Kinematics and center of axial rotation during walking after medial pivot type total knee arthroplasty
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(2020) 7:72
Journal of Experimental Orthopaedics
ORIGINAL PAPER
Open Access
Kinematics and center of axial rotation during walking after medial pivot type total knee arthroplasty Kota Miura1* , Yasumitsu Ohkoshi2, Takumi Ino1,3, Kengo Ukishiro1, Kensaku Kawakami4, Sho’ji Suzuki5, Ko Suzuki2 and Tatsunori Maeda2
Abstract Purpose: In recent years, the medial pivot (MP) type total knee arthroplasty (TKA) implant has been developed and marketed for achieving more natural kinematics with MP. However, little is known about the pivot pattern during walking after MP type TKA. This study aimed to determine the kinematics and center of axial rotation during walking after MP type TKA. Methods: This randomized prospective study enrolled 40 patients with MP type TKA, 20 with cruciate-substituting TKA (MP-CS group), 20 with posterior-stabilized TKA (MP-PS group), and 10 healthy volunteers (control group). The kinematics and center of axial rotation during overground walking were measured by a three-dimensional motion analysis system. The six-degrees-of-freedom kinematics of the knee were calculated by the point cluster method. Results: The amount of change in knee flexion in early stance phase was significantly lower in the MP-CS and MPPS groups than in the control group. The femur showed anterior translation during early stance phase in all three groups. The median center of axial rotation in the transverse plane was predominantly on the lateral side of the knee during stance in all groups. Conclusions: Kinematics during gait are thought to be determined by physical posture, the kinetic chain during weight-bearing, and the kinematic features of adjacent structures, such as the behavior of the biarticular muscles. MP-CS and MP-PS did not necessarily induce rotational motion centered on the medial ball-in-socket component during walking; translational and lateral pivoting movements were also observed. Long-term follow-up is needed to monitor for polyethylene wear and implant loosening. Keywords: Lateral pivot, Total knee arthroplasty, Center of axial rotation, Kinematics, Walking
Background Six-degrees-of-freedom (6DOF) kinematics of the knee joint during walking are determined by physical posture, the position of the body’s barycenter, the kinetic chain during weight-bearing, muscle coordination and antagonism, and the kinematic features of adjacent structures, including the behavior of the biarticular muscles [2, 8, 12, 15]. In recent years, many types of implants for total * Correspondence: [email protected] 1 Department of Rehabilitation, Hakodate Orthopedics Clinic, 2-115, Ishikawa-cho, Hakodate-shi, Hokkaido 041-0802, Japan Full list of author information is available at the end of the article
knee arthroplasty (TKA) have become available. The center of axial rotation (COR) of the knee joint is expressed as either medial or lateral pivot depending on the position of the COR on the tibial plateau [3]. Medial pivot (MP) type TKA is designed to create a medial ballin-socket structure to ensure a medial location
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