Summary: Even with the same total knee arthroplasty design concept, different tibial inserts produced different knee kinematics and stress distribution results.

Introduction

About 20% of patients remain unsatisfied even after modern total knee arthroplasty. However, despite new tibial insert designs that aim to improve patient satisfaction, it is uncertain whether the expected effects are achieved. In addition, few studies have demonstrated differences in clinical outcome between different implant design. The purpose of this study was to develop a musculoskeletal computer simulation to simultaneously investigate knee kinematics and stress distribution in post-TKA models.

Methods

A musculoskeletal computer simulation using computed tomography data of a volunteer was developed to analyze knee biomechanics during squat (0°–120°). We compared biomechanical changes between posterior cruciate ligament (PCL)-retaining (CR)-TKA and CR-TKA without anterolateral (AL)-PCL, because the AL-PCL can be damaged during tibial bone resection. If the PCL were damaged intraoperatively, the surgeon would use a cruciate-sacrificing (CS) tibial insert with high anterior lip or PCL-substituting (PS) components with a post-cam mechanism. The femoral components had a single radius of curvature design. The AP movement of the medial and lateral femoral condyles against the tibial insert and peak equivalent stresses on the tibial insert were measured.

Results

The CR model showed little femoral anterior movement during mid-flexion, and then suitable medial pivot motion and roll-back of the femoral component. The CR model without the AL-PCL showed relatively larger femoral anterior movement than the CR model with an intact PCL, and also had attenuated medial pivot motion and roll-back. In the CS model, the femoral component moved anteriorly until the high anterior lip of the tibial insert exerted an effect, and it then rolled back. The PS model exhibited the same type of anterior femoral movement as the CS model during mid-flexion. However, the PS femoral component was forcibly rolled back when the post-cam mechanism was active at knee flexion of 60° or more. Regarding to equivalent stresses on the tibial insert, the PS model due to its post-cam mechanism exhibited higher equivalent stress on the tibial insert throughout squat than the other TKA models. In the CR model, the TF contact stress increased at mid-flexion because increased PCL tension caused femoral roll-back. The TF contact stress in the CS model increased significantly during deep knee flexion.

Discussion

This study using a musculoskeletal computer simulation revealed that simply by changing the type of tibial insert can alter not only knee kinematics, but also stress distribution, even with the same femoral component design in the same knee. The CR design showed good knee kinematics with little paradoxical femoral anterior movement. However, CR-TKA with partial PCL damage caused femoral anterior movement during mid-flexion. After PCL dysfunction, switching to a CS tibial insert with a high anterior lip could not reduce the mid-flexion instability. In contrast, the change to the PS components resulted in mechanical femoral roll-back against the tibia, but also increased stress distribution on the tibial polyethylene. Even with the same TKA design concept, different models produced different biomechanical results. There is a close relationship between knee kinematics and stress distribution after TKA.

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Changes In Foot Pressure Among Patients With Varus Knee Osteoarthritis Undergoing Bilateral Simultaneous Total Knee Arthroplasty – A Prospective Observational Pedobarographic Assessment ePoster Presentation Roop Bhushan Kalia, M.S (Orthopaedics), INDIA Divyansh Sharma, MBBS,M.S (Orthopaedics), INDIA Pradeep Kumar Meena, MBBS,M.S(Orthopaedics), INDIA Raj Kumar Yadav, MBBS,M.D, INDIA Ankit Gaurav, MS ORTHOPAEDICS, INDIA
Is It Really Worth Changing From Computer Navigation to Robotic Knee Replacement? A Prospective Study to Compare Patient Outcomes Following Robotic-Assisted and Computer-Navigated TKA ePoster Presentation Jacob O'Brien, B. Physiotherapy (Hons), AUSTRALIA David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA Harbeer Ahedi, PhD Biomedical Sciences, AUSTRALIA Myles R. J. Coolican, FRACS, AUSTRALIA
Successful Outcomes in Combined Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction : A Clinical Study ePoster Presentation Theodore Balfousias, MD, MSc, FEBOT, GREECE Ilias Fanourgiakis, MD, MSc, FEBOT, GREECE Rainer Siebold, Prof. Dr. med., GERMANY
Does Robotic Assistance In Total Knee Arthroplasty Improve Preoperative Planning And Intraoperative Decision-Making? ePoster Presentation David H. Figueroa, MD, CHILE Waldo Gonzalez Duque, MD, CHILE Rafael Calvo, MD, CHILE Francisco Figueroa, MD, CHILE
Single-Shot Femoral Nerve Block Versus Local Infiltration Analgesia For Patients Undergoing Total Knee Arthroplasty: A Systematic Review And Meta-Analysis ePoster Presentation André Richard Da Silva Oliveira Filho, Student, BRAZIL Elcio Machinski, md, BRAZIL Vinícius Furtado, Student, BRAZIL Rodrigo Conde, MS, ARGENTINA Bruno Butturi Varone, MD, BRAZIL Riccardo Gomes Gobbi, MD, PhD, BRAZIL Camilo P. Helito, MD, PhD, Prof, BRAZIL Daniel Leal, MD, BRAZIL
Prospective Comparison Of Short-Term Outcomes In Kinematic And Mechanical Alignment Total Knee Arthroplasty ePoster Presentation Ofir Vinograd, MD , ISRAEL Netanel Steinberg, MD, ISRAEL Ahmad Essa, MPH MD, ISRAEL Dana Avraham, MD, ISRAEL Ilan Y Mitchnik, MD, ISRAEL Noam Shohat, MD, ISRAEL
Early Clinical Outcome In Inverse Kinematic Alignment For Total Knee Arthroplasty Using A Robotic Assisted System: Two Years Follow-Up ePoster Presentation Federica Manca, MD, ITALY Leo Massari, Prof., ITALY Alberto Belluati, MD, ITALY Andrea Colombelli, MD, ITALY
Use of Patient-Specific 3D-Printed Intraoperative Spacers in Complex Revision Total Knee Arthroplasty. Surgical Technique and Preliminary Results. ePoster Presentation Giulio Vittone, MD, ITALY Marcello Motta, MD, ITALY Marco Adriani, MD, ITALY Alberto Guizzi, ITALY Alessandro Colosio, MD, ITALY Giuseppe Milano, Prof., ITALY
Impact of Travel Distance on Short-Term Complications and Readmissions After Periprosthetic Joint Infection ePoster Presentation Logan Finger, MD, UNITED STATES Akeem Williams, BS, UNITED STATES Nicolas Aycardi, BS, UNITED STATES Yunseo Linda Park, BS, UNITED STATES Kenneth Urish, MD, PhD Michael O'Malley, MD, UNITED STATES Brian Klatt, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES
Almost 79% Survival Rate At 10-Year Follow-Up For The Patellofemoral Joint Arthroplasty: A Registry Study ePoster Presentation Piero Agostinone, MD, ITALY Anna Pagano, MD, ITALY Domenico Alesi, MD, ITALY Alberto Grassi, PhD, ITALY Stefano Zaffagnini, MD, Prof., ITALY
Catastrophic Full Thickness Wear In Oxinium Knee Implants: A Case Report And Analysis Of Failure Mechanisms ePoster Presentation Naman Wahal, MBBS, MS Orthopaedics, INDIA RAJESH MALHOTRA, MS Orthopaedics, FIMSA, FRCS, FACS, INDIA
Comparison Of Outcomes Of Revision Uka To Tka And Primary Tkas -A Propensity Matched Study. ePoster Presentation Myles R. J. Coolican, FRACS, AUSTRALIA Harbeer Ahedi, PhD Biomedical Sciences, AUSTRALIA
Clinical Outcomes Of Functional Versus Mechanical Alignment In Robotic-Arm Assisted Total Knee Arthroplasty: A Randomised Controlled Trial ePoster Presentation Simon W. Young, MD, FRACS, NEW ZEALAND Mei Lin Tay, PhD, NEW ZEALAND Kohei Kawaguchi, MD, PhD, JAPAN Bill Farrington, FRCS, NEW ZEALAND Rupert S Van Rooyen, MBChB, FRACS, NEW ZEALAND Matthew Walker, MBChB, FRACS, NEW ZEALAND Ali Bayan, MBChB, FRACS, NEW ZEALAND
Investigating Patient And Surgical Factors Affecting Same Day Discharge After Unicompartmental Knee Replacement ePoster Presentation Suleyman Ulla, MBChB, UNITED KINGDOM Patrick Richard Michael Nicholas, MBChB, MRCS(Glasg), UNITED KINGDOM Stuart Wilson Bell, MBChB MRCP FRCS (Orth), UNITED KINGDOM
High ten years survivorship and functional results of robotic-arm-assisted lateral unicompartmental knee arthroplasty ePoster Presentation Guido Maritan, MD, ITALY Mattia Berti, MD, ITALY Federico Roman, MD, ITALY Emanuele Furlan, MD, ITALY
Intra- and postoperative blood loss with and without use of tourniquet in knee arthroplasty. ePoster Presentation Kengo Kaji, MD, JAPAN Masaki Mori, MD, PhD, JAPAN Naoto Date, MD, JAPAN Masakazu Ishikawa, MD, PhD, JAPAN
All-Intra-Incisional-Pins In Robotic Total Knee Arthroplasty (TKA) As A New Standard Of Care – A Minimally Invasive Practical Technique Guide ePoster Presentation Glen Liau , MBBS, MRCS, MMed, FRCS, FAMS, MBA, SINGAPORE Ryan Wai Keong Loke, MBBS candidate, SINGAPORE Yu Liu, MBBS, SINGAPORE
An Artificial Intelligence-Based Approach In Total Knee Arthroplasty ePoster Presentation Umile Giuseppe Longo, MD, MSc, PhD, Prof., ITALY Sergio De Salvatore, MD, ITALY Federica Valente, MD, ITALY Bruno Violante, MD Ph.d, ITALY Mariajose Villa Corta, MD, ITALY Kristian Samuelsson, Prof, MD, PhD, MSc, SWEDEN Giuseppe Salvatore, MD, PhD, ITALY Alessandra Berton, MD, ITALY Letizia Mancini, MD, ITALY Vincenzo Candela, MD, PhD, ITALY Arianna Carnevale, PhD, ITALY Rocco Papalia, MD, PhD, Prof., ITALY
Mid To Long-Term Results Of Medial Unicompartmental Knee Arthroplasty : Mobile Versus Fixed-Bearing ePoster Presentation Sumin Lim, MD, PhD, KOREA, REPUBLIC OF Jun-Young Chung, MD, KOREA, REPUBLIC OF Tae Hun Kim, MD, KOREA, REPUBLIC OF Jeong-Hyun Koh, MD, KOREA, REPUBLIC OF Jeong Sunwoo, MD, KOREA, REPUBLIC OF Myung-Sub Lee, MD, KOREA, REPUBLIC OF
Factors Affecting Final Saggital Alignment In Robotic Total Knee Replacement ePoster Presentation George Jacob, MBBS, MS Ortho, FAOrthA, INDIA Yoong Lim, BEng, PhD, AUSTRALIA David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA
Primary Followed by Revision Total Knee Arthroplasty at Non-Tertiary Centers Have Higher Risk of Complications ePoster Presentation Logan Finger, MD, UNITED STATES Yunseo Linda Park, BS, UNITED STATES Matthew Como, BS, UNITED STATES Nicolas Aycardi, BS, UNITED STATES Kenneth Urish, MD, PhD Michael O'Malley, MD, UNITED STATES Brian Klatt, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES
The Effects Of The Flexion Gap Setting On Postoperative Outcomes Of Tka Using The Mako Robotic Arm ePoster Presentation Shuhei Sugioka, MD, JAPAN Masayoshi Okuda, MD, PhD, JAPAN Yuki Kawaguchi, PT, JAPAN Yasuhito Tanaka, Prof., JAPAN
High Incidence Of Torsional Deformities In Knee Osteoarthritis In Asian Population ePoster Presentation Xinyu Tao, MBBS, SINGAPORE Ashton Tan, MBBS, SINGAPORE Don Koh, MBBS, BSc, MRCS, MMED, SINGAPORE Kong Hwee Lee, MBBS, FRCS (Ortho), SINGAPORE Hamid Rahmatullah Bin Abd Razak, MBBS, FRCSEd (Ortho), FRCSGlasg (Tr & Orth), FAMS, SINGAPORE Junwei Soong, MBBS, MRCS (Edin), MMED (Ortho), FRCS (Edin), SINGAPORE
Differences In Coronal Plane Alignment Of The Knee (CPAK) Measured On Long-Leg Radiographs Compared To Computed Tomography For The Patients Undergoing Total Knee Arthroplasty ePoster Presentation Kohei Kawaguchi, MD, PhD, JAPAN Mei Lin Tay, PhD, NEW ZEALAND Bill Farrington, FRCS, NEW ZEALAND Rupert S Van Rooyen, MBChB, FRACS, NEW ZEALAND Matthew Walker, MBChB, FRACS, NEW ZEALAND Ali Bayan, MBChB, FRACS, NEW ZEALAND Simon W. Young, MD, FRACS, NEW ZEALAND
Forgotten Joint Score : Role in Identifying Patients Unlikely To Improve Following Total Knee Arthroplasty ePoster Presentation Adit Rajesh Maniar, MBBS, MS Orthopaedics, DNB Orthopaedics, INDIA Rajesh Maniar, INDIA Ishan Khanna, MBBS, MS, INDIA Pranav Shere, MS,DNB , INDIA Anish Nandkumar Tawde, M. S. Orthopaedics , INDIA Muhammad Naqvi, MBBS, MS, DNB, FNB, MRCSEd, INDIA
Increased Patient Travel Distance for Revision Total Knee Arthroplasty is Associated With a Higher Re-revision Rate ePoster Presentation Logan Finger, MD, UNITED STATES Yunseo Linda Park, BS, UNITED STATES Matthew Como, BS, UNITED STATES Akeem Williams, BS, UNITED STATES Kenneth Urish, MD, PhD Michael O'Malley, MD, UNITED STATES Brian Klatt, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES
Influence of Femorotibial Posterior Overhang and Posterior Tibial Slope on Patellar Changes After TKA ePoster Presentation Shunsuke Utsumi, MD, JAPAN Takashi Aki, PhD, JAPAN Masayuki Kamimura, JAPAN Kento Harada, MD, JAPAN Toshimi Aizawa, JAPAN
Impact of Preoperative Limb Alignment and Deformity on Postoperative Limb Alignment in Unicompartmental Knee Arthroplasty ePoster Presentation Takashi Ishitani, MD, JAPAN Shuhei Otsuki, MD, JAPAN Yoshinori Okamoto, MD, PhD, JAPAN
Association Between Surgeon Volume And Patient Outcomes After Elective Patellofemoral Joint Replacement Surgery Using Data From The National Joint Registry And Hospital Episode Statistics For England: Population Based Cohort Study ePoster Presentation Martinique Vella-Baldacchino, MD, MRCS, PG CERT (HEALTH LEADERSHIP), IOC DIp Spo, UNITED KINGDOM Alex Bottle, Phd, UNITED KINGDOM Justin Cobb, MCh FRCS, UNITED KINGDOM Alex D Liddle, MBBS BSc DPhil FRCS(Orth), UNITED KINGDOM
An Inlay Patellofemoral Arthroplasty With An Enlarged Trochlear Component Design Results In Better Patient Reported Outcomes Measures And Lower Failure Rates Compared To A Traditional Design: A Two-Year Follow Up Study ePoster Presentation Armin Runer, PD MD, GERMANY Jonas Pogorzelski, MD, PhD, MHBA, GERMANY Hugo Bothorel, MEng, SWITZERLAND Philippe Matthias Tscholl, MD, SWITZERLAND Matthias Cotic, MSc, GERMANY Sebastian Siebenlist, MD, MHBA, Prof., GERMANY Andreas B. Imhoff, MD, Prof. Emeritus, GERMANY
Impact of Unilateral and Bilateral Total Knee Arthroplasty for Bilateral Osteoarthritis on Postoperative Fractures Risk ePoster Presentation Hiroshi Fujii, MD, PhD, JAPAN
An MRI-Based Anatomy Study for Optimal Direction and Depth in Intraoperative Adductor Canal Block Injection ePoster Presentation Sueen Sohn, MD, PhD, KOREA, REPUBLIC OF Seung Yeob Kang, MD, KOREA, REPUBLIC OF Ki Hyun Kang, MD, KOREA, REPUBLIC OF
Robotic-Assisted Unicompartmental Knee Arthroplasty Shows Better Short-Term Results Than Conventional Technique. A Comparative Study. ePoster Presentation David H. Figueroa, MD, CHILE Maria Loreto Figueroa Berrios, MD, CHILE Carlos Nain Giugliano Rostion, Resident, CHILE Jorge Simon Isla, MD, CHILE Cristóbal Abarca, MD, CHILE Fernando Martin, MD, CHILE Federico Gili, MD, CHILE Alvaro Ferrer, MD, MSc, CHILE
A Different Course Of Recovery For Extension And Flexion Strengths Following Total And Unicompartmental Knee Arthroplasty: A Prospective Cohort Study Of 369 Cases ePoster Presentation Roderick J.M. Vossen, MD, UNITED STATES Joyce L. Benner, PhD, NETHERLANDS Gaby Victoria Ten Noever De Brauw, NETHERLANDS Gino M. M. J. Kerkhoffs, MD, PhD, Prof., NETHERLANDS Andrew D. Pearle, MD, UNITED STATES Hendrik Aernout Zuiderbaan, MD PhD, NETHERLANDS Lucien C.M. Keijser, MD PhD, NETHERLANDS
Robotic-Assisted Total Knee Arthroplasty Is Associated With Improved Surgical And Post-Operative Outcomes: A Large Single-Centre Study ePoster Presentation Mei Lin Tay, PhD, NEW ZEALAND Kohei Kawaguchi, MD, PhD, JAPAN Scott M Bolam, MBChB, PhD, NEW ZEALAND Ali Bayan, MBChB, FRACS, NEW ZEALAND Simon W. Young, MD, FRACS, NEW ZEALAND
The Impact Of Aging On Recovery And Satisfaction In Knee Replacement Patients ePoster Presentation Tess L.Y Tsoi , MBChB, HONG KONG Harbeer Ahedi, PhD Biomedical Sciences, AUSTRALIA David A. Parker, MBBS, BMedSc, FRACS, AUSTRALIA
Soft Tissue Balancing In Robotic-Assisted Total Knee Arthroplasty ePoster Presentation Tomoya Takasago, MD, PhD, JAPAN Katsutoshi Miyatake, MD, PhD, JAPAN Akihiro Nagamachi, MD, PhD, JAPAN
Knees With Lateral Compartment Osteoarthritis Show A Substantial Variability In Functional Knee Phenotypes With Gender-Specific And Age-Related Differences: Phenotypic Analysis Of 305 Knees ePoster Presentation Gaby Victoria Ten Noever De Brauw, NETHERLANDS Tarik Bayoumi, MD, NETHERLANDS Lindsey Ruderman, BA, UNITED STATES Gino M. M. J. Kerkhoffs, MD, PhD, Prof., NETHERLANDS Hendrik Aernout Zuiderbaan, MD PhD, NETHERLANDS Andrew D. Pearle, MD, UNITED STATES
Predicting And Preventing Overcorrection In Medial Unicompartmental Knee Arthroplasty: A Radiographic Study Based On Long-Leg Films And Valgus Stress Views. ePoster Presentation Stefano Gaggiotti, MD, ARGENTINA Constant Foissey, MD, FRANCE Cécile Batailler, MD, PhD, FRANCE Elvire Servien, MD, PhD, Prof., FRANCE Santino Gaggiotti, MD, ARGENTINA Gabriel Gaggiotti, MD, ARGENTINA Sebastien Lustig, MD, PhD, Prof., FRANCE

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Changes In Tibial Insert Design Can Alter Knee Kinematics And Tibiofemoral Stress Distributions In Total Knee Arthroplasty

Changes In Tibial Insert Design Can Alter Knee Kinematics And Tibiofemoral Stress Distributions In Total Knee Arthroplasty

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Knee Arthroplasty ePosters

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Changes In Tibial Insert Design Can Alter Knee Kinematics And Tibiofemoral Stress Distributions In Total Knee Arthroplasty

Changes In Tibial Insert Design Can Alter Knee Kinematics And Tibiofemoral Stress Distributions In Total Knee Arthroplasty

Introduction

Methods

Results

Discussion