Li Chunbao, Hosseini Ali, Tsai Tsung-Yuan, Kwon Young-Min, Li Guoan
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, Massachusetts 02114; Department of Orthopaedic Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 1000853, China.
J Orthop Res. 2015 Mar;33(3):349-58. doi: 10.1002/jor.22764. Epub 2014 Dec 2.
Accurate knowledge of tibiofemoral articular contact kinematics of the knee after total knee arthroplasty (TKA) is important for understanding the intrinsic knee biomechanics and improving the longevity of the components. The objective of this study was to compare the in vivo articular contact kinematics of the knees with end-stage medial osteoarthritis (OA) during a weight-bearing, single leg lunge activity before and after a posterior cruciate retaining TKA (CR-TKA) using a dual fluoroscopic imaging technique. We found that the CR-TKA resulted in more posterior contact positions on the tibial surface and a reduced range of motion in the medial and lateral compartments. The distances between medial and lateral contact locations in the CR-TKA knees were statistically larger than the OA knees. The articular contact centers have shifted from medial side of the tibial plateau pre-operatively to the lateral side after operation. This study indicated that the CR-TKA resulted in significant changes in contact kinematics of the knees in both anteroposterior and mediolateral directions. Further studies are needed to determine the influence of the altered in vivo contact kinematics on the longevity of polyethylene liner and long term clinical outcomes of the TKA.
准确了解全膝关节置换术(TKA)后膝关节胫股关节的接触运动学对于理解膝关节的内在生物力学以及提高假体组件的使用寿命至关重要。本研究的目的是使用双荧光透视成像技术,比较后交叉韧带保留型全膝关节置换术(CR-TKA)前后,终末期内侧骨关节炎(OA)患者在负重单腿弓步活动中膝关节的体内关节接触运动学。我们发现,CR-TKA导致胫骨表面的接触位置更靠后,内侧和外侧间室的活动范围减小。CR-TKA膝关节内侧和外侧接触位置之间的距离在统计学上大于OA膝关节。关节接触中心已从术前胫骨平台的内侧转移到术后的外侧。本研究表明,CR-TKA导致膝关节在前后方向和内外侧方向的接触运动学发生显著变化。需要进一步研究来确定体内接触运动学改变对聚乙烯衬垫使用寿命和TKA长期临床结果的影响。