Evaluation of a novel robotic testing method for stability and kinematics of total knee arthroplasty

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-10-24 DOI:10.1002/ksa.12516

Sander R. Holthof, Mick Rock, Richard van Arkel, Angela Brivio, David Barrett, Andrew A. Amis

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引用次数: 0

Abstract

Purpose

This work developed a novel preclinical test of total knee replacements (TKRs) in order to explain TKR instability linked to patient dissatisfaction. It was hypothesized that stability tests on the isolated moving prostheses would provide novel comparative data on the stability and kinematics among TKR designs.

Methods

Three TKR designs, DePuy Synthes Attune MS, Stryker Triathlon and Zimmer Biomet Persona MC, were assessed using a robotic arm while flexing–extending 0–140°. Tests imposed 710 N body weight combined with three tibial loads: no anterior–posterior (AP) force, 90 N anterior or 90 N posterior force. Other load effects were minimized and the kinematics was recorded. Each implant was tested six times to investigate the repeatability of the method. Data were analysed using statistical parametric mapping with one-way analysis of variance (ANOVA). If significance was found (p < 0.05), post hoc t tests with Bonferroni correction were used to contrast groups.

Results

Significant differences were found throughout flexion–extension. Femoral rollback, AP stability, coupled internal–external rotation and AP position (roll-back) were all influenced by implant design. AP stability of the TKRs reduced with flexion reaching Attune 15 mm, Persona 13 mm and Triathlon 21 mm at 140° flexion. Tractive rolling significantly affected kinematics in the less congruent Triathlon design, with 6 mm different paths between flexion and extension motion (p < 0.05 across 5–100°). Paradoxical anterior femoral sliding in early flexion (0–40°) occurred in Persona and Triathlon designs.

Conclusions

The novel testing technique provides, for the first time, comparative data on the inherent stability and kinematics of the TKR implants themselves across the arc of flexion–extension, independent of variables including soft tissue behaviour and surgical technique. The data show how much each prosthesis can contribute to the stability and motion of the implanted knee. Similar data from a wider range of designs will enable more informed decisions regarding implant design choice, aiming to reduce the prevalence of TKR instability in patients.

Level of Evidence

Controlled laboratory study.

Abstract Image

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评估全膝关节置换术稳定性和运动学的新型机器人测试方法。

目的：这项研究开发了一种新型全膝关节置换术（TKR）临床前测试，以解释与患者不满意有关的 TKR 不稳定性。假设对孤立移动的假体进行稳定性测试，可提供有关 TKR 设计稳定性和运动学的新型比较数据：方法：使用机械臂对三种 TKR 设计（DePuy Synthes Attune MS、Stryker Triathlon 和 Zimmer Biomet Persona MC）进行评估，同时屈伸 0-140°。测试施加了 710 牛顿的体重和三种胫骨负荷：无前后（AP）力、90 牛顿的前力或 90 牛顿的后力。其他载荷影响降至最低，并记录运动学数据。每个植入体都测试了六次，以研究该方法的可重复性。数据分析采用单因素方差分析（ANOVA）的统计参数图。如果发现显著性（p 结果：在整个屈伸过程中发现了显著差异。股骨回旋、AP稳定性、耦合内旋-外旋和AP位置（回旋）均受植入物设计的影响。在屈曲 140°时，TKR 的 AP 稳定性随屈曲度的增加而降低，Attune 为 15 mm，Persona 为 13 mm，Triathlon 为 21 mm。在一致性较差的 Triathlon 设计中，牵引滚动对运动学有明显影响，屈伸运动路径相差 6 毫米（p 结论：TKR 的牵引滚动对运动学有明显影响，屈伸运动路径相差 6 毫米（p 结论：TKR 的牵引滚动对运动学有明显影响：新颖的测试技术首次提供了有关 TKR 假体本身在屈伸弧线上的固有稳定性和运动学的比较数据，不受软组织行为和手术技术等变量的影响。数据显示了每种假体对植入膝关节的稳定性和运动的贡献程度。从更广泛的设计中获得的类似数据将有助于在选择假体设计时做出更明智的决定，从而降低患者TKR不稳定性的发生率：实验室对照研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).