Iwamoto Keiji, Yamazaki Takaharu, Sugamoto Kazuomi, Tomita Tetsuya
Department of Orthopedic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Department of Information Systems, Saitama Institute of Technology, Fukaya, Saitama, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2021 Oct 16;26:47-52. doi: 10.1016/j.asmart.2021.10.002. eCollection 2021 Oct.
The decision to choose cruciate retaining (CR) insert or cruciate substituting (CS) insert during total knee arthroplasty (TKA) remains a controversial issue. We hypothesized that there are different knee kinematics between CR and CS inserts and that a raised anterior lip design would offer a potential minimization of the paradoxical movement and provide joint stability. The objective of this study was to evaluate and compare kinematics of a CR and CS TKA of the same single-radius design.
We investigated the in vivo knee kinematics of 20 knees with a CR TKA (10 knees in the CR insert and 10 knees in the CS insert). Patients were examined during deep knee flexion using fluoroscopy and femorotibial motion was determined using a 2- to 3-dimensional registration technique, which used computer-assisted design models to reproduce the spatial positions of the femoral and tibial components. We evaluated the knee range of motion (ROM), femoral axial rotation relative to the tibial component, anteroposterior translation, and kinematic pathway of the nearest point of the medial and lateral femoral condyles on the tibial tray.
The average ROM was 121.0 ± 17.3° in CR and 110.8 ± 12.4° in CS. The amount of femoral axial rotation was 7.2 ± 3.9° in CR, and 7.4 ± 2.7° in CS. No significant difference was observed in the amount of anterior translation between CR and CS. The CR and CS inserts had a similar kinematic pattern up to 100° flexion that was central pivot up to 70° flexion and then paradoxical anterior femoral movement until 100° flexion.
The present study demonstrated that there was no significant difference between the inserts in knee kinematics. These kinematic results suggested that the increased anterior lip could not control anterior movement in the CS insert.
在全膝关节置换术（TKA）中选择保留交叉韧带（CR）假体还是替代交叉韧带（CS）假体仍然是一个有争议的问题。我们假设CR和CS假体之间存在不同的膝关节运动学，并且升高的前唇设计可能会使矛盾运动最小化并提供关节稳定性。本研究的目的是评估和比较相同单半径设计的CR和CS TKA的运动学。
我们研究了20例接受CR TKA的膝关节的体内运动学（10例使用CR假体，10例使用CS假体）。在深屈膝时使用荧光透视检查患者，并使用二维到三维配准技术确定股胫关节运动，该技术使用计算机辅助设计模型来再现股骨和胫骨组件的空间位置。我们评估了膝关节活动范围（ROM）、股骨相对于胫骨组件的轴向旋转、前后平移以及股骨内外侧髁在胫骨托上最近点的运动路径。
CR组的平均ROM为121.0±17.3°，CS组为110.8±12.4°。CR组的股骨轴向旋转量为7.2±3.9°，CS组为7.4±2.7°。CR组和CS组之间的前向平移量没有显著差异。CR和CS假体在屈膝100°之前具有相似的运动模式，即屈膝70°之前为中心旋转，然后在屈膝100°之前出现股骨矛盾性前向运动。
本研究表明，两种假体在膝关节运动学方面没有显著差异。这些运动学结果表明，增加的前唇不能控制CS假体中的前向运动。
