Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities
Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities
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DOI：
10.1007/s00167-019-05375-9
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发表时间：
2019-07-01
影响因子：
3.8
通讯作者：
Tanaka, Sakae
中科院分区：
文献类型：
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作者：
Kono, Kenichi;Inui, Hiroshi;Tanaka, Sakae
目的双交叉稳定型全膝关节置换术（BCS-TKA）采用双柱凸轮机制替代前交叉韧带和后交叉韧带（PCL），其表面几何形状为轴向旋转和后平移提供额外的引导。然而，尚未研究负重对BCS-TKA运动学的影响。因此，本研究的目的是澄清负重对BCS-TKA运动学的影响，在高屈曲activity.MethodsThe运动学的11 BCS-TKA进行了评价，在透视下，与二维和三维图像配准，在蹲负重和主动辅助膝关节屈曲非负重。测量了以下变量：膝关节活动范围、股骨相对于胫骨部件的旋转轴、内侧接触点的前后（AP）平移、关节表面的运动学路径、外侧股胫接触点以及前后凸轮接合。结果负重条件不影响膝关节屈曲范围、股骨旋转轴、早期屈曲期间的内侧枢轴模式，或双髁后滚超过中度屈曲。关于AP平移，在中度屈曲角度，内侧和外侧接触点在负重时的位置比非负重时的位置更靠后。负重组6/11例膝关节（54.5%）和非负重组4/11例膝关节（36.3%）发现前向啮合。后凸轮接合观察到在所有的膝盖，与屈曲角在接合是更大的负重比在non-weight-bearing.ConclusionAlthough负重导致在后方的位置的内侧和外侧接触点的BCS-TKA设计相比，非负重在膝关节屈曲的中期范围内，前平移量是小的整体。因此，BCS-TKA在高屈曲负重活动期间提供了良好的稳定性。然而，BCS-TKA与早期屈曲期间的高前向接合率相关。因此，在选择最合适的TKA方法时，了解患者的活动是一个重要因素。
PurposeBicruciate-stabilised total knee arthroplasty (BCS-TKA) uses a dual-post-cam mechanism as a substitute for the anterior cruciate ligament and posterior cruciate ligament (PCL), with the surface geometry providing additional guidance for axial rotation and posterior translation. However, the effect of weight-bearing on the kinematics of BCS-TKA has not been investigated. Therefore, the aim of this study was to clarify the effect of weight-bearing on the kinematics of BCS-TKA during high-flexion activities.MethodsThe kinematics of 11 BCS-TKAs were evaluated under fluoroscopy, with two- and three-dimensional image registration, during squatting weight-bearing and active-assisted knee flexion non-weight-bearing. The following variables were measured: knee range of motion, axis of femoral rotation relative to the tibial component, anteroposterior (AP) translation of the medial contact point, kinematic path of the joint surfaces, lateral femorotibial contact point, and anterior and post-cam engagement.ResultsThe weight-bearing condition did not influence the range of knee flexion, axis of femoral rotation, medial pivot pattern during early flexion, or bicondylar rollback beyond mid-flexion. With regard to AP translation, both the medial and lateral contact points had more posterior locations in weight-bearing than in non-weight-bearing at the mid-flexion angle. Anterior engagement was identified in 6/11 knees (54.5%) in weight-bearing and 4/11 knees (36.3%) in non-weight-bearing. Post-cam engagement was observed in all knees, with the angle of flexion at engagement being larger in weight-bearing than in non-weight-bearing.ConclusionAlthough weight-bearing resulted in a posterior location of the medial and lateral contact points of the BCS-TKA design compared with non-weight-bearing in the mid-range of knee flexion, the amount of anterior translation was small overall. Therefore, BCS-TKA provides good stability during high-flexion weight-bearing activities. However, BCS-TKA is associated with high rate of the anterior engagement during early flexion. Therefore, understanding a patient's activities is an important factor when selecting the most appropriate TKA method.