Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 6/2015

01-06-2015 | Knee Arthroplasty

Frontal plane stability following UKA in a biomechanical study

Authors: Thomas J. Heyse, Scott M. Tucker, Yogesh Rajak, Mohammad Kia, Joseph D. Lipman, Carl W. Imhauser, Geoffrey H. Westrich

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2015

Login to get access

Abstract

Introduction

Function and kinematics following unicondylar knee arthroplasty (UKA) have been reported to be close to the native knee. Gait, stair climbing and activities of daily living expose the knee joint to a combination of varus and valgus moments. Replacement of the medial compartment via UKA is likely to change the physiologic knee stability and its ability to respond to varus and valgus moments. It was hypothesized that UKA implantation would stiffen the knee and decrease range of motion in the frontal plane.

Materials and methods

Six fresh frozen cadaver knees were prepared and mounted in a six-degrees-of-freedom robot. An axial load of 200 N was applied with the knee in 15°, 45° and 90° of flexion. Varus and valgus moments were added, respectively, before and after implantation of medial UKA. Tests were than redone with a thicker polyethylene inlay to simulate overstuffing of the medial compartment. Range of motion in the frontal plane and the tibial response to moments were recorded via the industrial robot.

Results

The range of motion in the frontal plane was decreased with both, balanced and overstuffed UKA and shifted towards valgus. When exposed to valgus moments, knees following UKA were stiffer in comparison with the native knee. The effect was even more pronounced with medial overstuffing.

Conclusion

In UKA, the compressive anatomy is replaced by much stiffer components. This lack of medial compression and relative overstuffing leads to a tighter medial collateral ligament. This drives the trend towards a stiffer joint as documented by a decrease in frontal plane range of motion. Overstuffing should strictly be avoided when performing UKA.
Literature
1.
go back to reference Suggs JF, Li G, Park SE, Sultan PG, Rubash HE, Freiberg AA (2006) Knee biomechanics after UKA and its relation to the ACL–a robotic investigation. J Orthop Res 24(4):588–594CrossRefPubMed Suggs JF, Li G, Park SE, Sultan PG, Rubash HE, Freiberg AA (2006) Knee biomechanics after UKA and its relation to the ACL–a robotic investigation. J Orthop Res 24(4):588–594CrossRefPubMed
2.
go back to reference Citak M, Bosscher MR, Citak M, Musahl V, Pearle AD, Suero EM (2011) Anterior cruciate ligament reconstruction after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19(10):1683–1688CrossRefPubMed Citak M, Bosscher MR, Citak M, Musahl V, Pearle AD, Suero EM (2011) Anterior cruciate ligament reconstruction after unicompartmental knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 19(10):1683–1688CrossRefPubMed
3.
go back to reference Argenson JN, Komistek RD, Aubaniac JM, Dennis DA, Northcut EJ, Anderson DT, Agostini S (2002) In vivo determination of knee kinematics for subjects implanted with a unicompartmental arthroplasty. J Arthroplasty 17(8):1049–1054CrossRefPubMed Argenson JN, Komistek RD, Aubaniac JM, Dennis DA, Northcut EJ, Anderson DT, Agostini S (2002) In vivo determination of knee kinematics for subjects implanted with a unicompartmental arthroplasty. J Arthroplasty 17(8):1049–1054CrossRefPubMed
4.
go back to reference Akizuki S, Mueller JK, Horiuchi H, Matsunaga D, Shibakawa A, Komistek RD (2009) In vivo determination of kinematics for subjects having a Zimmer Unicompartmental High Flex Knee System. J Arthroplasty 24(6):963–971CrossRefPubMed Akizuki S, Mueller JK, Horiuchi H, Matsunaga D, Shibakawa A, Komistek RD (2009) In vivo determination of kinematics for subjects having a Zimmer Unicompartmental High Flex Knee System. J Arthroplasty 24(6):963–971CrossRefPubMed
5.
go back to reference Laurencin CT, Zelicof SB, Scott RD, Ewald FC (1991) Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res 273:151–156PubMed Laurencin CT, Zelicof SB, Scott RD, Ewald FC (1991) Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res 273:151–156PubMed
6.
go back to reference Rougraff BT, Heck DA, Gibson AE (1991) A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis. Clin Orthop Relat Res 273:157–164PubMed Rougraff BT, Heck DA, Gibson AE (1991) A comparison of tricompartmental and unicompartmental arthroplasty for the treatment of gonarthrosis. Clin Orthop Relat Res 273:157–164PubMed
7.
go back to reference Koskinen E, Paavolainen P, Eskelinen A, Pulkkinen P, Remes V (2007) Unicondylar knee replacement for primary osteoarthritis: a prospective follow-up study of 1819 patients from the Finnish Arthroplasty Register. Acta Orthop 78(1):128–135CrossRefPubMed Koskinen E, Paavolainen P, Eskelinen A, Pulkkinen P, Remes V (2007) Unicondylar knee replacement for primary osteoarthritis: a prospective follow-up study of 1819 patients from the Finnish Arthroplasty Register. Acta Orthop 78(1):128–135CrossRefPubMed
8.
go back to reference Lewold S, Robertsson O, Knutson K, Lidgren L (1998) Revision of unicompartmental knee arthroplasty: outcome in 1135 cases from the Swedish Knee Arthroplasty study. Acta Orthop Scand 69(5):469–474CrossRefPubMed Lewold S, Robertsson O, Knutson K, Lidgren L (1998) Revision of unicompartmental knee arthroplasty: outcome in 1135 cases from the Swedish Knee Arthroplasty study. Acta Orthop Scand 69(5):469–474CrossRefPubMed
9.
go back to reference Jaeger S, Helling A, Bitsch RG, Seeger JB, Schuld C, Clarius M (2012) The influence of the femoral force application point on tibial cementing pressure in cemented UKA: an experimental study. Arch Orthop Trauma Surg 132(11):1589–1594CrossRefPubMed Jaeger S, Helling A, Bitsch RG, Seeger JB, Schuld C, Clarius M (2012) The influence of the femoral force application point on tibial cementing pressure in cemented UKA: an experimental study. Arch Orthop Trauma Surg 132(11):1589–1594CrossRefPubMed
10.
go back to reference Chassin EP, Mikosz RP, Andriacchi TP, Rosenberg AG (1996) Functional analysis of cemented medial unicompartmental knee arthroplasty. J Arthrop 11(5):553–559CrossRef Chassin EP, Mikosz RP, Andriacchi TP, Rosenberg AG (1996) Functional analysis of cemented medial unicompartmental knee arthroplasty. J Arthrop 11(5):553–559CrossRef
11.
go back to reference Weinstein JN, Andriacchi TP, Galante J (1986) Factors influencing walking and stairclimbing following unicompartmental knee arthroplasty. J Arthrop 1(2):109–115CrossRef Weinstein JN, Andriacchi TP, Galante J (1986) Factors influencing walking and stairclimbing following unicompartmental knee arthroplasty. J Arthrop 1(2):109–115CrossRef
12.
go back to reference Besier TF, Lloyd DG, Cochrane JL, Ackland TR (2001) External loading of the knee joint during running and cutting maneuvers. Med Sci Sports Exerc 33(7):1168–1175CrossRefPubMed Besier TF, Lloyd DG, Cochrane JL, Ackland TR (2001) External loading of the knee joint during running and cutting maneuvers. Med Sci Sports Exerc 33(7):1168–1175CrossRefPubMed
13.
go back to reference Kitaoka HB, Crevoisier XM, Hansen D, Katajarvi B, Harbst K, Kaufman KR (2006) Foot and ankle kinematics and ground reaction forces during ambulation. Foot Ankle Int 27(10):808–813PubMed Kitaoka HB, Crevoisier XM, Hansen D, Katajarvi B, Harbst K, Kaufman KR (2006) Foot and ankle kinematics and ground reaction forces during ambulation. Foot Ankle Int 27(10):808–813PubMed
14.
go back to reference Hunt AE, Smith RM, Torode M, Keenan AM (2001) Inter-segment foot motion and ground reaction forces over the stance phase of walking. Clin Biomech 16(7):592–600CrossRef Hunt AE, Smith RM, Torode M, Keenan AM (2001) Inter-segment foot motion and ground reaction forces over the stance phase of walking. Clin Biomech 16(7):592–600CrossRef
15.
go back to reference Burstein AH, Wright TM (1994) Fundamentals of orthopaedic biomechanics. Lippincott Williams & Wilkins, Philadelphia Burstein AH, Wright TM (1994) Fundamentals of orthopaedic biomechanics. Lippincott Williams & Wilkins, Philadelphia
16.
go back to reference Markolf KL, Bargar WL, Shoemaker SC, Amstutz HC (1981) The role of joint load in knee stability. J Bone Joint surg Am 63(4):570–585PubMed Markolf KL, Bargar WL, Shoemaker SC, Amstutz HC (1981) The role of joint load in knee stability. J Bone Joint surg Am 63(4):570–585PubMed
17.
go back to reference Citak M, Dersch K, Kamath AF, Haasper C, Gehrke T, Kendoff D (2014) Common causes of failed unicompartmental knee arthroplasty: a single-centre analysis of four hundred and seventy one cases. Int Orthop 38(5):961–965CrossRefPubMedCentralPubMed Citak M, Dersch K, Kamath AF, Haasper C, Gehrke T, Kendoff D (2014) Common causes of failed unicompartmental knee arthroplasty: a single-centre analysis of four hundred and seventy one cases. Int Orthop 38(5):961–965CrossRefPubMedCentralPubMed
18.
go back to reference Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105(2):136–144CrossRefPubMed Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105(2):136–144CrossRefPubMed
19.
go back to reference Imhauser C, Mauro C, Choi D, Rosenberg E, Mathew S, Nguyen J, Ma Y, Wickiewicz T (2013) Abnormal tibiofemoral contact stress and its association with altered kinematics after center-center anterior cruciate ligament reconstruction: an in vitro study. Am J Sports Med 41(4):815–825CrossRefPubMedCentralPubMed Imhauser C, Mauro C, Choi D, Rosenberg E, Mathew S, Nguyen J, Ma Y, Wickiewicz T (2013) Abnormal tibiofemoral contact stress and its association with altered kinematics after center-center anterior cruciate ligament reconstruction: an in vitro study. Am J Sports Med 41(4):815–825CrossRefPubMedCentralPubMed
20.
go back to reference Mundermann A, Dyrby CO, D’Lima DD, Colwell CW Jr, Andriacchi TP (2008) In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement. J Orthop Res 26(9):1167–1172CrossRefPubMed Mundermann A, Dyrby CO, D’Lima DD, Colwell CW Jr, Andriacchi TP (2008) In vivo knee loading characteristics during activities of daily living as measured by an instrumented total knee replacement. J Orthop Res 26(9):1167–1172CrossRefPubMed
21.
go back to reference Wang X, Malik A, Bartel DL, Wickiewicz TL, Wright T (2014) Asymmetric varus and valgus stability of the anatomic cadaver knee and the load sharing between collateral ligaments and bearing surfaces. J Biomech Eng 136(8). doi:10.1115/1.4027662 Wang X, Malik A, Bartel DL, Wickiewicz TL, Wright T (2014) Asymmetric varus and valgus stability of the anatomic cadaver knee and the load sharing between collateral ligaments and bearing surfaces. J Biomech Eng 136(8). doi:10.​1115/​1.​4027662
22.
go back to reference Heyse TJ, Lipman JD, Imhauser CW, Tucker SM, Rajak Y, Westrich GH (2014) Accuracy of Individualized Custom Tibial Cutting Guides in UKA. HSS J 10(3):260–265CrossRefPubMed Heyse TJ, Lipman JD, Imhauser CW, Tucker SM, Rajak Y, Westrich GH (2014) Accuracy of Individualized Custom Tibial Cutting Guides in UKA. HSS J 10(3):260–265CrossRefPubMed
23.
go back to reference Coleman JL, Widmyer MR, Leddy HA, Utturkar GM, Spritzer CE, Moorman CT 3rd, Guilak F, DeFrate LE (2013) Diurnal variations in articular cartilage thickness and strain in the human knee. J Biomech 46(3):541–547CrossRefPubMedCentralPubMed Coleman JL, Widmyer MR, Leddy HA, Utturkar GM, Spritzer CE, Moorman CT 3rd, Guilak F, DeFrate LE (2013) Diurnal variations in articular cartilage thickness and strain in the human knee. J Biomech 46(3):541–547CrossRefPubMedCentralPubMed
24.
go back to reference Hobbs LW, Benezra Rosen V, Mangin SP, Treska M, Hunter G (2005) Oxidation microstructures and interfaces in the oxidized zirconium knee. Int J Appl Ceram Technol 2(3):221–246CrossRef Hobbs LW, Benezra Rosen V, Mangin SP, Treska M, Hunter G (2005) Oxidation microstructures and interfaces in the oxidized zirconium knee. Int J Appl Ceram Technol 2(3):221–246CrossRef
25.
go back to reference Hosseini A, Van de Velde SK, Kozanek M, Gill TJ, Grodzinsky AJ, Rubash HE, Li G (2010) In-vivo time-dependent articular cartilage contact behavior of the tibiofemoral joint. Osteoarthritis Cartilage 18(7):909–916CrossRefPubMedCentralPubMed Hosseini A, Van de Velde SK, Kozanek M, Gill TJ, Grodzinsky AJ, Rubash HE, Li G (2010) In-vivo time-dependent articular cartilage contact behavior of the tibiofemoral joint. Osteoarthritis Cartilage 18(7):909–916CrossRefPubMedCentralPubMed
26.
go back to reference Patil S, Colwell CW Jr, Ezzet KA, D’Lima DD (2005) Can normal knee kinematics be restored with unicompartmental knee replacement? J Bone Joint Surg Am 87(2):332–338CrossRefPubMed Patil S, Colwell CW Jr, Ezzet KA, D’Lima DD (2005) Can normal knee kinematics be restored with unicompartmental knee replacement? J Bone Joint Surg Am 87(2):332–338CrossRefPubMed
27.
go back to reference Mahfouz MR, Komistek RD, Dennis DA, Hoff WA (2004) In vivo assessment of the kinematics in normal and anterior cruciate ligament-deficient knees. J Bone Joint Surg Am 86(Suppl 2):56–61PubMed Mahfouz MR, Komistek RD, Dennis DA, Hoff WA (2004) In vivo assessment of the kinematics in normal and anterior cruciate ligament-deficient knees. J Bone Joint Surg Am 86(Suppl 2):56–61PubMed
28.
go back to reference Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M (2005) In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplasty 20(6):777–783CrossRefPubMed Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M (2005) In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplasty 20(6):777–783CrossRefPubMed
29.
go back to reference Heyse TJ, El-Zayat BF, De Corte R, Chevalier Y, Scheys L, Innocenti B, Fuchs-Winkelmann S, Labey L (2014) UKA closely preserves natural knee kinematics in vitro. Knee Surg Sports Traumatol Arthrosc 22(8):1902–1910CrossRefPubMed Heyse TJ, El-Zayat BF, De Corte R, Chevalier Y, Scheys L, Innocenti B, Fuchs-Winkelmann S, Labey L (2014) UKA closely preserves natural knee kinematics in vitro. Knee Surg Sports Traumatol Arthrosc 22(8):1902–1910CrossRefPubMed
30.
go back to reference Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90(9):1922–1931CrossRefPubMed Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90(9):1922–1931CrossRefPubMed
31.
go back to reference Becker R, Mauer C, Starke C, Brosz M, Zantop T, Lohmann CH, Schulze M (2013) Anteroposterior and rotational stability in fixed and mobile bearing unicondylar knee arthroplasty: a cadaveric study using the robotic force sensor system. Knee Surg Sports Traumatol Arthrosc 21(11):2427–2432CrossRefPubMed Becker R, Mauer C, Starke C, Brosz M, Zantop T, Lohmann CH, Schulze M (2013) Anteroposterior and rotational stability in fixed and mobile bearing unicondylar knee arthroplasty: a cadaveric study using the robotic force sensor system. Knee Surg Sports Traumatol Arthrosc 21(11):2427–2432CrossRefPubMed
Metadata
Title
Frontal plane stability following UKA in a biomechanical study
Authors
Thomas J. Heyse
Scott M. Tucker
Yogesh Rajak
Mohammad Kia
Joseph D. Lipman
Carl W. Imhauser
Geoffrey H. Westrich
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 6/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-015-2198-6

Other articles of this Issue 6/2015

Archives of Orthopaedic and Trauma Surgery 6/2015 Go to the issue