 156-162
    CrossrefPubMedGoogle Scholar
  • 30 Belvedere C, Ensini A, Leardini A, Bianchi L, Catani F, Giannini S. Alignment of resection planes in total knee replacement obtained with the conventional technique, as assessed by a modern computer-based navigation system. Int J Med Robot 2007; 3 (02) 117-124
    CrossrefPubMedGoogle Scholar
  • 31 d'Amato M, Ensini A, Leardini A. et al. Conventional versus computer-assisted surgery in total knee arthroplasty: comparison at ten years follow-up. Int Orthop 2019; 43 (06) 1355-1363
    CrossrefPubMedGoogle Scholar
  • 32 Belvedere C, Ensini A, d'Amato M, Barbadoro P, Leardini A. Three-dimensional patellar tendon fibre kinematics in navigated TKA with and without patellar resurfacing. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3834-3843
    CrossrefPubMedGoogle Scholar
  • 33 Belvedere C, Tamarri S, Notarangelo DP, Ensini A, Feliciangeli A, Leardini A. Three-dimensional motion analysis of the human knee joint: comparison between intra- and post-operative measurements. Knee Surg Sports Traumatol Arthrosc 2013; 21 (10) 2375-2383
    CrossrefPubMedGoogle Scholar
  • 34 Banks SA, Hodge WA. Accurate measurement of three-dimensional knee replacement kinematics using single-plane fluoroscopy. IEEE Trans Biomed Eng 1996; 43 (06) 638-649
    CrossrefPubMedGoogle Scholar
  • 35 Siston RA, Giori NJ, Goodman SB, Delp SL. Surgical navigation for total knee arthroplasty: a perspective. J Biomech 2007; 40 (04) 728-735
    CrossrefPubMedGoogle Scholar
  • 36 Banks SA, Hodge WA. Implant design affects knee arthroplasty kinematics during stair-stepping. Clin Orthop Relat Res 2004; (426): 187-193
    CrossrefPubMedGoogle Scholar
  • 37 Belvedere C, Leardini A, Catani F, Pianigiani S, Innocenti B. In vivo kinematics of knee replacement during daily living activities: Condylar and post-cam contact assessment by three-dimensional fluoroscopy and finite element analyses. J Orthop Res 2017; 35 (07) 1396-1403
    CrossrefPubMedGoogle Scholar
  • 38 Catani F, Ensini A, Belvedere C. et al. In vivo kinematics and kinetics of a bi-cruciate substituting total knee arthroplasty: a combined fluoroscopic and gait analysis study. J Orthop Res 2009; 27 (12) 1569-1575
    CrossrefPubMedGoogle Scholar
  • 39 Fantozzi S, Benedetti MG, Leardini A. et al. Fluoroscopic and gait analysis of the functional performance in stair ascent of two total knee replacement designs. Gait Posture 2003; 17 (03) 225-234
    CrossrefPubMedGoogle Scholar
  • 40 Fantozzi S, Catani F, Ensini A, Leardini A, Giannini S. Femoral rollback of cruciate-retaining and posterior-stabilized total knee replacements: in vivo fluoroscopic analysis during activities of daily living. J Orthop Res 2006; 24 (12) 2222-2229
    CrossrefPubMedGoogle Scholar
  • 41 Victor J, Mueller JK, Komistek RD, Sharma A, Nadaud MC, Bellemans J. In vivo kinematics after a cruciate-substituting TKA. Clin Orthop Relat Res 2010; 468 (03) 807-814
    CrossrefPubMedGoogle Scholar
  • 42 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
  • 43 Kennedy DM, Stratford PW, Riddle DL, Hanna SE, Gollish JD. Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther 2008; 88 (01) 22-32
    CrossrefPubMedGoogle Scholar
  • 44 Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86 (05) 963-974
    CrossrefPubMedGoogle Scholar
  • 45 Catani F, Belvedere C, Ensini A, Feliciangeli A, Giannini S, Leardini A. In-vivo knee kinematics in rotationally unconstrained total knee arthroplasty. J Orthop Res 2011; 29 (10) 1484-1490
    CrossrefPubMedGoogle Scholar
  • 46 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
    CrossrefPubMedGoogle Scholar