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Evaluations of Designs and Techniques

Which Evaluation Methods Are Applicable, and Are There Differences Between Designs and Techniques?

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The Artificial Knee

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Abstract

Since artificial knees were introduced, the most widely used evaluation parameter has been survivorship. Countries such as in Scandinavia have been able to collect data on all of their artificial knee cases from the beginning. Results have shown a steady increase in survivorship over the decades, to the point where a great deal of further improvement is un likely. Hence there is now greater attention on functional outcomes. The universal method of assessing function is patient-reported outcome measures (PROMs). While there are numerous versions, the most common are KSS, KOOS, WOMAC, and FJS. These measures have been used to compare different designs of artificial knees, in the expectation that some designs would have superior performance. However, despite the major differences in the mechanics of different designs, there have been few striking functional differences found. The same has applied to different surgical techniques. To obtain more objective comparisons, biomechanical evaluation methods are being used more. The methods include gait and kinetic analysis, fluoroscopy, and basic clinical tests such as TUG or STS. These have in general shown more differences between designs and techniques. Further objectivity has been obtained using laboratory tests machines, and computer modeling. The latter has the advantage of accounting for variations in patient characteristics and surgical variations.

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References

  • Aljehani M, Madara K, Snyder-Mackler L, Christiansen C, Zeni JA Jr. The contralateral knee may not be a valid control for biomechanical outcomes after unilateral total knee arthroplasty. Gait Posture. 2019;70:179–84.

    Article  PubMed  Google Scholar 

  • Andriacchi TP, Andersson GB, Fermier RW, Stern D, Galante JO. A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am. 1980;62(5):749–57.

    Article  CAS  PubMed  Google Scholar 

  • Andriacchi TP, Galante JO, Fermier RW. The influence of total knee-replacement design on walking and stair-climbing. J Bone Joint Surg Am. 1982;64(9):1328–35.

    Article  CAS  PubMed  Google Scholar 

  • Angerame MR, Holst DC, Jennings JM, Komistek RD, Dennis DA. Total knee arthroplasty kinematics. J Arthroplast. 2019;34(10):2502–10.

    Article  Google Scholar 

  • Bailey O, Ferguson K, Crawfurd E, James P, May PA, Brown S, Blyth M, Leach WJ. No clinical difference between fixed- and mobile-bearing cruciate-retaining total knee arthroplasty: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc. 2015;23(6):1653–9.

    Article  CAS  PubMed  Google Scholar 

  • Banks SA, Hodge WA. Accurate measurement of 3-dimensional knee replacement kinematics using single-plane fluoroscopy. IEEE Trans Biomed Eng. 1996;43(6):638–49.

    Article  CAS  PubMed  Google Scholar 

  • Beaupre LA, Sharifi B, Johnston DWC. A randomized clinical trial comparing Posterior-Cruciate Stabilizing vs Posterior Cruciate-Retaining Prostheses in primary total knee. J Arthroplasty. 2017;32(3):819–23.

    Google Scholar 

  • Behrend H, Giesinger K, Giesinger JM, Kuster MS. The “forgotten joint” as the ultimate goal in joint arthroplasty: validation of a new patient-reported outcome measure. J Arthroplasty. 2012;27(3):430–436.e431.

    Article  PubMed  Google Scholar 

  • Behrend H, Zdravkovic V, Bosch M, Hochreiter B. No difference in joint awareness after TKA: a matched-pair analysis of a classic implant and its evolutional design. Knee Surg Sports Traumatol Arthrosc. 2019;27(7):2124–9.

    Article  PubMed  Google Scholar 

  • Benjamin B, Pietrzak JRT, Tahmassebi J, Haddad FS. A functional comparison of medial pivot and condylar knee designs based on patient outcomes and parameters of gait. Bone Joint J. 2018;100-b(1 Supple A):76–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Berend KR, Lombardi AV, Adams JB. Which total knee replacement implant should I pick? Correcting the pathology: the role of knee bearing designs. Bone Joint J. 2013;95-B(11 Suppl A):129–32.

    Article  CAS  PubMed  Google Scholar 

  • Bergmann G, Bender A, Graichen F, et al. Standardized loads acting in knee implants. PLoS One. 2014;9(1):e86035.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Berliner JL, Brodke DJ, Chan V, SooHoo NF, Bozic KJ. Can preoperative patient-reported outcome measures be used to predict meaningful improvement in function after TKA? Clin Orthop Relat Res. 2017;475(1):149–57.

    Article  PubMed  Google Scholar 

  • Bordini B, Ancarani C, Fitch DA. Long-term survivorship of a medial-pivot total knee system compared with other cemented designs in an arthroplasty registry. J Orthop Surg Res. 2016;11:44.

    Article  PubMed  PubMed Central  Google Scholar 

  • Catani F, Benedetti MG, Bianchi L, Marchionni V, Giannini S, Leardini A. Muscle activity around the knee and gait performance in unicompartmental knee arthroplasty patients: a comparative study on fixed- and mobile-bearing designs. Knee Surg Sports Traumatol Arthrosc. 2012;20(6):1042–8.

    Article  PubMed  Google Scholar 

  • D’Lima DD, Patil S, Steklov N, Colwell CW Jr. The 2011 ABJS Nicolas Andry award: ‘Lab’-in-a-knee: in vivo knee forces, kinematics, and contact analysis. Clin Orthop Relat Res. 2011;469(10):2953–70.

    Article  PubMed  PubMed Central  Google Scholar 

  • Daines BK, Dennis DA. Gap balancing vs. measured resection technique in total knee arthroplasty. Clin Orthop Surg. 2014;6(1):1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dennis DA, Komistek RD, Mahfouz MR, Haas BD, Stiehl JB. Multicenter determination of in vivo kinematics after total knee arthroplasty. Clin Orthop Relat Res. 2003;416:37–57.

    Article  Google Scholar 

  • DesJardins JD, Walker PS, Haider H, Perry J. The use of a force-controlled dynamic knee simulator to quantify the mechanical performance of total knee replacement designs during functional activity. J Biomech. 2000;33(10):1231–42.

    Article  CAS  PubMed  Google Scholar 

  • Dobson F. Timed up and go test in musculoskeletal conditions. J Physiother. 2015;61(1):47.

    Article  PubMed  Google Scholar 

  • Dobson F, Hinman RS, Roos EM, Abbott JH, Stratford P, Davis AM, Buchbinder R, Snyder-Mackler L, Henrotin Y, Thumboo J, Hansen P, Benell K. OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis. Osteoarthr Cartil. 2013;21(8):1042–52.

    Article  CAS  PubMed  Google Scholar 

  • Ewald FC. The knee society total knee arthroplasty roentgenographic evaluation and scoring system. Clin Orthop Relat Res. 1989;248:9–12.

    Google Scholar 

  • Frosch KH, Nägerl H, Kubein-Meesenburg D, Buchholz J, Dörner J, Dathe H, Hellerer O, Dumont C, Stürmer KM. A new total knee arthroplasty with physiologically shaped surfaces. Part 2: first clinical results. Unfallchirurg. 2009;112(2):176–84.

    Article  PubMed  Google Scholar 

  • Giesinger K, Hamilton DF, Jost B, Holzner B, Giesinger JM. Comparative responsiveness of outcome measures for total knee arthroplasty. Osteoarthr Cartil. 2014;22(2):184–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Goh GS, Bin Abd Razak HR, Tay DK, Chia SL, Lo NN, Yeo SJ. Unicompartmental knee arthroplasty achieves greater flexion with no difference in functional outcome, quality of life, and satisfaction vs total knee arthroplasty in patients younger than 55 years. A propensity score-matched cohort analysis. J Arthroplast. 2018;33(2):355–61.

    Article  Google Scholar 

  • Graff C, Hohmann E, Bryant AL, Tetsworth K. Subjective and objective outcome measures after total knee replacement: is there a correlation? ANZ J Surg. 2016;86(11):921–5.

    Article  PubMed  Google Scholar 

  • Haider H. Chapter 7.10: Wear: knee joint arthroplasty. In: Ducheyne P, Grainger DW, Healy KE, Hutmacher DW, Kirkpatrick CJ, editors. Comprehensive biomaterials II, vol. 7. Oxford: Elsevier; 2017. p. 152–74.

    Chapter  Google Scholar 

  • Harrington MA, Hopkinson WJ, Hsu P, Manion L. Fixed- vs mobile-bearing total knee arthroplasty: does it make a difference?--a prospective randomized study. J Arthroplast. 2009;24(6 Suppl):24–7.

    Article  Google Scholar 

  • Harris AI, Christen B, Malcorps JJ, O’Grady CP, Kopjar B, Sensiba PR, Vandenneucker H, Huang BK, Cates HE, Hur J, Marra DA. Midterm performance of a Guided-Motion bicruciate-stabilized total knee system: rseults from the International study of over 2000 consevutive primary total knee arthroplasties. J Arthroplasty. 2019;34(7S):S201–S208.

    Google Scholar 

  • Hauer G, Sadoghi P, Bernhardt GA, Wolf M, Ruckenstuhl P, Fink A, Leithner A, Gruber G. Greater activity, better range of motion and higher quality of life following unicompartmental knee arthroplasty: a comparative case-control study. Arch Orthop Trauma Surg. 2020;140(2):231–7.

    Google Scholar 

  • Hossain FS, Konan S, Patel S, Rodriguez-Merchan EC, Haddad FS. The assessment of outcome after total knee arthroplasty: are we there yet? Bone Joint J. 2015;97-b(1):3–9.

    Article  CAS  PubMed  Google Scholar 

  • Howell SM, Shelton TJ, Hull ML. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplast. 2018;33(12):3678–84.

    Article  Google Scholar 

  • Jaffe WL, Dundon JM, Camus T. Alignment and balance methods in total knee arthroplasty. J Am Acad Orthop Surg. 2018;26(20):709–16.

    Article  PubMed  Google Scholar 

  • Jiang C, Liu Z, Wang Y, Bian Y, Feng B, Weng X. Posterior cruciate ligament retention versus posterior stabilization for total knee arthroplasty: a meta-analysis. PLoS One. 2016;11(1):e0147865.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Katchky AM, Jones CW, Walter WL, Shimmin AJ. Medial ball and socket total knee arthroplasty five-year clinical results. Bone Joint J. 2019;101B(1_Supple_A):59–65.

    Article  Google Scholar 

  • Kim YH, Park JW, Kim JS. Clinical outcome of medial pivot compared with press-fit condylar sigma cruciate-retaining mobile-bearing total knee arthroplasty. J Arthroplast. 2017;32(10):3016–23.

    Article  Google Scholar 

  • Kleeblad LJ, van der List JP, Zuiderbaan HA, Pearle AD. Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2018;26(6):1811–22.

    Article  PubMed  Google Scholar 

  • Komnik I, Weiss S, Pagani CF, Potthast W. Motion analysis of patients after knee arthroplasty during activities of daily living–a systematic review. Gait Posture. 2015;41(2):370–7.

    Article  CAS  PubMed  Google Scholar 

  • Lipperts M, Laarhoven SV, Senden R, Heyligers I, Grimm B. Clinical validation of a body-fixed 3D accelerometer and algorithm for activity monitoring in orthopaedic patients. J Orthop Transl. 2017;11:19–29.

    Google Scholar 

  • Longstaff LM, Sloan K, Stamp N, Scaddan M, Beaver R. Good alignment after total knee arthroplasty leads to faster rehabilitation and better function. J Arthroplast. 2009;24(4):570–8.

    Article  Google Scholar 

  • Lyons MC, MacDonald SJ, Somerville LE, Naudie DD, McCalden RW. Unicompartmental versus total knee arthroplasty database analysis: is there a winner? Clin Orthop Relat Res. 2012;470(1):84–90.

    Article  PubMed  Google Scholar 

  • McClelland JA, Webster KE, Feller JA. Gait analysis of patients following total knee replacement: a systematic review. Knee. 2007;14(4):253–63.

    Article  PubMed  Google Scholar 

  • Meneghini RM, Stefl MD, Hodge WA, Banks SA. A cam–post mechanism is no longer necessary in modern primary total knee arthroplasty. J Knee Surg. 2019;32:710–3.

    Article  PubMed  Google Scholar 

  • Migliorini F, Tingart M, Niewiera M, Rath B, Eschweiler J. Unicompartmental versus total knee arthroplasty for knee osteoarthritis. Eur J Orthop Surg Traumatol. 2019;29(4):947–55.

    Article  PubMed  Google Scholar 

  • Mizner RL, Petterson SC, Clements KE, Zeni JA Jr, Irrgang JJ, Snyder-Mackler L. Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes. J Arthroplast. 2011;26(5):728–37.

    Article  Google Scholar 

  • Nha K-W, Shon O-J, Kong B-S, Shin Y-S. Gait comparison of unicompartmental knee arthroplasty and total knee arthroplasty during level walking. PLoS One. 2018;13(8):e0203310.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Parks NL, Whitney CE, Engh GA. Can we quantify functional improvement following total knee arthroplasty in the clinical setting? J Knee Surg. 2015;28(6):475–82.

    PubMed  Google Scholar 

  • Pfitzner T, Perka C, von Roth P. Unicompartmental vs. total knee arthroplasty for medial osteoarthritis. Zeitschrift fur Orthopadie und Unfallchirurgie. 2017;155(5):527–33.

    Article  PubMed  Google Scholar 

  • Powell AJ, Crua E, Chong BC, et al. A randomized prospective study comparing mobile-bearing against fixed-bearing PFC Sigma cruciate-retaining total knee arthroplasties with ten-year minimum follow-up. Bone Joint J. 2018;100-b(10):1336–44.

    Article  CAS  PubMed  Google Scholar 

  • Pozzi F, White DK, Snyder-Mackler L, Zeni JA. Restoring physical function after knee replacement: a cross sectional comparison of progressive strengthening vs standard physical therapy. Physiother Theory Pract. 2020;36(1):122–33.

    Google Scholar 

  • Pritchett JW. Patients prefer a bicruciate-retaining or the medial pivot total knee prosthesis. J Arthroplast. 2011;26(2):224–8.

    Article  Google Scholar 

  • Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998;28(2):88–96.

    Article  CAS  PubMed  Google Scholar 

  • Samy DA, Wolfstadt JI, Vaidee I, Backstein DJ. A retrospective comparison of a medial pivot and posterior-stabilized total knee arthroplasty with respect to patient-reported and radiographic outcomes. J Arthroplast. 2018;33(5):1379–83.

    Article  Google Scholar 

  • Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new knee society knee scoring system. Clin Orthop Relat Res. 2012;470(1):3–19.

    Article  PubMed  Google Scholar 

  • Scuderi GR, Sikorskii A, Bourne RB, Lonner JH, Benjamin JB, Noble PC. The knee society short form reduces respondent burden in the assessment of patient-reported outcomes. Clin Orthop Relat Res. 2016;474(1):134–42.

    Article  PubMed  Google Scholar 

  • Serna-Berna R, Lizaur-Utrilla A, Vizcaya-Moreno MF, Miralles Muñoz FA, Gonzalez-Navarro B, Lopez-Prats FA. Cruciate-retaining vs posterior-stabilized primary total arthroplasty. Clinical outcome comparison with a minimum follow-up of 10 years. J Arthroplast. 2018;33(8):2491–5.

    Article  Google Scholar 

  • Shakespeare D, Ledger M, Kinzel V. Flexion after total knee replacement. A comparison between the Medial Pivot knee and a posterior stabilised implant. Knee. 2006;13(5):371–3.

    Article  PubMed  Google Scholar 

  • Siljander MP, McQuivey KS, Fahs AM, Galasso LA, Serdahely KJ, Karadsheh MS. Current trends in patient-reported outcome measures in total joint arthroplasty: a study of 4 major orthopaedic journals. J Arthroplast. 2018;33(11):3416–21.

    Article  Google Scholar 

  • Singleton N, Nicholas B, Gormack N, Stokes A. Differences in outcome after cruciate retaining and posterior stabilized total knee arthroplasty. J Orthop Surg (Hong Kong). 2019;27(2):2309499019848154.

    Article  Google Scholar 

  • Skoffer B, Dalgas U, Mechlenburg I, Soballe K, Maribo T. Functional performance is associated with both knee extensor and flexor muscle strength in patients scheduled for total knee arthroplasty: a cross-sectional study. J Rehabil Med. 2015;47(5):454–9.

    Article  PubMed  Google Scholar 

  • Spekenbrink-Spooren A, Van Steenbergen LN, Denissen GAW, Swierstra BA, Poolman RW, Nelissen RGHH. Higher mid-term revision rates of posterior stabilized compared with cruciate retaining total knee arthroplasties: 133,841 cemented arthroplasties for osteoarthritis in the Netherlands in 2007-2016. Acta Orthop. 2018;89(6):640–5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Stöggl T, Martiner A. Validation of Moticon’s OpenGo sensor insoles during gait, jumps, balance and cross-country skiing specific imitation movements. J Sports Sci. 2017;35(2):196–206.

    Article  PubMed  Google Scholar 

  • Van der List JP, Kleeblad LJ, Zuiderbaan HA, Pearle AD. Mid-term outcomes of metal-backed unicompartmental knee arthroplasty show superiority to all-polyethylene unicompartmental and total knee arthroplasty. HSS J. 2017;13(3):232–40.

    Article  PubMed  PubMed Central  Google Scholar 

  • Varadarajan KM, Harry RE, Johnson T, Li G. Can in vitro systems capture the characteristic differences between the flexion–extension kinematics of the healthy and TKA knee? Med Eng Phys. 2009;31(8):899–906.

    Article  PubMed  Google Scholar 

  • Weiss JM, Noble PC, Conditt MA, et al. What functional activities are important to patients with knee replacements? Clin Orthop Relat Res. 2002;404:172–88.

    Article  Google Scholar 

  • White PB, Ranawat AS, Ranawat CS. Fixed bearings versus rotating platforms in total knee arthroplasty. J Knee Surg. 2015;28(5):358–62.

    Article  PubMed  Google Scholar 

  • Willing R, Walker PS. Measuring the sensitivity of total knee replacement kinematics and laxity to soft tissue imbalances. J Biomech. 2018;77:62–8.

    Article  PubMed  Google Scholar 

  • Yoshida Y, Mizner RL, Snyder-Mackler L. Association between long-term quadriceps weakness and early walking muscle co-contraction after total knee arthroplasty. Knee. 2013;20(6):426–31.

    Article  PubMed  Google Scholar 

  • Young T, Dowsey MM, Pandy M, Choong PF. A systematic review of clinical functional outcomes after medial stabilized versus non-medial stabilized total knee joint replacement. Front Surg. 2018;5:25.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Department of Orthopedic Surgery, New York University, New York, NY, USA

    Peter S. Walker

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Walker, P.S. (2020). Evaluations of Designs and Techniques. In: The Artificial Knee. Springer, Cham. https://doi.org/10.1007/978-3-030-38171-4_14

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  • DOI: https://doi.org/10.1007/978-3-030-38171-4_14

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