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Clinical Orthopaedics and Related Research®

Published in:

01-01-2014 | Symposium: 2013 Knee Society Proceedings

Knee Moments After Unicompartmental Knee Arthroplasty During Stair Ascent

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

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2014

Abstract

Background

For unicompartmental knee arthroplasty (UKA), abnormal loading on the tibiofemoral joint could exacerbate knee osteoarthritis or implant wear. Joint moments are an indirect measure of such loading. However, little is known about knee moments of patients with UKA, tempering enthusiasm for its use.

Questions/purposes

In patients with UKAs performing stair ascent, we (1) determined whether interlimb differences for knee moments are demonstrated, (2) described the knee kinetics of patients with medial and lateral UKAs, and (3) investigated possible factors that might influence the knee abductor moments.

Methods

In our cross-sectional study, we recruited 26 patients with UKA with nondiseased contralateral limbs who performed stair ascent. Seventeen patients had medial UKAs and nine had lateral UKAs. Paired t-tests and CIs were applied to determine interlimb differences within each UKA group for peak knee moments and times to peak moments.

Results

During stair ascent, the medial UKA group displayed greater peak extensor moments for the nondiseased compared to the UKA limb (p = 0.030), whereas the lateral UKA group did not (p = 0.087). For both medial and lateral UKA groups, the UKA limb demonstrated greater internal peak abductor moments (p = 0.005 and 0.013, respectively). Both UKA groups exhibited knee moments similar to those in the literature. Limb dominance and postoperative time were correlated for both UKA groups.

Conclusions

Reduced knee extensor moments of limbs with UKA displayed by some participants may indicate less compressive loading on the tibiofemoral joint surfaces, whereas the increased abductor moments suggest increased compression on the medial compartment. These findings suggest UKA knees may not be subjected to excessive loads regardless of the side reconstructed.

Level of Evidence

Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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

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

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, Stanwyck TS, Galante JO. Knee biomechanics and total knee replacement. J Arthroplasty. 1986;1:211–219.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

Berend KR, Lombardi AV, Mallory TH, Adams JB, Groseth KL. Early failure of minimally invasive unicompartmental knee arthroplasty is associated with obesity. Clin Orthop Relat Res. 2005;440:60–66.PubMedCrossRef

Carr BC, Goswami T. Knee implants—review of models and biomechanics. Materials & Design. 2009;30:398–413.CrossRef

Chassin EP, Mikosz RP, Andriacchi TP, Rosenberg AG. Functional analysis of cemented medial unicompartmental knee arthroplasty. J Arthroplasty. 1996;11:553–559.PubMedCrossRef

Cooke TD, Sled EA, Scudamore RA. Frontal plane knee alignment: a call for standardized measurement. J Rheumatol. 2007;34:1796–1801.PubMed

10.

Costigan PA, Deluzio KJ, Wyss UP. Knee and hip kinetics during normal stair climbing. Gait Posture. 2002;16:31–37.PubMedCrossRef

11.

Fu YC, Simpson KJ, Kinsey TL, Mahoney OM. Does interlimb knee symmetry exist after unicompartmental knee arthroplasty? Clin Orthop Relat Res. 2013;471:142–149.PubMedCrossRef

12.

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

13.

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.PubMedCrossRef

14.

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

15.

Hopkins AR, New AM, Rodriguez-y-Baena F, Taylor M. Finite element analysis of unicompartmental knee arthroplasty. Med Eng Phys. 2010;32:14–21.PubMedCrossRef

16.

Huang SC, Wei IP, Chien HL, Wang TM, Liu YH, Chen HL, Lu TW, Lin JG. Effects of severity of degeneration on gait patterns in patients with medial knee osteoarthritis. Med Eng Phys. 2008;30:997–1003.PubMedCrossRef

17.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRef

18.

Lin HC, Lu TW, Hsu HC. Comparisons of joint kinetics in the lower extremity between stair ascent and descent. J Mech. 2005;21:41–50.CrossRef

19.

Lu TW, 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

20.

Lu TW, O’Connor JJ. Bone position estimation from skin marker co-ordinates using globla optimisation with joint constraints. J Biomech. 1999;32:129–134.PubMedCrossRef

21.

Lu TW, O’Connor JJ, Taylor SJ, Walker PS. Validation of a lower limb model with in vivo femoral forces telemetered from two subjects. J Biomech. 1998;31:63–69.PubMedCrossRef

22.

Mariani EM, Bourne MH, Jackson RT, Jackson ST, Jones P. Early failure of unicompartmental knee arthroplasty. J Arthroplasty. 2007;22:81–84.PubMedCrossRef

23.

Milner CE. Interlimb asymmetry during walking following unilateral total knee arthroplasty. Gait Posture. 2008;28:69–73.PubMedCrossRef

24.

Nadeau S, McFadyen BJ, Malouin F. Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking? Clin Biomech (Bristol, Avon). 2003;18:950–959.CrossRef

25.

Novak AC, Brouwer B. Sagittal and frontal lower limb joint moments during stair ascent and descent in young and older adults. Gait Posture. 2011;33:54–60.PubMedCrossRef

26.

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.PubMedCentralPubMedCrossRef

27.

Pandit H, Van Duren BH, Gallagher JA, Beard DJ, Dodd CA, Gill HS, Murray DW. Combined anterior cruciate reconstruction and Oxford unicompartmental knee arthroplasty: in vivo kinematics. Knee. 2008;15:101–106.PubMedCrossRef

28.

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 (Bristol, Avon). 2007;22:203–210.CrossRef

29.

Reeves ND, Spanjaard M, Mohagheghi AA, Baltzopoulos V, Maganaris CN. Older adults employ alternative strategies to operate within their maximum capabilities when ascending stairs. J Electromyogr Kinesiol. 2009;19:e57–e68.PubMedCrossRef

30.

Riddle DL, Jiranek WA, McGlynn FJ. Yearly incidence of unicompartmental knee arthroplasty in the United States. J Arthroplasty. 2008;23:408–412.PubMedCrossRef

31.

Riener R, Rabuffetti M, Frigo C. Stair ascent and descent at different inclinations. Gait Posture. 2002;15:32–44.PubMedCrossRef

32.

Robertsson O, Borgquist L, Knutson K, Lewold S, Lidgren L. Use of unicompartmental instead of tricompart-mental prostheses for unicompartmental arthrosis in the knee is a cost-effective alternative: 15,437 primary tricompartmental prostheses were compared with 10,624 primary medial or lateral unicompartmental prostheses. Acta Orthop Scand. 1999;70:170–175.PubMedCrossRef

33.

Rossi MD. An overview of total knee replacement and the role of the strength and conditioning professional. Strength and Conditioning Journal. 2011;33:88–99.CrossRef

34.

Sadeghi H, Allard P, Prince F, Labelle H. Symmetry and limb dominance in able-bodied gait: a review. Gait Posture. 2000;12:34–45.PubMedCrossRef

35.

Schindler OS, Scott WN, Scuderi GR. The practice of unicompartmental knee arthroplasty in the United Kingdom. J Orthop Surg (Hong Kong). 2010;18:312–319.PubMed

36.

Specogna AV, Birmingham TB, DaSilva JJ, Milner JS, Kerr J, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR. Reliability of lower limb frontal plane alignment measurements using plain radiographs and digitized images. J Knee Surg. 2004;17:203–210.PubMed

37.

Startzell JK, Owens DA, Mulfinger LM, Cavanagh PR. Stair negotiation in older people: a review. J Am Geriatr Soc. 2000;48:567–580.PubMed

38.

Torzilli PA, Xianghua D, Warren RF. The effect of joint-compressive load and quadriceps muscle force on knee motion in the intact and anterior cruciate ligament-sectioned knee. Am J Sports Med. 1994;22:105–112.PubMedCrossRef

39.

Vincent KR, Conrad BP, Fregly BJ, Vincent HK. The pathophysiology of osteoarthritis: a mechanical perspective on the knee joint. PM R. 2012;4(5 suppl):S3–S9.PubMedCentralPubMedCrossRef

40.

Webster KE, Wittwer JE, Feller JA. Quantitative gait analysis after medial unicompartmental knee arthroplasty for osteoarthritis. J Arthroplasty. 2003;18:751–759.PubMedCrossRef

41.

Weinstein JN, Andriacchi TP, Galante J. Factors influencing walking and stairclimbing following unicompartmental knee arthroplasty. J Arthroplasty. 1986;1:109–115.PubMedCrossRef

42.

Wilson DR, McWalter EJ, Johnston JD. The measurement of joint mechanics and their role in osteoarthritis genesis and progression. Med Clin North Am 2009;93:67–82.PubMedCrossRef

43.

Winter DH. Biomechanics and Motor Control of Human Movement. Hoboken, NJ: John Wiley & Sons; 2005:63–64.

44.

Woltring HJ. A Fortran package for generalized cross-validatory spline smoothing and differentiation. Adv Eng Software. 1986;8:104–113.CrossRef

45.

Wright JG, Treble N, Feinstein AR. Measurement of lower limb alignment using long radiographs. J Bone Joint Surg Br. 1991;73:721–723.PubMed

46.

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; Standardization and Terminology Committee of the International Society of Biomechanics. 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.PubMedCrossRef

47.

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 (Bristol, Avon). 2008;23:320–328.CrossRef

Title: Knee Moments After Unicompartmental Knee Arthroplasty During Stair Ascent
Authors: Yang-Chieh Fu, PhD
Kathy J. Simpson, PhD
Cathleen Brown, PhD
Tracy L. Kinsey, MSPH
Ormonde M. Mahoney, MD
Publication date: 01-01-2014
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 1/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-3128-y

ACC 2024 Congress

Springer Medicine

Knee Moments After Unicompartmental Knee Arthroplasty During Stair Ascent

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

ACC 2024 Congress

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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