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Mobile-bearing insert used with total knee arthroplasty does not rotate on the tibial tray during a squatting activity: a cross-sectional study

BACKGROUND: Total knee arthroplasty (TKA) is commonly performed around the world. Implant designs include fixed-bearing and mobile-bearing. Mobile-bearing design was developed as a rotating platform that allows axial rotation of the insert around the longitudinal axis. This phenomenon may limit full...

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Autores principales: Hoshi, Kenji, Watanabe, Goro, Kurose, Yasuo, Tanaka, Ryuji, Fujii, Jiro, Gamada, Kazuyoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085202/
https://www.ncbi.nlm.nih.gov/pubmed/32197628
http://dx.doi.org/10.1186/s13018-020-1570-6
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author Hoshi, Kenji
Watanabe, Goro
Kurose, Yasuo
Tanaka, Ryuji
Fujii, Jiro
Gamada, Kazuyoshi
author_facet Hoshi, Kenji
Watanabe, Goro
Kurose, Yasuo
Tanaka, Ryuji
Fujii, Jiro
Gamada, Kazuyoshi
author_sort Hoshi, Kenji
collection PubMed
description BACKGROUND: Total knee arthroplasty (TKA) is commonly performed around the world. Implant designs include fixed-bearing and mobile-bearing. Mobile-bearing design was developed as a rotating platform that allows axial rotation of the insert around the longitudinal axis. This phenomenon may limit full exploitation of the characteristics of the mobile-bearing insert, which may cause wearing and reduce longevity. However, there is limited knowledge on rotational behavior of the polyethylene mobile-bearing insert under weight-bearing conditions. We aimed at determining the rotational motion of each component at full extension and flexed positions during a squatting activity after TKA. METHODS: This study was a cross-sectional study (level 4) involving patients with severe knee osteoarthritis scheduled to receive TKA. We examined 13 knees of 11 patients after mobile-bearing TKA (NexGen LPS-Flex, Zimmer Inc.) at 10 weeks and 1 year postoperatively. Four identical metallic beads were embedded into the insert. Wide-base squatting was chosen for analyses. Three-dimensional in vivo poses of the prostheses were created using a 3D-to-2D registration technique. During flexion, rotation of the femoral component relative to the insert (FEM/INS) and tibial component (FEM/TIB) as well as insert rotation relative to the tibial component (INS/TIB) were computed. Repeated measure 2-way ANOVA and post hoc test was used. RESULTS: In the fully extended position, FEM/INS was significantly smaller than INS/TIB both at 10 weeks (− 0.3° vs. 6.3°, p = .013) and 1 year (− 0.8° vs. 4.9°, p = .011), respectively. During the squatting activity, rotation motions of FEM/TIB, FEM/INS, INS/TIB were 5.7°, 5.9°, and 1.8° at 10 weeks and 6.3°, 5.5°, and 1.6° at 1 year, respectively. Rotation motion of FEM/INS was significantly greater than that of INS/TIB at both 10 weeks (p < .001) and 1 year (p < .001). CONCLUSIONS: The mobile-bearing insert enhances the compatibility of FEM/INS in extension; the amount of INS/TIB rotation is significantly smaller than that of FEM/INS during a squatting activity. This information will inform surgeons to take caution to perform TKA with a fixed insert in which 6.3° of rotational offset would be added to the rotational alignment at FEM/INS at full extension. TRIAL REGISTRATION: UMIN-CTR, UMIN000024196. Retrospectively registered on 9 September 2016.
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spelling pubmed-70852022020-03-23 Mobile-bearing insert used with total knee arthroplasty does not rotate on the tibial tray during a squatting activity: a cross-sectional study Hoshi, Kenji Watanabe, Goro Kurose, Yasuo Tanaka, Ryuji Fujii, Jiro Gamada, Kazuyoshi J Orthop Surg Res Research Article BACKGROUND: Total knee arthroplasty (TKA) is commonly performed around the world. Implant designs include fixed-bearing and mobile-bearing. Mobile-bearing design was developed as a rotating platform that allows axial rotation of the insert around the longitudinal axis. This phenomenon may limit full exploitation of the characteristics of the mobile-bearing insert, which may cause wearing and reduce longevity. However, there is limited knowledge on rotational behavior of the polyethylene mobile-bearing insert under weight-bearing conditions. We aimed at determining the rotational motion of each component at full extension and flexed positions during a squatting activity after TKA. METHODS: This study was a cross-sectional study (level 4) involving patients with severe knee osteoarthritis scheduled to receive TKA. We examined 13 knees of 11 patients after mobile-bearing TKA (NexGen LPS-Flex, Zimmer Inc.) at 10 weeks and 1 year postoperatively. Four identical metallic beads were embedded into the insert. Wide-base squatting was chosen for analyses. Three-dimensional in vivo poses of the prostheses were created using a 3D-to-2D registration technique. During flexion, rotation of the femoral component relative to the insert (FEM/INS) and tibial component (FEM/TIB) as well as insert rotation relative to the tibial component (INS/TIB) were computed. Repeated measure 2-way ANOVA and post hoc test was used. RESULTS: In the fully extended position, FEM/INS was significantly smaller than INS/TIB both at 10 weeks (− 0.3° vs. 6.3°, p = .013) and 1 year (− 0.8° vs. 4.9°, p = .011), respectively. During the squatting activity, rotation motions of FEM/TIB, FEM/INS, INS/TIB were 5.7°, 5.9°, and 1.8° at 10 weeks and 6.3°, 5.5°, and 1.6° at 1 year, respectively. Rotation motion of FEM/INS was significantly greater than that of INS/TIB at both 10 weeks (p < .001) and 1 year (p < .001). CONCLUSIONS: The mobile-bearing insert enhances the compatibility of FEM/INS in extension; the amount of INS/TIB rotation is significantly smaller than that of FEM/INS during a squatting activity. This information will inform surgeons to take caution to perform TKA with a fixed insert in which 6.3° of rotational offset would be added to the rotational alignment at FEM/INS at full extension. TRIAL REGISTRATION: UMIN-CTR, UMIN000024196. Retrospectively registered on 9 September 2016. BioMed Central 2020-03-20 /pmc/articles/PMC7085202/ /pubmed/32197628 http://dx.doi.org/10.1186/s13018-020-1570-6 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Hoshi, Kenji
Watanabe, Goro
Kurose, Yasuo
Tanaka, Ryuji
Fujii, Jiro
Gamada, Kazuyoshi
Mobile-bearing insert used with total knee arthroplasty does not rotate on the tibial tray during a squatting activity: a cross-sectional study
title Mobile-bearing insert used with total knee arthroplasty does not rotate on the tibial tray during a squatting activity: a cross-sectional study
title_full Mobile-bearing insert used with total knee arthroplasty does not rotate on the tibial tray during a squatting activity: a cross-sectional study
title_fullStr Mobile-bearing insert used with total knee arthroplasty does not rotate on the tibial tray during a squatting activity: a cross-sectional study
title_full_unstemmed Mobile-bearing insert used with total knee arthroplasty does not rotate on the tibial tray during a squatting activity: a cross-sectional study
title_short Mobile-bearing insert used with total knee arthroplasty does not rotate on the tibial tray during a squatting activity: a cross-sectional study
title_sort mobile-bearing insert used with total knee arthroplasty does not rotate on the tibial tray during a squatting activity: a cross-sectional study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085202/
https://www.ncbi.nlm.nih.gov/pubmed/32197628
http://dx.doi.org/10.1186/s13018-020-1570-6
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