gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2019)

22. - 25.10.2019, Berlin

Effect of controlled ligament tensioning in the knee joint kinematics after total knee arthroplasty

Meeting Abstract

  • presenting/speaker Philippe Moewis - Julius Wolff Institut, Charité Universitätsmedizin Berlin, Berlin, Germany
  • Georg N. Duda - Julius Wolff Institut, Center for Musculoskeletal Surgery, Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
  • Adam Trepczynski - Julius Wolff Institut, Charité Universitätsmedizin Berlin, Berlin, Germany
  • Hagen Hommel - Krankenhaus Märkisch-Oderland GmbH, Klinik für Orthopädie und Unfallchirurgie, Strausberg, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocAB37-749

doi: 10.3205/19dkou267, urn:nbn:de:0183-19dkou2676

Published: October 22, 2019

© 2019 Moewis et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: A medial pivot together with a roll-back of the lateral femoral condyle on the tibia plateau throughout knee flexion is the accepted physiological knee joint kinematics [1]. Total knee arthroplasty (TKA) designs try to emulate this behavior with specific design features, however the proper tensioning of the ligaments needs to be considered. The more common technique to tension the ligaments is the measured resection (MR) technique, which is performed using spacer blocks. On the other hand, the gap-balancing (GB) technique allows a more controlled ligament tensioning combined with patient specific instrumentation [2]. The aim of this study was to analyze the influence of a controlled ligament tensioning on the kinematic of the knee joint.

Methods: A retrospective study was conducted. Two cohorts of 20 patients with gradually changing TKA design and MR technique and 8 patients with a multi radius design and GB technique respectively were measured using single plane fluoroscopy during unloaded flexion-extension and loaded lunge. Specific 3D models of the TKA designs were registered to the fluoroscopic images to conduct an analysis of the anterior-posterior position of both medial and lateral femoral compartments on the tibia plateau.

Results and conclusion: During the flexion-extension, the MR group showed a lateral roll-back at approximately 60° of flexion, while the lateral compartment in the GB group remained relatively stationery. The medial condyle in the MR group showed a progressive anterior shift while in the GB group showed a pivot until 30° of flexion followed by an anterior shift. During lunge, both groups showed a lateral roll-back together with an early medial pivot followed by a reduced anterior shift compared to the unloaded activity (Figure 1 [Fig. 1]).

The results suggest a possible positive influence of the GB technique on the reduction of the anterior shift in the lateral compartment, particularly during early flexion, as well as an increase of the roll-back. The achievement of roll-back in the group with the gradually changing design seems to be influenced by the geometry and loading and could probably profit from a GB technique. The interaction between design, balancing strategy and load needs to be considered in future conceptual designs.


References

1.
Pinskerova V, Johal P, Nakagawa S, Sosna A, Williams A, Gedroyc W, Freeman MA. Does the femur roll-back with flexion? J Bone Joint Surg Br. 2004 Aug;86(6):925-31.
2.
Nielsen ES, Hsu A, Patil S, Colwell CW Jr, D'Lima DD. Second-Generation Electronic Ligament Balancing for Knee Arthroplasty: A Cadaver Study. J Arthroplasty. 2018 Jul;33(7):2293-2300. DOI: 10.1016/j.arth.2018.02.057 External link