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Kinematic behaviour and soft tissue management in guided motion total knee replacement
Camilla Halewood1, Michael Risebury, Neil P Thomas
1The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK, c.halewood@imperial.ac.uk.
Summary
Guided motion total knee arthroplasty (TKA) may reduce anterolateral knee pain by addressing abnormal tibial rotation. Updated designs show promise in mitigating soft tissue strain during flexion, potentially improving patient outcomes after TKA.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Biomaterials Science
Background:
- Total knee arthroplasty (TKA) aims to restore knee function but can lead to patient dissatisfaction.
- Abnormal knee kinematics and soft tissue stretching are potential causes of persistent pain after TKA.
- Guided motion TKAs are designed to mimic natural knee kinematics, but concerns exist regarding anterolateral knee pain.
Purpose of the Study:
- To investigate the hypothesis that excessive tibial internal rotation and femoral rollback in guided motion TKAs cause anterolateral knee pain.
- To evaluate the biomechanical effects of different TKA designs on knee kinematics and ligamentous structures.
- To compare the kinematics of guided motion TKAs (Journey, Journey II) and a conventional TKA (Genesis II PS) with the intact knee.
Main Methods:
- Utilized 18 fresh-frozen knee specimens for biomechanical analysis.
- Employed a knee extension rig with transducers to measure ligament length changes during flexion.
- Used a knee flexion rig with optical trackers to assess tibiofemoral kinematics under various TKA conditions.
Main Results:
- TKA did not significantly elongate examined ligaments; some TKAs caused minor, non-significant changes in ligament lengths and iliotibial band tension.
- None of the tested TKAs fully restored normal knee kinematics, with the screw-home mechanism absent in all.
- Increased anterior laxity was observed in all TKAs up to 90° flexion; tibial internal rotation was not increased, but Journey I TKA showed greater anterior translation.
Conclusions:
- The initial hypothesis regarding excessive rotation and rollback causing soft tissue strain in guided motion knees was supported, with updated designs showing reduced tendency.
- The findings suggest that changes in knee kinematics after TKA may contribute to anterolateral knee pain.
- Clinical implications indicate a potential reduction in anterolateral knee pain incidence with guided motion TKA, particularly with updated designs.
