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Published in: Clinical Orthopaedics and Related Research® 1/2013

01-01-2013 | Symposium: Papers Presented at the Annual Meetings of the Knee Society

Does Interlimb Knee Symmetry Exist After Unicompartmental Knee Arthroplasty?

Authors: Yang-Chieh Fu, PhD, Kathy J. Simpson, PhD, Tracy L. Kinsey, MSPH, Ormonde M. Mahoney, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2013

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Abstract

Background

Unicompartmental knee arthroplasty (UKA) has long been a treatment option for patients with disease limited primarily to one compartment with small, correctable deformities. However, some surgeons presume that normal kinematics of a lateral compartment UKA are difficult to achieve. Furthermore, it is unclear whether UKA restores normal knee kinematics and interlimb symmetry.

Questions/purposes

We determined knee kinematics exhibited during stair ascent by patients with medial- (MED-UKA) or lateral-UKA (LAT-UKA) and if the knee kinematics of the operated and nonoperated limbs were symmetrical.

Methods

Participants were 17 individuals with MED-UKA and nine with LAT-UKA, all with nondiseased contralateral limbs. For each limb, participants walked up four stairs for five trials while a motion-capture system obtained reflective marker locations. Temporal events were determined by force platform signals. Interlimb symmetry was classified for temporal gait and knee angular kinematics by comparing observed interlimb differences with clinically meaningful differences set at 5% of stride time for temporal variables and 5° for angular variables. The minimum postoperative followup was 6 months (median, 24 months; range, 6–53 months).

Results

Neither group demonstrated clinically meaningful mean interlimb differences. However, approximately half of participants of each UKA group displayed asymmetry favoring the operative or nonoperative limb with similar frequency.

Conclusions

Many patients undergoing UKA demonstrate kinematic interlimb symmetry during stair ascent. Interlimb asymmetry may be affected by a variety of factors unrelated to the UKA.

Clinical Relevance

A MED- or LAT-UKA can potentially restore normal knee function for a demanding task of daily life.
Literature
1.
go back to reference Akizuki S, Mueller JKP, Horiuchi H, Matsunaga D, Shibakawa A, Komistek RD. In vivo determination of kinematics for subjects having a Zimmer unicompartmental high flex knee system. J Arthroplasty. 2009;24:963–971.PubMedCrossRef Akizuki S, Mueller JKP, Horiuchi H, Matsunaga D, Shibakawa A, Komistek RD. In vivo determination of kinematics for subjects having a Zimmer unicompartmental high flex knee system. J Arthroplasty. 2009;24:963–971.PubMedCrossRef
2.
go back to reference Alnahdi AH, Zeni JA, Snyder-Mackler L. Gait after unilateral total knee arthroplasty: frontal plane analysis. J Orthop Res. 2010;29:647–652.PubMedCrossRef Alnahdi AH, Zeni JA, Snyder-Mackler L. Gait after unilateral total knee arthroplasty: frontal plane analysis. J Orthop Res. 2010;29:647–652.PubMedCrossRef
3.
go back to reference Amin AK, Patton JT, Cook RE, Gaston M, Brenkel IJ. Unicompartmental or total knee arthroplasty? Results from a matched study. Clin Orthop Relat Res. 2006;451:101–106.PubMedCrossRef Amin AK, Patton JT, Cook RE, Gaston M, Brenkel IJ. Unicompartmental or total knee arthroplasty? Results from a matched study. Clin Orthop Relat Res. 2006;451:101–106.PubMedCrossRef
4.
go back to reference Andriacchi TP, Andersson GBJ, Fermier RW, Stern D, Galante JO. A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am. 1980;62:749–757.PubMed Andriacchi TP, Andersson GBJ, Fermier RW, Stern D, Galante JO. A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am. 1980;62:749–757.PubMed
5.
go back to reference Andriacchi TP, Galante JO, Fermier RW. The influence of total knee-replacement design on walking and stair-climbing. J Bone Joint Surg Am. 1982;64:1328–1335.PubMed Andriacchi TP, Galante JO, Fermier RW. The influence of total knee-replacement design on walking and stair-climbing. J Bone Joint Surg Am. 1982;64:1328–1335.PubMed
6.
go back to reference Banks SA, Fregly BJ, Boniforti F, Reinschmidt C, Romagnoli S. Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc. 2005;13:551–556.PubMedCrossRef Banks SA, Fregly BJ, Boniforti F, Reinschmidt C, Romagnoli S. Comparing in vivo kinematics of unicondylar and bi-unicondylar knee replacements. Knee Surg Sports Traumatol Arthrosc. 2005;13:551–556.PubMedCrossRef
7.
go back to reference Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following unicompartmental or bicompartmental knee arthroplasty: a meta-analysis. J Arthroplasty. 1995;10:141–150.PubMedCrossRef Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following unicompartmental or bicompartmental knee arthroplasty: a meta-analysis. J Arthroplasty. 1995;10:141–150.PubMedCrossRef
8.
go back to reference Cappozzo A, Catani F, Della Croce U, Leardini A. Position and orientation in space of bones during movement: anatomical frame definition and determination. Clin Biomech. 1995;10:171–178.CrossRef Cappozzo A, Catani F, Della Croce U, Leardini A. Position and orientation in space of bones during movement: anatomical frame definition and determination. Clin Biomech. 1995;10:171–178.CrossRef
9.
go back to reference Catani F, Benedetti MG, De Felice R, Buzzi R, Giannini S, Aglietti P. Mobile and fixed bearing total knee prosthesis functional comparison during stair climbing. Clin Biomech. 2003;18:410–418.CrossRef Catani F, Benedetti MG, De Felice R, Buzzi R, Giannini S, Aglietti P. Mobile and fixed bearing total knee prosthesis functional comparison during stair climbing. Clin Biomech. 2003;18:410–418.CrossRef
10.
go back to reference Costigan PA, Deluzio KJ, Wyss UP. Knee and hip kinetics during normal stair climbing. Gait Posture. 2002;16:31.PubMedCrossRef Costigan PA, Deluzio KJ, Wyss UP. Knee and hip kinetics during normal stair climbing. Gait Posture. 2002;16:31.PubMedCrossRef
11.
go back to reference Fuchs S, Tibesku CO, Frisse D, Laa H, Rosenbaum D. Quality of life and gait after unicondylar knee prosthesis are inferior to age-matched control subjects. Am J Phys Med Rehabil. 2003;82:441–446.PubMed Fuchs S, Tibesku CO, Frisse D, Laa H, Rosenbaum D. Quality of life and gait after unicondylar knee prosthesis are inferior to age-matched control subjects. Am J Phys Med Rehabil. 2003;82:441–446.PubMed
12.
go back to reference Geller JA, Yoon RS, Macaulay W. Unicompartmental knee arthroplasty: a controversial history and a rationale for contemporary resurgence. J Knee Surg. 2008;21:7–14.PubMed Geller JA, Yoon RS, Macaulay W. Unicompartmental knee arthroplasty: a controversial history and a rationale for contemporary resurgence. J Knee Surg. 2008;21:7–14.PubMed
13.
go back to reference Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. 1983;105:136–144.PubMedCrossRef Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. 1983;105:136–144.PubMedCrossRef
14.
go back to reference Hassaballa MA, Porteous AJ, Newman JH. Observed kneeling ability after total, unicompartmental and patellofemoral knee arthroplasty: perception versus reality. Knee Surg Sports Traumatol Arthrosc. 2004;12:136–139.PubMedCrossRef Hassaballa MA, Porteous AJ, Newman JH. Observed kneeling ability after total, unicompartmental and patellofemoral knee arthroplasty: perception versus reality. Knee Surg Sports Traumatol Arthrosc. 2004;12:136–139.PubMedCrossRef
15.
go back to reference Heyse TJ, Tibesku CO. Lateral unicompartmental knee arthroplasty: a review. Arch Orthop Trauma Surg. 2010:1539–1548. Heyse TJ, Tibesku CO. Lateral unicompartmental knee arthroplasty: a review. Arch Orthop Trauma Surg. 2010:1539–1548.
16.
go back to reference Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res. 1990;8:383–392.PubMedCrossRef Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res. 1990;8:383–392.PubMedCrossRef
17.
go back to reference Kleijn LLA, van Hemert WLW, Meijers WGH, Kester ADM, Lisowski L, Grimm B, Heyligers IC. Functional improvement after unicompartmental knee replacement: a follow-up study with a performance based knee test. Knee Surg Sports Traumatol Arthrosc. 2007;15:1187–1193.PubMedCrossRef Kleijn LLA, van Hemert WLW, Meijers WGH, Kester ADM, Lisowski L, Grimm B, Heyligers IC. Functional improvement after unicompartmental knee replacement: a follow-up study with a performance based knee test. Knee Surg Sports Traumatol Arthrosc. 2007;15:1187–1193.PubMedCrossRef
18.
go back to reference Lu T-W, O’Connor JJ. A three-dimensional computer graphics-based animated model of the human locomotor system with anatomical joint constraints. J Biomech. 1998;31:116.CrossRef Lu T-W, O’Connor JJ. A three-dimensional computer graphics-based animated model of the human locomotor system with anatomical joint constraints. J Biomech. 1998;31:116.CrossRef
19.
go back to reference Lu T-W, O’Connor JJ. Bone position estimation from skin marker co-ordinates using global optimisation with joint constraints. J Biomech. 1999;32:129–134.PubMedCrossRef Lu T-W, O’Connor JJ. Bone position estimation from skin marker co-ordinates using global optimisation with joint constraints. J Biomech. 1999;32:129–134.PubMedCrossRef
20.
go back to reference Lu T-W, O’Connor JJ, Taylor SJG, Walker PS. Validation of a lower limb model with in vivo femoral forces telemetered from two subjects. J Biomech. 1998;31:63–69.PubMedCrossRef Lu T-W, O’Connor JJ, Taylor SJG, Walker PS. Validation of a lower limb model with in vivo femoral forces telemetered from two subjects. J Biomech. 1998;31:63–69.PubMedCrossRef
21.
go back to reference Mariani EM, Bourne MH, Jackson RT, Jackson ST, Jones P. Early failure of unicompartmental knee arthroplasty. J Arthroplasty. 2007;22:81–84.PubMedCrossRef Mariani EM, Bourne MH, Jackson RT, Jackson ST, Jones P. Early failure of unicompartmental knee arthroplasty. J Arthroplasty. 2007;22:81–84.PubMedCrossRef
22.
go back to reference Milner CE. Interlimb asymmetry during walking following unilateral total knee arthroplasty. Gait Posture. 2008;28:69–73.PubMedCrossRef Milner CE. Interlimb asymmetry during walking following unilateral total knee arthroplasty. Gait Posture. 2008;28:69–73.PubMedCrossRef
23.
go back to reference Orishimo K, Kremenic I, Deshmukh A, Nicholas S, Rodriguez J. Does total knee arthroplasty change frontal plane knee biomechanics during gait? Clin Orthop Relat Res. 2012;470:1171–1176.PubMedCrossRef Orishimo K, Kremenic I, Deshmukh A, Nicholas S, Rodriguez J. Does total knee arthroplasty change frontal plane knee biomechanics during gait? Clin Orthop Relat Res. 2012;470:1171–1176.PubMedCrossRef
24.
go back to reference Pandit H, Van Duren BH, Gallagher JA, Beard DJ, Dodd CAF, Gill HS, Murray DW. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee. 2008;15:101–106.PubMedCrossRef Pandit H, Van Duren BH, Gallagher JA, Beard DJ, Dodd CAF, Gill HS, Murray DW. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee. 2008;15:101–106.PubMedCrossRef
25.
go back to reference Protopapadaki A, Drechsler WI, Cramp MC, Coutts FJ, Scott OM. Hip, knee, ankle kinematics and kinetics during stair ascent and descent in healthy young individuals. Clin Biomech. 2007;22:203–210.CrossRef Protopapadaki A, Drechsler WI, Cramp MC, Coutts FJ, Scott OM. Hip, knee, ankle kinematics and kinetics during stair ascent and descent in healthy young individuals. Clin Biomech. 2007;22:203–210.CrossRef
26.
go back to reference Reeves ND, Spanjaard M, Mohagheghi AA, Baltzopoulos V, Maganaris CN. The demands of stair descent relative to maximum capacities in elderly and young adults. J Electromyogr Kinesiol. 2008;18:218–227.PubMedCrossRef Reeves ND, Spanjaard M, Mohagheghi AA, Baltzopoulos V, Maganaris CN. The demands of stair descent relative to maximum capacities in elderly and young adults. J Electromyogr Kinesiol. 2008;18:218–227.PubMedCrossRef
27.
go back to reference Riener R, Rabuffetti M, Frigo C. Stair ascent and descent at different inclinations. Gait Posture. 2002;15:32–44.PubMedCrossRef Riener R, Rabuffetti M, Frigo C. Stair ascent and descent at different inclinations. Gait Posture. 2002;15:32–44.PubMedCrossRef
28.
go back to reference Schindler OS, Scott WN, Scuderi GR. The practice of unicompartmental knee arthroplasty in the United Kingdom. J Orthop Surg. 2010;18:312–319. Schindler OS, Scott WN, Scuderi GR. The practice of unicompartmental knee arthroplasty in the United Kingdom. J Orthop Surg. 2010;18:312–319.
29.
go back to reference Startzell JK, Owens DA, Mulfinger LM, Cavanagh PR. Stair negotiation in older people: a review. J Am Geriatr Soc. 2000;48:567–580.PubMed Startzell JK, Owens DA, Mulfinger LM, Cavanagh PR. Stair negotiation in older people: a review. J Am Geriatr Soc. 2000;48:567–580.PubMed
30.
go back to reference Verdonk R, Cottenie D, Almqvist KF, Vorlat P. The Oxford unicompartmental knee prosthesis: a 2-14 year follow-up. Knee Surg Sports Traumatol Arthrosc. 2005;13:163–166.PubMedCrossRef Verdonk R, Cottenie D, Almqvist KF, Vorlat P. The Oxford unicompartmental knee prosthesis: a 2-14 year follow-up. Knee Surg Sports Traumatol Arthrosc. 2005;13:163–166.PubMedCrossRef
31.
go back to reference Webster KE, Wittwer JE, Feller JA. Quantitative gait analysis after medial unicompartmental knee arthroplasty for osteoarthritis. J Arthroplasty. 2003;18:751–759.PubMedCrossRef Webster KE, Wittwer JE, Feller JA. Quantitative gait analysis after medial unicompartmental knee arthroplasty for osteoarthritis. J Arthroplasty. 2003;18:751–759.PubMedCrossRef
32.
go back to reference Weinstein JN, Andriacchi TP, Galante J. Factors influencing walking and stairclimbing following unicompartmental knee arthroplasty. J Arthroplasty. 1986;1:109–115.PubMedCrossRef Weinstein JN, Andriacchi TP, Galante J. Factors influencing walking and stairclimbing following unicompartmental knee arthroplasty. J Arthroplasty. 1986;1:109–115.PubMedCrossRef
33.
go back to reference Woltring HJ. A Fortran package for generalized cross-validatory spline smoothing and differentiation. Adv Eng Softw. 1986;8:104–113.CrossRef Woltring HJ. A Fortran package for generalized cross-validatory spline smoothing and differentiation. Adv Eng Softw. 1986;8:104–113.CrossRef
34.
go back to reference Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D’Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. International Society of Biomechanics. J Biomech. 2002;35:543–548. Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D’Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I. ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. International Society of Biomechanics. J Biomech. 2002;35:543–548.
35.
go back to reference Yoshida Y, Mizner RL, Ramsey DK, Snyder-Mackler L. Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clin Biomech. 2008;23:320–328.CrossRef Yoshida Y, Mizner RL, Ramsey DK, Snyder-Mackler L. Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clin Biomech. 2008;23:320–328.CrossRef
36.
go back to reference Zifchock RA, Davis I, Higginson J, Royer T. The symmetry angle: a novel, robust method of quantifying asymmetry. Gait Posture. 2008;27:622–627.PubMedCrossRef Zifchock RA, Davis I, Higginson J, Royer T. The symmetry angle: a novel, robust method of quantifying asymmetry. Gait Posture. 2008;27:622–627.PubMedCrossRef
Metadata
Title
Does Interlimb Knee Symmetry Exist After Unicompartmental Knee Arthroplasty?
Authors
Yang-Chieh Fu, PhD
Kathy J. Simpson, PhD
Tracy L. Kinsey, MSPH
Ormonde M. Mahoney, MD
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 1/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2522-1

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