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The Mark Coventry Award: in vivo knee forces during recreation and exercise after knee arthroplasty.

ABSTRACT: Knee forces directly affect arthroplasty component survivorship, wear of articular bearing surfaces, and integrity of the bone-implant interface. It is not known which activities generate forces within a range that is physiologically desirable but not high enough to jeopardize the survivorship of the prosthetic components. We implanted three patients with an instrumented tibial prosthesis and measured knee forces and moments in vivo during exercise and recreational activities. As expected, stationary bicycling generated low tibial forces, whereas jogging and tennis generated high peak forces. On the other hand, the golf swing generated unexpectedly high forces, especially in the leading knee. Exercise on the elliptical trainer generated lower forces than jogging but not lower than treadmill walking. These novel data allow for a more scientific approach to recommending activities after TKA. In addition, these data can be used to develop clinically relevant structural and tribologic testing, which may result in activity-specific knee designs such as a knee design more tolerant of golfing by optimizing the conflicting needs of increased rotational laxity and conformity.

SUBMITTER: D'Lima DD

PROVIDER: S-EPMC2565055 | biostudies-other | 2008 Nov

REPOSITORIES: biostudies-other

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In vivo contact kinematics and contact forces of the knee after total knee arthroplasty during dynamic weight-bearing activities.

Project description:Analysis of polyethylene component wear and implant loosening in total knee arthroplasty (TKA) requires precise knowledge of in vivo articular motion and loading conditions. This study presents a simultaneous in vivo measurement of tibiofemoral articular contact forces and contact kinematics in three TKA patients. These measurements were accomplished via a dual fluoroscopic imaging system and instrumented tibial implants, during dynamic single leg lunge and chair rising-sitting. The measured forces and contact locations were also used to determine mediolateral distribution of axial contact forces. Contact kinematics data showed a medial pivot during flexion of the knee, for all patients in the study. Average axial forces were higher for lunge compared to chair rising-sitting (224% vs. 187% body weight). In this study, we measured peak anteroposterior and mediolateral forces averaging 13.3% BW during lunge and 18.5% BW during chair rising-sitting. Mediolateral distributions of axial contact force were both patient and activity specific. All patients showed equitable medial-lateral loading during lunge but greater loads at the lateral compartment during chair rising-sitting. The results of this study may enable more accurate reproduction of in vivo loads and articular motion patterns in wear simulators and finite element models. This in turn may help advance our understanding of factors limiting longevity of TKA implants, such as aseptic loosening and polyethylene component wear, and enable improved TKA designs.

| S-EPMC3177238 | biostudies-literature

In vivo knee kinematics during high flexion after a posterior-substituting total knee arthroplasty.

Project description:The objective of this study was to investigate biomechanics of TKA patients during high flexion. Six patients (seven knees) with a posterior-substituting TKA and weight-bearing flexion >130 degrees were included in the study. The six degree-of-freedom kinematics, tibiofemoral contact, and cam-post contact were measured during a deep knee bend using dual-plane fluoroscopy. The patients achieved average weight-bearing flexion of 139.5 +/- 4.5 degrees. Posterior femoral translation and internal tibial rotation increased steadily beyond 90 degrees flexion, and a sharp increase in varus rotation was noted at maximum flexion. Initial cam-post engagement was observed at 100.3 +/- 6.7 degrees flexion. Five knees had cam-post disengagement before maximum flexion. Lateral femoral condylar lift-off was found in five out of seven knees at maximum flexion, and medial condylar lift-off was found in one knee. Future studies should investigate if the kinematic characteristics of posterior-substituting TKA knees noted in this study are causative factors of high knee flexion.

| S-EPMC2903155 | biostudies-literature

Expression data from total knee arthroplasty patients

Project description:Ischaemic preconditioning is a method of protecting tissue against ischaemia-reperfusion injury. It is an innate protective mechanism that increases a tissue's tolerance to prolonged ischaemia when it is first subjected to short burst of ischaemia and reperfusion. It is thought to provide this protection by increasing the tissue's tolerance to ischaemia, therby reducing oxidative stress, inflammation and apoptosis in the preconditioned tissue. We used microarrays to investigate the genomic response induced by ischaemic preconditioning in muscle biopsies taken from the operative leg of total knee arthroplasty patients in order to gain insight into the ischaemic preconditioning mechanism. Patients undergoing primary knee arthroplasty were randomised to control and treatment (ischaemic preconditioning) groups. Patients in the treatment group received a preconditioning stimulus immediately prior to surgery. The ischaemic preconditioning stimulus consisted of three five-minute periods of tourniquet insufflation on the lower operative limb, interrupted by five minute periods of reperfusion. All patients had a tourniquet applied to the lower limb after the administration of spinal anaesthesia, as per normal protocol for knee arthroplasty surgery. Muscle biopsies were taken from the quadriceps muscle of the operative knee at the immediate onset of surgery (T0) and at 1 hour into surgery (T1). Total RNA was extracted from biospies of four control and four treatment patients and hybridised to the Affymetrix Human U133 2.0 chip.

2010-04-12 | E-GEOD-21164 | biostudies-arrayexpress

Expression data from total knee arthroplasty patients

2010-04-02 | GSE21164 | GEO

Gait comparison of unicompartmental knee arthroplasty and total knee arthroplasty during level walking.

Project description:This meta-analysis compared the gait patterns of unicompartmental knee arthroplasty (UKA) patients and total knee arthroplasty (TKA) patients during level walking by evaluating the kinetics, kinematics, and spatiotemporal parameters. Studies were included in the meta-analysis if they assessed the vertical ground reaction force (GRF), joint moment at stance, flexion at initial contact, flexion at swing, overall range of motion (ROM), coronal knee angle at stance, walking speed, cadence, and stride length in UKA patients or TKA patients. Seven non-randomized studies met the criteria for inclusion in this meta-analysis. UKA patients and TKA patients were similar in terms of vertical GRF (95% CI: -0.36 to 0.20; P = 0.60), joint moment (95% CI: -0.55 to 0.63; P = 0.90), kinematic outcomes (95% CI: -0.72 to 1.02; P = 0.74), walking speed (95% CI: -0.27 to 0.81; P = 0.32), and cadence (95% CI: -0.14 to 0.68; P = 0.20). In contrast, the stride length (95% CI: 0.01 to 0.80; P = 0.04) differed significantly between groups. Subgroup analyses revealed that the pooled data were similar between the groups: 1st maximum (heel strike), -0.18 BW (P = 0.53); 1st minimum (mid-stance), -0.43 BW (P = 0.08); and 2nd maximum (toe off), -0.03 BW (P = 0.87). On gait analysis, there were no significant differences in vertical GRF, joint moment at stance, overall kinematics, walking speed, or cadence between UKA patients and TKA patients during level walking. However, the TKA group had significantly shorter stride length than UKA patients. Although the comparison was inconclusive in determining which types of knee arthroplasty offered the closest approximation to normal gait, we consider it important to provide better rehabilitation programs to reduce the abnormal stride length in TKA patients compared to UKA patients.

| S-EPMC6117028 | biostudies-literature

Muscle transcriptome analysis following Total Knee Arthroplasty with Tourniquet

Project description:Transcriptome profiling was performed on muscle biopsies from patients immediately before Total Knee Arthroplasty and two hours after TKA and tourniquet application.

2016-02-01 | GSE75432 | GEO

Popliteal artery damage during total knee arthroplasty.

Project description:Injury of popliteal artery during total knee arthroplasty is a relatively rare complication. We report on one case of transverse semi-dissection of the popliteal artery during the tibial cut and one case of popliteal pseudoaneurysm formation caused by Hohmann retractors. Diagnosis was made early in the first case but it was delayed in the second due to misdiagnosis of deep vein thrombosis. Both injuries were managed eventually by open surgery. Postoperative clinical examination and ultrasound imaging confirmed the successful restoration of the blood flow. This case report also describes the classification system of the type of vascular damage and describes the mechanism, the clinical presentation, diagnostic modalities and treatment options for these rare complications of total knee arthroplasty surgery.

| S-EPMC4956686 | biostudies-literature

Physical exercise after knee arthroplasty: a systematic review of controlled trials.

Project description:Total knee arthroplasty (TKA) is the gold standard treatment for end-stage knee osteoarthritis. Most patients report successful long-term outcomes and reduced pain after TKA, but recovery is variable and the majority of patients continue to demonstrate lower extremity muscle weakness and functional deficits compared to age-matched control subjects. Given the potential positive influence of postoperative rehabilitation and the lack of established standards for prescribing exercise paradigms after TKA, the purpose of this study was to systematically review randomized, controlled studies to determine the effectiveness of postoperative outpatient care on short- and long-term functional recovery. Nineteen studies were identified as highly relevant for the review and four categories of postoperative intervention were discussed: 1) strengthening exercises; 2) aquatic therapy; 3) balance training; and 4) clinical environment. Optimal outpatient physical therapy protocols should include: strengthening and intensive functional exercises given through land-based or aquatic programs, the intensity of which is increased based on patient progress. Due to the highly individualized characteristics of these types of exercises, outpatient physical therapy performed in a clinic under the supervision of a trained physical therapist may provide the best long-term outcomes after the surgery. Supervised or remotely supervised therapy may be effective at reducing some of the impairments following TKA, but several studies without direct oversight produced poor results. Most studies did not accurately describe the "usual care" or control groups and information about the dose, frequency, intensity and duration of the rehabilitation protocols were lacking from several studies.

| S-EPMC4131551 | biostudies-literature

Endoplasmic Reticulum Stress Activation during Total Knee Arthroplasty.

Project description:Total knee arthroplasty (TKA) is the most common remediation for knee pain from osteoarthritis (OA) and is performed 650,000 annually in the U.S. A tourniquet is commonly used during TKA which causes ischemia and reperfusion (I/R) to the lower limb but the effects of I/R on muscle are not fully understood. Previous reports suggest upregulation of cell-stress and catabolism and downregulation of markers of cap-dependent translation during and after TKA. I/R has also been shown to cause endoplasmic reticulum (ER) stress and induce the unfolded protein response (UPR). We hypothesized that the UPR would be activated in response to ER stress during TKA. We obtained muscle biopsies from the vastus lateralis at baseline, before TKA; at maximal ischemia, prior to tourniquet deflation; and during reperfusion in the operating room. Phosphorylation of 4E-BP1 and AKT decreased during ischemia (-28%, p < .05; -20%, p < .05 respectively) along with an increase in eIF2α phosphorylation (64%, p < .05) suggesting decreased translation initiation. Cleaved ATF6 protein increased in ischemia (39%, p = .056) but returned to baseline during reperfusion. CASP3 activation increased during reperfusion compared to baseline (23%, p < .05). XBP1 splicing assays revealed an increase in spliced transcript during ischemia (31%, p < .05) which diminished during reperfusion. These results suggest that in response to I/R during TKA all three branches of the ER stress response are activated.

| S-EPMC3804266 | biostudies-literature

Compromised knee internal rotation in total knee arthroplasty patients during stair climbing.

Project description:Due to the significant role of rotational properties for normal knee function, this study aimed to investigate transverse plane kinematics and kinetics in total knee arthroplasty and unicondylar knee arthroplasty patients during activities of daily living compared to a healthy control group, including stair ascent and descent. The study participants consisted of a total knee arthroplasty group including posterior cruciate retaining and posterior stabilized designs as well as a unicondylar knee arthroplasty group and a healthy control group. Three-dimensional kinematics and kinetics were captured using a Vicon system and two Kistler force plates embedded in the floor and another two in a staircase. Inverse dynamics of the lower limbs was computed in Anybody™ Modeling System. Transverse plane joint angles and joint moments were analyzed utilizing the statistical non-parametric mapping approach, considering the entire curve shape for statistical analysis. The patients with total knee arthroplasty exhibited significantly reduced knee internal rotation of the operated knee compared to the control group and the patients' unimpaired limb, especially during the stair climbing tasks. Both unicondylar and total knee arthroplasty patients were found to have similar reduced internal rotation motion time series in stair descent. In conclusion, potential kinematic and kinetic benefits of unicondylar knee arthroplasty over total knee arthroplasty could not be proven in the current study. Aside from the usually mentioned reasons inducing constrained knee internal rotation in total knee arthroplasty patients, future studies should investigate to what extent co-contraction may contribute to this functional impairment in patients after knee arthroplasty surgery.

| S-EPMC6179266 | biostudies-literature

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