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A constrained-condylar fixed-bearing total knee arthroplasty is stabilised by the medial soft tissues
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Athwal2021_Article_AConstrained-condylarFixed-bea.pdf | Published version | 603.82 kB | Adobe PDF | View/Open |
Title: | A constrained-condylar fixed-bearing total knee arthroplasty is stabilised by the medial soft tissues |
Authors: | Athwal, KK Willinger, L Manning, W Deehan, D Amis, AA |
Item Type: | Journal Article |
Abstract: | Purpose Revision constrained-condylar total knee arthroplasty (CCK-TKA) is often used to provide additional mechanical constraint after failure of a primary TKA. However, it is unknown how much this translates to a reliance on soft-tissue support. The aim of this study was therefore to compare the laxity of a native knee to the CCK-TKA implanted state and quantify how medial soft-tissues stabilise the knee following CCK-TKA. Methods Ten intact cadaveric knees were tested in a robotic system at 0°, 30°, 60° and 90° flexion with ± 90 N anterior–posterior force, ± 8 Nm varus-valgus and ± 5 Nm internal–external torques. A fixed-bearing CCK-TKA was implanted and the laxity tests were repeated with the soft tissues intact and after sequential cutting. The deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) were sequentially transected and the percentage contributions of each structure to restraining the applied loads were calculated. Results Implanting a CCK-TKA did not alter anterior–posterior laxity from that of the original native knee, but it significantly decreased internal–external and varus-valgus rotational laxity (p < 0.05). Post CCK-TKA, the sMCL restrained 34% of the tibial displacing load in anterior drawer, 16% in internal rotation, 17% in external rotation and 53% in valgus, across the flexion angles tested. The dMCL restrained 11% of the valgus rotation moment. Conclusions With a fully-competent sMCL in-vitro, a fixed-bearing CCK-TKA knee provided more rotational constraint than the native knee. The robotic test data showed that both the soft-tissues and the semi-constrained implant restrained rotational knee laxity. Therefore, in clinical practice, a fixed-bearing CCK-TKA knee could be indicated for use in a knee with lax, less-competent medial soft tissues. |
Issue Date: | 22-Apr-2020 |
Date of Acceptance: | 10-Apr-2020 |
URI: | http://hdl.handle.net/10044/1/79308 |
DOI: | 10.1007/s00167-020-05995-6 |
ISSN: | 0942-2056 |
Publisher: | Springer Verlag |
Start Page: | 659 |
End Page: | 667 |
Journal / Book Title: | Knee Surgery Sports Traumatology Arthroscopy |
Volume: | 29 |
Copyright Statement: | © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
Keywords: | Science & Technology Life Sciences & Biomedicine Orthopedics Sport Sciences Surgery Revision total knee arthroplasty Stability Medial collateral ligament Semi-constrained implant Total knee replacement Constrained condylar prosthesis Robotic testing COLLATERAL LIGAMENT RECONSTRUCTION BIOMECHANICS Constrained condylar prosthesis Medial collateral ligament Revision total knee arthroplasty Robotic testing Semi-constrained implant Stability Total knee replacement Science & Technology Life Sciences & Biomedicine Orthopedics Sport Sciences Surgery Revision total knee arthroplasty Stability Medial collateral ligament Semi-constrained implant Total knee replacement Constrained condylar prosthesis Robotic testing COLLATERAL LIGAMENT RECONSTRUCTION BIOMECHANICS 1103 Clinical Sciences 1106 Human Movement and Sports Sciences Orthopedics |
Publication Status: | Published online |
Online Publication Date: | 2020-04-22 |
Appears in Collections: | Mechanical Engineering Faculty of Engineering |
This item is licensed under a Creative Commons License