Implant design affects walking and stair navigation after total knee arthroplasty: a double-blinded randomised controlled trial

Dimitrios-Sokratis Komaris, Cheral Govind, Andrew James Murphy, Jon Clarke, Alistair Ewen, Hollie Leonard, Philip Riches, Dimitrios-Sokratis Komaris, Cheral Govind, Andrew James Murphy, Jon Clarke, Alistair Ewen, Hollie Leonard, Philip Riches

Abstract

Background: Dissimilar total knee arthroplasty implant designs offer different functional characteristics. This is the first work in the literature to fully assess the Columbus ultra-congruent mobile (UCR) system with a rotating platform.

Methods: This is a double-blinded randomised controlled trial, comparing the functional performance of the low congruent fixed (CR DD), ultra-congruent fixed (UC) and UCR Columbus Total Knee Systems. The pre-operative and post-operative functional performance of twenty-four osteoarthritic patients was evaluated against nine control participants when carrying out everyday tasks. Spatiotemporal, kinematic and kinetic gait parameters in walking and stair navigation were extracted by means of motion capture.

Results: The UC implant provided better post-operative function, closely followed by the UCR design. However, both the UC and UCR groups exhibited restricted post-operative sagittal RoM (walking, 52.1 ± 4.4° and 53.2 ± 6.6°, respectively), whilst patients receiving a UCR implant did not show an improvement in their tibiofemoral axial rotation despite the bearing's mobile design (walking, CR DD 13.2 ± 4.6°, UC 15.3 ± 6.7°, UCR 13.5 ± 5.4°). Patients with a CR DD fixed bearing showed a statistically significant post-operative improvement in their sagittal RoM when walking (56.8 ± 4.6°).

Conclusion: It was concluded that both ultra-congruent designs in this study, the UC and UCR bearings, showed comparable functional performance and improvement after TKA surgery. The CR DD group showed the most prominent improvement in the sagittal RoM during walking.

Trial registration: The study is registered under the clinical trial registration number: NCT02422251 . Registered on April 21, 2015.

Keywords: Fixed bearing; Implant congruency; Knee prosthesis; Mobile bearing; Motion analysis; Range of motion.

Conflict of interest statement

The authors declare no competing interest.

Figures

Fig. 1
Fig. 1
CONSORT enrollment flow diagram
Fig. 2
Fig. 2
Staircase with a step height and length of 185 mm and 280 mm, respectively
Fig. 3
Fig. 3
Average (solid lines) knee flexion ±2 standard deviations (shaded bands) for the pre-operative (in red), post-operative (in blue) and control (max/min in black; no average shown) groups. Toe off occurrences (% gait cycle) are indicated by vertical solid lines
Fig. 4
Fig. 4
Average (solid lines) knee moments in walking and ±2 standard deviations (shaded bands) for the pre-operative (in red), post-operative (in blue) and control (black; no average shown) groups. Foot off occurrences (% gait cycle) are indicated by vertical solid lines

References

    1. Carr BC, Goswami T. Knee implants – review of models and biomechanics. Materials & Design. 2009;30(2):398–413. doi: 10.1016/j.matdes.2008.03.032.
    1. Kim Y-H, Kim D-Y, Kim J-S. Simultaneous mobile- and fixed-bearing total knee replacement in the same patients: a prospective comparison of mid-term outcomes using a similar design of prosthesis. J Bone Joint Surg British Volume. 2007;89(7):904–910. doi: 10.1302/0301-620X.89B7.18635.
    1. Victor J, Banks S, Bellemans J. Kinematics of posterior cruciate ligament-retaining and -substituting total knee arthroplasty: a prospective randomised outcome study. J Bone Joint Surg British volume. 2005;87(5):646–655. doi: 10.1302/0301-620X.87B5.15602.
    1. Simpson DJ, Gray H, D’Lima D, Murray D, Gill H. The effect of bearing congruency, thickness and alignment on the stresses in unicompartmental knee replacements. Clin Biomechanics. 2008;23(9):1148–1157. doi: 10.1016/j.clinbiomech.2008.06.001.
    1. Ezzet KA, Garcia R, Barrack RL. Effect of component fixation method on osteolysis in total knee arthroplasty. Clin Orthop Relat Res. 1995;321:86–91.
    1. Feller JA, Bartlett RJ, Lang DM. Patellar resurfacing versus retention in total knee arthroplasty. The Journal of bone and joint surgery British volume. 1996;78(2):226–228. doi: 10.1302/0301-620X.78B2.0780226.
    1. Lampe F, Sufi-Siavach A, Bohlen KE, Hille E, Dries SPM. One year after navigated total knee replacement, no clinically relevant difference found between fixed bearing and mobile bearing knee replacement in a double-blind randomized controlled trial. Open Orthop J. 2011;5:201–208. doi: 10.2174/1874325001105010201.
    1. Goebel D, Schultz W. The Columbus Knee System: 4-year results of a new deep flexion design compared to the NexGen full flex implant. Arthritis. 2012;2012:213817. doi: 10.1155/2012/213817.
    1. Jung W-H, Jeong J-H, Ha Y-C, Lee Y-K, Koo K-H. High early failure rate of the Columbus posterior stabilized high-flexion knee prosthesis. Clin Orthop Relat Res. 2012;470(5):1472–1481. doi: 10.1007/s11999-011-2202-6.
    1. Hakki S, Saleh KJ, Potty AG, Bilotta V, Oliveira D. Columbus navigated TKA system: clinical and radiological results at a minimum of 5 years with survivorship analysis. Orthopedics. 2013;36(3):e308–e318. doi: 10.3928/01477447-20130222-19.
    1. Marques CJ, Daniel S, Sufi-Siavach A, Lampe F. No differences in clinical outcomes between fixed- and mobile-bearing computer-assisted total knee arthroplasties and no correlations between navigation data and clinical scores. Knee Surgery, Sports Traumatology, Arthroscopy. 2015;23(6):1660–1668. doi: 10.1007/s00167-014-3127-x.
    1. Luzo MVM, Ambra LFM, Debieux P. Franciozi CEdS, Costi RR, Petrilli MdT, et al. Total knee arthroplasty with computer-assisted navigation: an analysis of 200 cases. Rev Bras Ortop. 2014;49(2):149–153. doi: 10.1016/j.rbo.2014.01.016.
    1. Kim SH, Lim J-W, Ko Y-B, Song M-G, Lee H-J. Comparison of ultra-congruent mobile- and fixed-bearing navigation-assisted total knee arthroplasty with minimum 5-year follow-up. Knee Surgery, Sports Traumatology, Arthroscopy. 2016;24(11):3466–3473. doi: 10.1007/s00167-016-4147-5.
    1. Lutzner J, Beyer F, Dexel J, Fritzsche H, Lutzner C, Kirschner S. No difference in range of motion between ultracongruent and posterior stabilized design in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthroscopy. 2017;25(11):3515–3521. doi: 10.1007/s00167-016-4331-7.
    1. Yoon JR, Yang JH. Satisfactory short-term results of navigation-assisted gap-balancing total knee arthroplasty using ultracongruent insert. J Arthroplasty. 2018;33(3):723–728. doi: 10.1016/j.arth.2017.09.049.
    1. Yoon J-R, Yang J-H. Unsatisfactory clinical outcomes of second-generation mobile bearing floating platform total knee arthroplasty: comparing outcomes with fixed bearing after five years minimum. Int Orthopaedics. 2018;42(11):2583–2589. doi: 10.1007/s00264-018-3886-y.
    1. Fuchs A, Häussermann P, Hömig D, Ochs BG, Müller CA, Helwig P, et al. 5-Jahres-Follow-up von 210 Columbus-Knietotalendoprothesen. Der Orthopäde. 2018;47(10):859–866. doi: 10.1007/s00132-018-3587-7.
    1. Urwin SG, Kader DF, Caplan N, Gibson ASC, Stewart S. Gait analysis of fixed bearing and mobile bearing total knee prostheses during walking: do mobile bearings offer functional advantages? The Knee. 2014;21(2):391–395. doi: 10.1016/j.knee.2013.10.007.
    1. Jenny JY, Diesinger Y. The Oxford Knee Score: compared performance before and after knee replacement. Orthopaedics Traumatol Surg Res. 2012;98(4):409–412. doi: 10.1016/j.otsr.2012.03.004.
    1. Reeves ND, Spanjaard M, Mohagheghi AA, Baltzopoulos V, Maganaris CN. Influence of light handrail use on the biomechanics of stair negotiation in old age. Gait & Posture. 2008;28(2):327–336. doi: 10.1016/j.gaitpost.2008.01.014.
    1. Komaris D-S, Govind C, Murphy A, Ewen A, Riches P. Identification of movement strategies during the sit-to-walk movement in patients with knee osteoarthritis. J Appl Biomechanics. 2018;34(2):96–103. doi: 10.1123/jab.2016-0279.
    1. Komaris D-S, Govind C, Clarke J, Ewen A, Jeldi A, Murphy A, et al. Identifying car ingress movement strategies before and after total knee replacement. International Biomechanics. 2020;7(1):9–18. doi: 10.1080/23335432.2020.1716847.
    1. Kramers-de Quervain IA, Stüssi E, Müller R, Drobny T, Munzinger U, Gschwend N. Quantitative gait analysis after bilateral total knee arthroplasty with two different systems within each subject. J Arthroplasty. 1997;12(2):168–179. doi: 10.1016/S0883-5403(97)90063-2.
    1. Sosio C, Gatti R, Corti M, Locatelli E, Fraschini G. Motion analysis after total knee arthroplasty. Sport Sciences for Health. 2008;4(1):1–6. doi: 10.1007/s11332-008-0059-1.
    1. Stephen PM, Walter HE, Thomas ED, Timothy M, Margaret KJ, Mary LOT, et al. Obesity: effects on gait in an osteoarthritic population. J Appl Biomechanics. 1996;12(2):161–172. doi: 10.1123/jab.12.2.161.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel