Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany.
Orthopaedic Traumatology Centre Regensburg, Paracelsusstraße 2, 93053, Regensburg, Germany.
Arch Orthop Trauma Surg. 2022 Mar;142(3):501-509. doi: 10.1007/s00402-021-03816-0. Epub 2021 Mar 12.
Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are standard procedures for treating knee joint arthritis. Neither UKA nor TKA seems to be optimally suited for patients with bicompartmental osteoarthritis that affects only the medial and patellofemoral compartments. A bicompartmental knee arthroplasty (BKA) was designed for this patient group. This study aimed to compare the effectiveness of a BKA and TKA in restoring the kinematics of the knee joint.
In this in vitro study, three types of knee arthroplasties (BKA, posterior cruciate ligament-retaining, and posterior cruciate ligament-resecting TKA) were biomechanically tested in six freshly frozen human cadaveric specimens. Complete three-dimensional kinematics was analyzed for each knee arthroplasty during both passive and loaded conditions in a validated knee kinematics rig. Infrared motion capture cameras and retroreflective markers were used for recording data.
No significant differences could be found between the three types of arthroplasties. However, similar kinematic changes between BKA and a native knee joint were documented under passive conditions. However, in a weight-bearing mode, a significant decrease in femoral rotation during the range of motion was found in arthroplasties compared to the native knee, probably caused by contraction of the quadriceps femoris muscle, which leads to a decrease in the anterior translation of the tibia.
Kinematics similar to that of the natural knee can be achieved by BKA under passive conditions. However, no functional advantage of BKA over TKA was detected, which suggests that natural knee kinematics cannot be fully imitated by an arthroplasty yet. Further prospective studies are required to determine the anatomic and design factors that might affect the physiologic kinematics.
单髁膝关节置换术（UKA）和全膝关节置换术（TKA）是治疗膝关节关节炎的标准手术。UKA 和 TKA 似乎都不能为仅影响内侧和髌股关节间室的双间室骨关节炎患者提供最佳治疗。为此设计了双间室膝关节置换术（BKA）。本研究旨在比较 BKA 和 TKA 在恢复膝关节运动学方面的效果。
在这项体外研究中，对 6 个新鲜冷冻的人体尸体标本中的三种膝关节置换物（BKA、保留后交叉韧带和切除后交叉韧带的 TKA）进行了生物力学测试。在经过验证的膝关节运动学装置中，对每种膝关节置换物在被动和加载条件下进行了完整的三维运动学分析。使用红外运动捕捉摄像机和反射标记物进行数据记录。
三种类型的关节置换物之间没有发现显著差异。然而，在被动条件下，BKA 和自然膝关节之间记录到了相似的运动学变化。然而，在承重模式下，与自然膝关节相比，关节置换物在运动范围内的股骨旋转明显减少，这可能是由于股四头肌的收缩导致胫骨的前向平移减少所致。
在被动条件下，BKA 可以实现类似于自然膝关节的运动学。然而，并未发现 BKA 相对于 TKA 的功能优势，这表明关节置换术还不能完全模仿自然膝关节的运动学。需要进一步的前瞻性研究来确定可能影响生理运动学的解剖和设计因素。
